Implementation of Digital Contact Tracing for COVID-19 in a Hospital Context: Experiences and Perspectives of Leaders and Healthcare Workers

Abstract

Background. In parallel with public health responses, health systems have had to rapidly implement infection control strategies during the SARS-CoV-2 (COVID-19) pandemic. Various technologies, such as digital contact tracing (DCT), have been implemented to enhance case investigations among healthcare workers' (HCWs). Currently, little attention has focused on the perspectives of those who have implemented DCT innovations and those who have adopted such technologies within a healthcare environment. --

Objective. This study aimed to describe the implementation, acceptance, and outcomes of a web-based DCT tool used extensively at a specialized pediatric acute-care hospital in Ontario during the COVID-19 pandemic from the perspective of key stakeholders. --

Methods. Using an exploratory qualitative design, this research involved 21 semi-structured interviews with healthcare administrators (n=6; 29%), occupational health specialists (n=8; 38%), and healthcare workers (n=7; 33/%) at the Children's Hospital of Eastern Ontario. Interview protocols and analysis were guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The interviews lasted on average 33.6 minutes in length and were audio-recorded. Verbatim transcripts were subjected to thematic analysis using NVivo software. --

Results. The implementation of DCT during the COVID-19 pandemic was viable and well-received among stakeholders. End-users cited that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk-assessment consequences and access concerns were present as barriers (reach). Stakeholders commonly agreed that the DCT tool exerted a positive outcome on the hospital's capacity to meet the demands of COVID-19, notably through the facilitation of timely case investigations and by informing decision-making processes (effectiveness). Implementors and occupational specialists conveyed staffing impacts, and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a technology that was human-centered were crucial factors driving staff adoption. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs standard practices, alongside the evolving perspectives of COVID-19. Some end-users expressed an initial disconnect towards the DCT tool, raising questions about the fidelity of the implementation. However, stakeholders collectively agreed on the viability of the DCT approach and its applicability to infectious disease practices (maintenance). --

Conclusion. Stakeholders reported DCT in the hospital context to be acceptable and efficient in meeting the demands of the COVID-19 pandemic. Recommendations for optimized DCT use include education and training for relevant personnel, improved access and usability, and integration into clinical systems. The findings contribute to evidence-based practices and guide future scale-up initiatives focused on digital surveillance in the hospital context.