Design of a Multifaceted Transitional Care Digital Intervention: Double Diamond Approach

Background Transitions of care, where patients move between clinical settings or providers, pose considerable risks to patient safety, situations exacerbated by the absence of adequate digital infrastructure that enables information exchange. The timeliness and accuracy of medication information transfer are central to ensuring patient safety during transitions of care, including post-discharge from the hospital. In designing a multifaceted digital intervention to support the transfer of medication information from hospital to community settings, it was necessary to gauge the views of all relevant stakeholders on the practical challenges involved in transferring medication information. Objective This study aimed to define the challenges experienced by stakeholders, develop potential solutions, and use a collaborative approach to design a multifaceted digital intervention that spans hospital and community settings. Methods This project involved multiple health service organizations in Queensland, Australia’s second-largest state geographically. Design of the intervention was guided by the United Kingdom Design Council’s Double Diamond Framework. This phased approach is particularly suitable for complex interventions involving multiple stakeholders. Over 12 months, we held an initial workshop with consumers (n=4), hospital clinicians (n=6), and primary care clinicians (n=7), and then convened over 50 hours of committee meetings, working groups, and consultations, undertook a system-walkthrough, and assessed the feasibility of the intervention. Participants were patients with relevant lived experience, clinicians, and those with technical, clinical governance, policy, research, and digital health implementation expertise. Results Challenges described by workshop participants included fragmented digital systems across care settings, delays in discharge documentation reaching primary care clinicians, and current systems that function as incomplete or inconsistently used sources of medication information. Based on stakeholder consultation, our multifaceted intervention comprises both clinician- and patient-facing elements. These include a hospital-based Pharmacist Navigator role to facilitate post-discharge handover; a clinical dashboard for identifying and stratifying patient risk of medication misadventure; a software application for post-discharge pharmacist-led medication review and communication of the review to the patient’s general practitioner (GP); a Pharmacist Navigator notifying GPs of a patient’s hospital stay; patient education materials; and online training for community pharmacists conducting the medication reviews. Conclusions Designing a multifaceted digital intervention to support medication information transfer at hospital discharge required significant time, effort, coordination, and engagement from a large number of stakeholders with various roles and areas of expertise. Key learnings are that transitional care interventions must be flexible and adaptable to align with the complex, evolving nature of health care, and that the success of a digital intervention relies heavily on human engagement and ongoing support.