'I just don't want them to be my patient again': an exploratory mixed-methods study examining provider home safety concerns for adolescents with acquired brain injuries in the US Midwest

Objective: Adolescents with acquired brain injuries are at risk for additional injuries after hospital discharge. We asked healthcare providers to identify and prioritise urgent hazards in the home setting for this population.

Methods: We used a convergent mixed methods approach. Healthcare providers who do discharge planning and community re-integration for adolescent patients with brain injury were recruited from hospitals in the US Midwest. Participants completed two structured surveys, semi-structured interviews and a Hazard Prioritisation Matrix Activity. We analysed quantitative data via descriptive statistics and qualitative data via inductive thematic analysis to identify hazards, urgency, interactive themes and generate a conceptual model.

Results: All participants validated four preidentified hazards in the surveys and the interviews: slippery objects on the floor, large furniture/objects in the path of travel, unattended open flames and inappropriate use of cooking appliances. 59 hazards were self-identified during the Hazard Priority Matrix Activity and assigned an urgency rating, with 12 (20.3%) urgent, 20 (33.9%) major, 19 (32.2%) moderate and 8 (13.6%) minor risks. We identified seven interactive themes about hazard factors: hazardous activities, hazardous situations, hazardous objects, hazardous others, hazardous spaces, harms and client factors. A conceptual model for home safety concerns links hazards, risks and harms.

Conclusions: Adolescents with acquired brain injuries need healthcare providers to recognise unique and complex hazards in their homes that could lead to harm. Mitigating home hazards may prevent additional unintentional injury for these adolescents. More research is needed to generalise this information for this population across clinical settings.

Trial registration number: NCT04768946.