Mobile App PocketDr Delivers Evidence-Based Clinical Checklists for Junior Doctors’ to Improve Management of Ill Patients
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Abstract
Aim and Objectives:
1. To assess information and help used by junior doctors on call. Identify which areas they felt least comfortable with and determine whether they would use a quick access app as a resource.
2. Provide quick evidence-based on-call references for common clinical encounters via a mobile phone app.
3. Analyse use of the resource and obtain feedback to improve the app with the overall goal of improving patient safety.
Methods:
In 2012, an online survey of 324 junior doctors (158 FY1, 136 FY2, 26 CT1, 4 other) asked: When you need help on-call which resources do you use? Are medical apps convenient / suitable and would you feel comfortable using them? Would you use a clinically-focused book / app designed for “instant-access� What clinical information would be most helpful to have instantly available?
A literature search for best practice clinical guidelines was conducted. Checklists for the 28 most requested scenarios were written based on best practice sources including NICE and Royal College guidelines. Checklists included deteriorating conditions such as hypoxia and bradycardia, and 20 acute medical presentations such as atrial fibrillation, alcohol withdrawal and sepsis. The mobile phone app was published for doctors to download at no charge in July 2014.
Results:
Primary market research on resources for junior doctors on-call was carried out between 25 April and 23 May 2012, 324 foundation doctors responded to a structured online survey.
Whilst the majority (77%) often referred to a senior for advice when on-call, many (61%) also often sought a peer colleague’s advice, which has implications for patient safety and untoward events.
Virtually all (97%) used the internet at times to look up information, but only 37% used apps to the same extent. Most thought they were convenient / suitable (72%) and would feel comfortable using them (68%).
PocketDr analytics reveal use is greatest when the least doctors were working with the minimum amount of senior support – after 5pm. Overall use at weekends was equitable with that on weekdays, but with only a backbone of on-call staff and minimal support - showing high use per doctor on-call.
Conclusions:
Being on-call is one of the most challenging roles of the newly qualified doctor. Undergraduate education offers a limited introduction to the practicalities of being on-call, often alone. Many junior doctors feel inadequately prepared for the role. When on-call speed and safety are vital and human factors often come into play. Time pressure and inexperience can create an uncomfortable level of stress, which may lead to clinical error. The aim of developing an open-access best clinical practice resource for on-call junior doctors was achieved. Following successful implementation of the iPhone version, an Android version is currently under development to widen access to the resource. Guidance is updated as new guidelines and evidence emerges. PocketDr is an ongoing project with many updates and improvements. Initial feedback has been positive, with requests for further checklists to be added. Research is needed to evaluate impact on patient outcomes and serious incidents.
1. To assess information and help used by junior doctors on call. Identify which areas they felt least comfortable with and determine whether they would use a quick access app as a resource.
2. Provide quick evidence-based on-call references for common clinical encounters via a mobile phone app.
3. Analyse use of the resource and obtain feedback to improve the app with the overall goal of improving patient safety.
Methods:
In 2012, an online survey of 324 junior doctors (158 FY1, 136 FY2, 26 CT1, 4 other) asked: When you need help on-call which resources do you use? Are medical apps convenient / suitable and would you feel comfortable using them? Would you use a clinically-focused book / app designed for “instant-access� What clinical information would be most helpful to have instantly available?
A literature search for best practice clinical guidelines was conducted. Checklists for the 28 most requested scenarios were written based on best practice sources including NICE and Royal College guidelines. Checklists included deteriorating conditions such as hypoxia and bradycardia, and 20 acute medical presentations such as atrial fibrillation, alcohol withdrawal and sepsis. The mobile phone app was published for doctors to download at no charge in July 2014.
Results:
Primary market research on resources for junior doctors on-call was carried out between 25 April and 23 May 2012, 324 foundation doctors responded to a structured online survey.
Whilst the majority (77%) often referred to a senior for advice when on-call, many (61%) also often sought a peer colleague’s advice, which has implications for patient safety and untoward events.
Virtually all (97%) used the internet at times to look up information, but only 37% used apps to the same extent. Most thought they were convenient / suitable (72%) and would feel comfortable using them (68%).
PocketDr analytics reveal use is greatest when the least doctors were working with the minimum amount of senior support – after 5pm. Overall use at weekends was equitable with that on weekdays, but with only a backbone of on-call staff and minimal support - showing high use per doctor on-call.
Conclusions:
Being on-call is one of the most challenging roles of the newly qualified doctor. Undergraduate education offers a limited introduction to the practicalities of being on-call, often alone. Many junior doctors feel inadequately prepared for the role. When on-call speed and safety are vital and human factors often come into play. Time pressure and inexperience can create an uncomfortable level of stress, which may lead to clinical error. The aim of developing an open-access best clinical practice resource for on-call junior doctors was achieved. Following successful implementation of the iPhone version, an Android version is currently under development to widen access to the resource. Guidance is updated as new guidelines and evidence emerges. PocketDr is an ongoing project with many updates and improvements. Initial feedback has been positive, with requests for further checklists to be added. Research is needed to evaluate impact on patient outcomes and serious incidents.
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