Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

Frederic Ehrler, Carlotta Tuor, Remy Trompier, Antoine Berger, Michael Ramusi, Robin Rey, Johan N Siebert, Frederic Ehrler, Carlotta Tuor, Remy Trompier, Antoine Berger, Michael Ramusi, Robin Rey, Johan N Siebert

Abstract

For maintaining collaboration and coordination among emergency department (ED) caregivers, it is essential to effectively share patient-centered information. Indirect activities on patients, such as searching for laboratory results and sharing information with scattered colleagues, waste resources to the detriment of patients and staff. Therefore, we conducted a pilot study to evaluate the initial efficacy of a mobile app to facilitate rapid mobile access to central laboratory results and remote interprofessional communication. A total of 10 ED residents and registered nurses were randomized regarding the use of the app versus conventional methods during semi-simulated scenarios in a pediatric ED (PED). The primary outcome was the elapsed time in minutes in each group from the availability of laboratory results to their consideration by participants. The secondary outcome was the elapsed time to find a colleague upon request. Time to consider laboratory results was significantly reduced from 23 min (IQR 10.5-49.0) to 1 min (IQR 0-5.0) with the use of the app compared to conventional methods (92.2% reduction in mean times, p = 0.0079). Time to find a colleague was reduced from 24 min to 1 min (i.e., 93.0% reduction). Dedicated mobile apps have the potential to improve information sharing and remote communication in emergency care.

Keywords: clinical laboratory information systems; communication; digital technology; emergency department; emergency service; hospital; mHealth; mobile application; pediatrics; text messaging.

Conflict of interest statement

F.E. and J.N.S. are the owners of the PIMPmyHospital mobile app. The app is currently not available on the commercial Google Play Store or App Store (Apple). F.E. and J.N.S. declare no support from commercial entities for the submitted work and no financial relationships with any commercial entities that might have an interest in the submitted work in the previous years. F.E. and J.N.S. declare no other relationships or activities that could appear to have influenced the submitted work. The rest of the authors declare no potential conflict of interests in connection with the app, research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
PIMPmyHospital screenshots. (a) Color-coded bars represent patient status on the five-level Canadian Triage and Acuity Scale [31]; patient gender and identity; time since admission as radial circular timers; patient allocation per room; color-coded box of individuals in charge of the patient; and patient status (seen by a physician, waiting for results, CT-scan in progress, etc.). Push notifications prompt the user to be aware of the situations. (b,c) Selecting a patient opens a new page with scrollable contextual tab menus containing information related to laboratory results, imaging, patient files, electrocardiograms, and prescriptions entered in the computerized institutional prescription software. (d) The instant messaging system. The logos at the bottom of the screen represent the possibility to also import and link documents to the conversion as well as to send voice memos. Adapted from [26].
Figure 2
Figure 2
CONSORT flowchart.
Figure 3
Figure 3
Boxplots of time to laboratory review and time to find a colleague when using the mobile app compared to conventional methods. Solid horizontal lines denote median and IQR; the endpoints of the whiskers indicate the range. The long upper whiskers show that participants were more varied among the most positive quartile groups. The cross denotes the mean.
Figure 4
Figure 4
Time to laboratory consideration and to find a colleague. (a) Kaplan–Meier curves of time elapsed from the laboratory report to consideration of results and (b) time from request to find a colleague to a physical connection using the PIMPmyHospital app (plain lines) vs conventional methods (dashed lines). Log-rank (Mantel–Cox) test comparing curves: χ2 = 8.2 and p = 0.004 for laboratory results; χ2 = 2.7 and p = 0.1 for finding a colleague.

References

    1. Javidan A.P., Hansen K., Higginson I., Jones P., Lang E. The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary. Int. J. Emerg. Med. 2021;14:4. doi: 10.1186/s12245-020-00312-x.
    1. Franklin B.J., Li K.Y., Somand D.M., Kocher K.E., Kronick S.L., Parekh V.I., Goralnick E., Nix A.T., Haas N.L. Emergency department provider in triage: Assessing site-specific rationale, operational feasibility, and financial impact. J. Am. Coll. Emerg. Physicians Open. 2021;2:e12450. doi: 10.1002/emp2.12450.
    1. Driesen B., van Riet B.H.G., Verkerk L., Bonjer H.J., Merten H., Nanayakkara P.W.B. Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis. PLoS ONE. 2018;13:e0202751. doi: 10.1371/journal.pone.0202751.
    1. Trzeciak S., Rivers E.P. Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emerg. Med. J. 2003;20:402–405. doi: 10.1136/emj.20.5.402.
    1. Andersson J., Nordgren L., Cheng I., Nilsson U., Kurland L. Long emergency department length of stay: A concept analysis. Int. Emerg. Nurs. 2020;53:100930. doi: 10.1016/j.ienj.2020.100930.
    1. Yoon P., Steiner I., Reinhardt G. Analysis of factors influencing length of stay in the emergency department. Can. J. Emerg. Med. 2003;5:155–161. doi: 10.1017/S1481803500006539.
    1. Van der Veen D., Remeijer C., Fogteloo A.J., Heringhaus C., de Groot B. Independent determinants of prolonged emergency department length of stay in a tertiary care centre: A prospective cohort study. Scand. J. Trauma Resusc. Emerg. Med. 2018;26:81. doi: 10.1186/s13049-018-0547-5.
    1. Mwogi T., Mercer T., Tran D.N.T., Tonui R., Tylleskar T., Were M.C. Therapeutic turnaround times for common laboratory tests in a tertiary hospital in Kenya. PLoS ONE. 2020;15:e0230858. doi: 10.1371/journal.pone.0230858.
    1. Steindel S.J., Howanitz P.J. Changes in emergency department turnaround time performance from 1990 to 1993: A comparison of two College of American Pathologists Q-probes studies. Arch. Pathol. Lab. Med. 1997;121:1031–1041.
    1. Hawkins R.C. Laboratory turnaround time. Clin. Biochem. Rev. 2007;28:179–194.
    1. Tindle K., David A., Carlisle S., Faircloth B., Fields J.M., Hayden G., Ku B. Relationship of the built environment on nursing communication patterns in the emergency department: A task performance and analysis time study. J. Emerg. Nurs. 2020;46:440–448. doi: 10.1016/j.jen.2020.04.005.
    1. Bekkink M.O., Farrell S.E., Takayesu J.K. Interprofessional communication in the emergency department: Residents’ perceptions and implications for medical education. Int. J. Med. Educ. 2018;9:262–270. doi: 10.5116/ijme.5bb5.c111.
    1. Ong Z.H., Tan L.H.E., Ghazali H.Z.B., Ong Y.T., Koh Y.T., Ang R.Z.E., Bok C., Chiam M., Lee A.S.I., Chin A.M.C., et al. A systematic scoping review on pedagogical strategies of interprofessional communication for physicians in emergency medicine. J. Med. Educ. Curric. Dev. 2021;8:23821205211041794. doi: 10.1177/23821205211041794.
    1. Coiera E.W., Jayasuriya R.A., Hardy J., Bannan A., Thorpe M.E. Communication loads on clinical staff in the emergency department. Med. J. Aust. 2002;176:415–418. doi: 10.5694/j.1326-5377.2002.tb04482.x.
    1. Woloshynowych M., Davis R., Brown R., Vincent C. Communication patterns in a UK emergency department. Ann. Emerg. Med. 2007;50:407–413. doi: 10.1016/j.annemergmed.2007.08.001.
    1. Weng S.J., Tsai M.C., Tsai Y.T., Gotcher D.F., Chen C.H., Liu S.C., Xu Y.Y., Kim S.H. Improving the efficiency of an emergency department based on activity-relationship diagram and radio frequency identification technology. Int. J. Environ. Res. Public Health. 2019;16:4478. doi: 10.3390/ijerph16224478.
    1. Hollingsworth J.C., Chisholm C.D., Giles B.K., Cordell W.H., Nelson D.R. How do physicians and nurses spend their time in the emergency department? Ann. Emerg. Med. 1998;31:87–91. doi: 10.1016/S0196-0644(98)70287-2.
    1. Weigl M., Handl T., Wehler M., Schneider A. Time-allocation study of nurse and physician activities in the emergency department. Med. Klin. Intensivmed. Notfmed. 2021;116:229–237. doi: 10.1007/s00063-020-00657-4.
    1. Mamykina L., Vawdrey D.K., Hripcsak G. How do residents spend their shift time? A time and motion study with a particular focus on the use of computers. Acad. Med. 2016;91:827–832. doi: 10.1097/ACM.0000000000001148.
    1. Peters G.A., Wong M.L., Sanchez L.D. Pedometer-measured physical activity among emergency physicians during shifts. Am. J. Emerg. Med. 2020;38:118–121. doi: 10.1016/j.ajem.2019.07.019.
    1. Raymond L., Pare G., Maillet E., de Guinea A.O., Trudel M.C., Marsan J. Improving performance in the ED through laboratory information exchange systems. Int. J. Emerg. Med. 2018;11:15. doi: 10.1186/s12245-018-0179-6.
    1. Alhejily W.A. Implementing “chest pain pathway” using smartphone messaging application “WhatsApp” as a corrective action plan to improve ischemia time in “ST-Elevation Myocardial Infarction” in primary PCI capable center “WhatsApp-STEMI Trial”. Crit. Pathw. Cardiol. 2021;20:179–184. doi: 10.1097/HPC.0000000000000264.
    1. Noone M.L., Moideen F., Krishna R.B., Kumar V.G.P., Karadan U., Chellenton J., Salam K.A. Mobile app based strategy improves door-to-needle time in the treatment of acute ischemic stroke. J. Stroke Cerebrovasc. Dis. 2020;29:105319. doi: 10.1016/j.jstrokecerebrovasdis.2020.105319.
    1. Ehrler F., Sahyoun C., Manzano S., Sanchez O., Gervaix A., Lovis C., Courvoisier D.S., Lacroix L., Siebert J.N. Impact of a shared decision-making mHealth tool on caregivers’ team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: Study protocol of a cluster randomized controlled trial. Trials. 2021;22:277. doi: 10.1186/s13063-021-05170-3.
    1. Boillat T., Siebert J.N., Alduaij N., Ehrler F. GOFlow: Smartwatch app to deliver laboratory results in emergency departments—A feasibility study. Int. J. Med. Inform. 2020;134:104034. doi: 10.1016/j.ijmedinf.2019.104034.
    1. Ehrler F., Tuor C., Rey R., Siebert J.N. A mobile app to improve patient management in emergency departments: Caregiver needs analysis, design and early technology acceptance assessment. Stud. Health Technol. Inform. 2021;285:233–238.
    1. Cheng A., Kessler D., Mackinnon R., Chang T.P., Nadkarni V.M., Hunt E.A., Duval-Arnould J., Lin Y., Cook D.A., Pusic M., et al. Reporting guidelines for health care simulation research: Extensions to the CONSORT and STROBE statements. Simul. Healthc. 2016;11:238–248. doi: 10.1097/SIH.0000000000000150.
    1. Eysenbach G., Consort-Ehealth Group Consort-Ehealth: Improving and standardizing evaluation reports of Web-based and mobile health interventions. J. Med. Internet Res. 2011;13:e126. doi: 10.2196/jmir.1923.
    1. Schulz K.F., Altman D.G., Moher D., Consort Group CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. doi: 10.1136/bmj.c332.
    1. Sealed Envelope Ltd Simple Randomisation Service. 2021. [(accessed on 7 February 2022)]. Available online: .
    1. Beveridge R. CAEP issues. The Canadian Triage and Acuity Scale: A new and critical element in health care reform. Canadian Association of Emergency Physicians. J. Emerg. Med. 1998;16:507–511.
    1. Cairns C., Kang K., Santo L. National Hospital Ambulatory Medical Care Survey: 2018 Emergency Department Summary Tables. [(accessed on 7 February 2022)];2018 Available online: .
    1. Rohr U.P., Binder C., Dieterle T., Giusti F., Messina C.G., Toerien E., Moch H., Schafer H.H. The value of in vitro diagnostic testing in medical practice: A status report. PLoS ONE. 2016;11:e0149856. doi: 10.1371/journal.pone.0149856.
    1. Ong M.S., Magrabi F., Coiera E. Delay in reviewing test results prolongs hospital length of stay: A retrospective cohort study. BMC Health Serv. Res. 2018;18:369. doi: 10.1186/s12913-018-3181-z.
    1. Schimke I. Quality and timeliness in medical laboratory testing. Anal. Bioanal. Chem. 2009;393:1499–1504. doi: 10.1007/s00216-008-2349-5.
    1. Wilson S., Bohn M.K., Adeli K. POCT: An inherently ideal tool in pediatric laboratory medicine. EJIFCC. 2021;32:145–157.
    1. Goyder C., Tan P.S., Verbakel J., Ananthakumar T., Lee J.J., Hayward G., Turner P.J., Van Den Bruel A. Impact of point-of-care panel tests in ambulatory care: A systematic review and meta-analysis. BMJ Open. 2020;10:e032132. doi: 10.1136/bmjopen-2019-032132.
    1. Alter D.N. Point-of-care testing for the emergency department patient: Quantity and quality of the available evidence. Arch. Pathol. Lab. Med. 2021;145:308–319. doi: 10.5858/arpa.2020-0495-RA.
    1. Gottlieb M., Farcy D.A., Moreno L.A., Vilke G.M., Guittard J.A. Triage nurse-ordered testing in the emergency department setting: A review of the literature for the clinician. J. Emerg. Med. 2021;60:570–575. doi: 10.1016/j.jemermed.2020.11.004.
    1. Larsson A., Greig-Pylypczuk R., Huisman A. The state of point-of-care testing: A European perspective. Ups. J. Med. Sci. 2015;120:1–10. doi: 10.3109/03009734.2015.1006347.
    1. Á Torkilsheyggi A., Hertzum M., From G. Evaluating the impact of electronic whiteboard icons: An observational study of the work with blood tests in an emergency department. Scand. J. Trauma Resusc. Emerg. Med. 2013;1 doi: 10.1186/1757-7241-21-S2-A26.
    1. Hertzum M., Simonsen J. Effects of electronic emergency-department whiteboards on clinicians’ time distribution and mental workload. Health Inform. J. 2016;22:3–20. doi: 10.1177/1460458214529678.
    1. Salmasian H., Landman A.B., Morris C. An electronic notification system for improving patient flow in the emergency department. AMIA Jt Summits Transl. Sci. Proc. 2019;2019:242–247.
    1. Chopra V., McMahon L.F., Jr. Redesigning hospital alarms for patient safety: Alarmed and potentially dangerous. JAMA. 2014;311:1199–1200. doi: 10.1001/jama.2014.710.
    1. Winters B.D., Slota J.M., Bilimoria K.Y. Safety culture as a patient safety practice for alarm fatigue. JAMA. 2021;326:1207–1208. doi: 10.1001/jama.2021.8316.
    1. Slovis B.H., Nahass T.A., Salmasian H., Kuperman G., Vawdrey D.K. Asynchronous automated electronic laboratory result notifications: A systematic review. J. Am. Med. Inform. Assoc. 2017;24:1173–1183. doi: 10.1093/jamia/ocx047.
    1. Verma A., Wang A.S., Feldman M.J., Hefferon D.A., Kiss A., Lee J.S. Push-alert notification of troponin results to physician smartphones reduces the time to discharge emergency department patients: A randomized controlled trial. Ann. Emerg Med. 2017;70:348–356. doi: 10.1016/j.annemergmed.2017.03.021.
    1. Trotzky D., Posner L., Mosery J., Cohen A., Avisar S., Pachys G. Do automatic push notifications improve patient flow in the emergency department? analysis of an ED in a large medical center in Israel. PLoS ONE. 2021;16:e0258169. doi: 10.1371/journal.pone.0258169.
    1. Koziatek C., Swartz J., Iturrate E., Levy-Lambert D., Testa P. Decreasing the lag between result availability and decision-making in the emergency department using push notifications. West. J. Emerg Med. 2019;20:666–671. doi: 10.5811/westjem.2019.5.42749.
    1. Creswick N., Westbrook J.I., Braithwaite J. Understanding communication networks in the emergency department. BMC Health Serv. Res. 2009;9:247. doi: 10.1186/1472-6963-9-247.
    1. Pun J.K., Chan E.A., Murray K.A., Slade D., Matthiessen C.M. Complexities of emergency communication: Clinicians’ perceptions of communication challenges in a trilingual emergency department. J. Clin. Nurs. 2017;26:3396–3407. doi: 10.1111/jocn.13699.
    1. Weigl M., Catchpole K., Wehler M., Schneider A. Workflow disruptions and provider situation awareness in acute care: An observational study with emergency department physicians and nurses. Appl. Ergon. 2020;88:103155. doi: 10.1016/j.apergo.2020.103155.
    1. Weigl M., Beck J., Wehler M., Schneider A. Workflow interruptions and stress at work: A mixed-methods study among physicians and nurses of a multidisciplinary emergency department. BMJ Open. 2017;7:e019074. doi: 10.1136/bmjopen-2017-019074.
    1. Pun J.K., Matthiessen C.M., Murray K.A., Slade D. Factors affecting communication in emergency departments: Doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong. Int. J. Emerg. Med. 2015;8:48. doi: 10.1186/s12245-015-0095-y.
    1. The Joint Commission 2022 National Patient Safety Goals. 2022. [(accessed on 7 February 2022)]. Available online: .
    1. Dungarwalla M., Chapireau D., Bentley R. Use of WhatsApp in an oral and maxillofacial surgery department at a major trauma centre and its role during major incidents: Our experience. Br. J. Oral Maxillofac. Surg. 2019;57:449–453. doi: 10.1016/j.bjoms.2018.11.024.
    1. Johnston M.J., King D., Arora S., Behar N., Athanasiou T., Sevdalis N., Darzi A. Smartphones let surgeons know WhatsApp: An analysis of communication in emergency surgical teams. Am. J. Surg. 2015;209:45–51. doi: 10.1016/j.amjsurg.2014.08.030.
    1. Watson L., Pathiraja F., Depala A., O’Brien B., Beyzade S. Ensuring safe communication in health care: A response to Johnston et al on their paper “Smartphones let surgeons know WhatsApp: An analysis of communication in emergency surgical teams”. Am. J. Surg. 2016;211:302–303. doi: 10.1016/j.amjsurg.2015.04.017.
    1. Kentab O., Soliman K., Al Ibrahim A.A., Alresseeni A., Aljohani K., Aljahany M. A Push-to-talk Application as an interprofessional communication tool in an emergency department during the COVID-19 pandemic. Open Access Emerg. Med. 2021;13:189–199. doi: 10.2147/OAEM.S308804.
    1. Hansen J.E., Lazow M., Hagedorn P.A. Reducing interdisciplinary communication failures through secure text messaging: A quality improvement project. Pediatr. Qual. Saf. 2018;3:e053. doi: 10.1097/pq9.0000000000000053.
    1. Pourmand A., Roberson J., Gallugi A., Sabha Y., O’Connell F. Secure smartphone application-based text messaging in emergency department, a system implementation and review of literature. Am. J. Emerg. Med. 2018;36:1680–1685. doi: 10.1016/j.ajem.2018.06.067.
    1. Cheng A., Auerbach M., Hunt E.A., Chang T.P., Pusic M., Nadkarni V., Kessler D. Designing and conducting simulation-based research. Pediatrics. 2014;133:1091–1101. doi: 10.1542/peds.2013-3267.
    1. Lundberg G.D. Acting on significant laboratory results. JAMA. 1981;245:1762–1763. doi: 10.1001/jama.1981.03310420052033.
    1. Pati H.P., Singh G. Turnaround Time (TAT): Difference in Concept for Laboratory and Clinician. Indian J. Hematol. Blood Transfus. 2014;30:81–84. doi: 10.1007/s12288-012-0214-3.

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