Can smartphone technology improve patient care?

Introduction The emergence of evidenced-based medicine (EBM) has led to an ever-increasing plethora of guidelines to follow in order to best deliver this high standard of care. Compliance with such guidelines remains sub-optimal and novel methods of guideline dissemination have become popular. Two patient safety areas of major morbidity and, potentially, mortality for patients are venous thromboembolism (VTE) and sepsis. Prophylaxis is available to minimise risk of VTE and early resuscitation bundles for sepsis, such as Sepsis Six have become widely promoted. Both of these areas have local guidelines that should be followed but compliance is poor. At the start of this period of research Sepsis Six had not yet been rolled-out in the surgical department at the RAH, Paisley. This provided a golden opportunity to look at guideline dissemination for one area, using a variety of modalities. Smartphone technology has become ubiquitous in the past few years. The reasons for this are examined and the role for smartphones, and their applications (apps) in delivering assistance to doctors involved in front-line care is discussed. Potential regulatory issues are reviewed. Aims The aims of this thesis are: To assess prevalence of smartphones in the doctor population in a three-site hospital board area and these doctors’ attitudes to smartphone technology for clinical uses. To design and implement novel apps for thromboprophylaxis and Sepsis Six as a supplemental modality for guideline dissemination. To assess the impact of the introduction of these apps on guideline compliance, including assessing for fatiguing of interest. Materials and Methods A SurveyMonkey questionnaire was emailed to all 456 doctors across the three hospitals in the GGC Clyde sector asking about smartphone ownership and usage and their views on the roles of apps for clinical care. Native smartphone apps were designed and developed for both iPhone and android platforms for both VTE prophylaxis and Sepsis Six. Once these had been field-tested, and pre-app audit of current guideline compliance undertaken they were manually deployed to the surgical junior doctors at the Royal Alexandra Hospital, Paisley. Concurrently, while the Sepsis Six app was being developed the concept of Sepsis Six was rolled out using standard posters, presentations and tutorials. After each modality introduction for both VTE prophylaxis and Sepsis Six audit was undertaken both early, and some time later, to try and assess possible fatiguing of interest and compliance. Results There was a good response to the survey, revealing very high smartphone ownership levels at virtually 90%, with 100% ownership in doctors in the early years of training. Further analysis revealed that doctors in the middle of their training, rather than at either extreme, were the most likely to use a smartphone for clinical care. Doctors preferentially own iPhones rather than Android based smartphones which is out-of-keeping with worldwide, and indeed UK statistics, strongly favouring Android. VTE prophylaxis at baseline audit was better than expected. This meant it was difficult to show any improvement on addition of the smartphone app. There were transient improvements in the correct prescribing of anti-embolic stockings however but generally results suggested that the app simply wasn’t being used. Sepsis bundle compliance at baseline was poor but slowly improved over the seven audit points. There were no sharp improvements in Sepsis Six bundle compliance to suggest that either the traditional methods or the app were particularly good at improving guideline compliance. Conclusions Electronic patient care is fast becoming universal and smartphone/ tablet technology will be at the forefront of this. Despite disappointing results here,the use of an app for more complex patient-specific guidelines is likely to become increasingly popular, as long as accuracy of the information provided by the app can be guaranteed