Abstract
Background: External fixation is widely used in treating complex fractures and limb reconstruction. Pin site infections remain a significant complication, impacting on patients’ physical and psychosocial wellbeing. This clinical improvement project at a University Hospital in Southern Denmark aimed to enhance pin site care by involving patients and caregivers throughout the treatment pathway. Pin site care is crucial for preventing serious infections/osteomyelitis and involves collaboration between hospital and municipal caregivers. Traditional pin site care in our unit was complex and timeconsuming, causing patient anxiety and frequent unplanned clinic visits.
Approach: Inspired by the Participatory Design research methodology, a quality improvement project was conducted in three phases:
(1) identifying users’ needs, through field observations, interviews with nurses (from the hospital and the community), and patients combined with a review of existing international litterature (2) developing solutions collaboratively through workshops with representaives from the hospital and the community, cognitive reflexions with patients and conducting a 'mini' Health Technological Assessment, and (3) testing/evaluating the created solutions through surveys, interviews and field observations. Iterative cycles of planning, acting, observing, and reflecting were employed, facilitating mutual learning among all participants. Interviews with patients, families and healthcare professionals and field observations both at the hospital and in the municipality/community were conducted.
Results: Phase 1 identified the need for improved education of both patients and carers about infection recognition and the need for an assessment tool for pin site infection. Similarly, a less painful and time-consuming dressing method was warrented by both patients and cross-sectional carers. Phase 2 involved extensive user input to develop and implement a new dressing procedure using PolyMem™ along with an assessment tool.
Phase 3 evaluated the new methods, revealing reduced patient pain, fewer clinic visits, and stable infection rates as well as less time-consuming pin site care.
Conclusion: The project enhanced pin site care, involving users in developing a new care process, thus improving patient satisfaction and care efficiency. Information material (a leaflet) for both patients and staff at the hospital and the municipality/community staff. This material also aimed to educate HCPs about patients’ psychosocial concerns identified in phase one, and to empower patients and their families by involving them in the care process and supporting them in identifying signs of infection. The information material for the municipality also featured a QR code directing care staff to a video demonstrating the new dressing process. All the information was made available at “Mit Sygehus” (“My Hospital”), a free app for communicating health information in the Region of Southern Denmark.
Implications for future practice: Incorporating patient perspectives and collaborative methods can significantly improve clinical care pathways. There is general interest in finding new ways to use technology in healthcare. We found that an app accessible via a QR-code can support written information with video and other ways of presenting knowledge of importance to both healthcare professionals and patients/ families. The results have implications for how care can be organized with the involvement of patient perspectives and in creating new ways of communicating healthcare knowledge.