The Journal of mHealth Vol 3 Issue 5 (Oct/Nov) - Page 42

Pilot Study: A Mobile Phone Application for NHS Staff to Communicate... Pilot Study: A Mobile Phone Application for NHS Staff to Communicate Ward-Based Inefficiencies to Managers Kalraiya A; Kennedy A; Watson L; Chadha P Authors Ashish Kalraiya (Corresponding Author) - West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex, TW76AF email: Alex Kennedy - Royal Free Hospital, Pond Street, London, NW3 2QG Lara Watson - Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH Priyanka Chadha - Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH Developed by Comuzi in partnership with MediShout ABSTRACT Introduction Ward-based inefficiencies such as depleted stock or missing equipment wastes countless hours of NHS staff time as well as money, yet are infrequently reported. The mobile phone application (app) named MediShout solves this problem by enabling ward staff to instantly report inefficiencies directly to the hospital managers capable of implementing change. Keywords Communication, Inefficiency, Mobile app, Resources Objectives To technologically integrate the app into a hospital and ascertain what positive changes occurred. Method In this prospective study, MediShout was used by ten doctors, on five surgical wards for eight weeks. We assessed the number of messages communicated and their impact, plus gathered further data via a staff questionnaire. Results 23 messages were sent, broadly categorized as stock shortages (43.5%), workflow inefficiency (43.5%) or IT problems (13%); and 74% of these resulted in positive changes. One example included a reduction in delayed discharged summaries by increasing the number of ward computers. We estimated that the changes resulting from the sent messages would have saved an estimated £14,000 worth of doctors hours across a year. 100% of responders to a questionnaire approved the use of the app. Discussion NHS staff are often unable to instantly report ward issues and are usually unaware how to, or to whom. The MediShout app so lved this problem. The improvements saved staff time and this equates to saving the hospital money, plus it created a more positive 40 October/November 2016 working environment by bringing ward staff closer to managers and creating a culture of problem-solving. Ultimately, this also meant staff could spend more time at the patients’ bedside. INTRODUCTION Technology Over the past decade, communication techniques have advanced beyond recognition. Today, modern technology allows us to email, communicate with mass audiences and make visual contact at the click of a button. This has provided an invaluable opportunity for the National Health Service (NHS) to develop new and innovative methods of communication and information management to improve the standard of patient care. Effective communication is vital amongst hospital staff due to the mobile nature of work, the multidisciplinary management of patients and the impact of the time to treatment factor.1 Modern communications are already fully engaged within other industries such as the business, finance and legal world; however the medical field is often accused of being a slow-adopter of new technology, despite leading some of the most ground-breaking scientific developments in other areas.2 Some examples of where technology has been successfully integrated into hospital infrastructure include digital patient tracking, electronic prescribing, online medical reference tools and online medical education.3, 4 On an individual level, NHS staff have shown themselves to be keen users of mobile technology to improve their standards of patient care. Studies have proved that the incorporation of mobile devices in hospitals to provide access to the latest clinical guidelines and resources, can promote evidence-based practice and help ensure optimal patient management.5 For example, giving doctors personal digital assistants (PDAs) had a positive impact on communication and information handling through facilitating rapid response and error prevention.1 It is therefore no surprise that the uptake of mobile phone applications (apps) by ward staff has also gathered momentum. Many doctors now use apps to assist their daily practice; from calculating Pilot Study: A Mobile Phone Application for NHS Staff to Communicate... medical scores such as CURB-65 to using AO’s Surgery Reference app for evidence-based management plans of fractures.6, 7 Such initiatives demonstrate the huge potential for mobile technology to improve patient care. Whilst hospitals have traditionally been slow adopters of this technology, there is currently a new generation of technologically proficient doctors and nurses working within the NHS. Hospitals would benefit from harnessing their skills and utilizing mobile devices to promote better communication between healthcare staff. NHS Staff Reporting Problems Incident reporting is a cornerstone of good medical practice. It helps staff avoid future adverse events by identifying systemic problems and promotes the development of prevention strategies. Unfortunately, under-reporting is a major issue in all NHS trusts.8 As an example, one study discovered that only 11 out of 66 incidents were formally reported over a trial period,9 indicating current reporting methods don’t provide an accurate reflection of the actual incidents occurring. The literature proposes rates of reporting would improve by supplementing current systems with a variety of other methods which should function as an integral part of healthcare workers’ daily practice.9, 10 Such methods should be versatile, fast and non-persecutory in order to overcome the cultural, legal and time constraints that can deter healthcare professionals from reporting.10, 11, 12 Using this specification, mobile phones and in particular mobile phone apps provide an ideal method of reporting adverse events in hospitals. Mobile Phone App For Reporting Ward-Based Inefficiencies Datix is currently the NHS’ major software resource for reporting patient safety incidents and adverse events.13 However, its function does not incorporate reporting of ward-based inefficiencies which are not patient-critical and yet contribute to wasted resources, staff time and money. For example, there are few simplified or formalised channels to report a broken computer, stock deficiency, item of missing equipment or workflow inefficiency such as blood samples not being collected. Such seemingly small problems can accumulate yet too little emphasis is given to them as, in isolation, they do not necessarily contribute to poor patient care. Ward based issues are infrequently reported by NHS staff for several main reasons; they often don’t know who to report to or via what communication channel, are too busy during out-of-hours shifts or simply they forget to report by the end of the working day. The consequence is that the same inefficiency is still present the next day, the next week or even the next month. After enduring countless frustrations from such problems, a group of junior doctors created an intervention. They developed an app named MediShout which enables NHS staff to instantly report ward-based issues directly to the hospital managers capable of implementing positive change. The app was designed to be simple for staff to use; they simply had to choose the ward they were on from a drop-down menu and type in the problem they encountered. Then, they simply had to press “Send” for the message to be instantly delivered to the manager. OBJECTIVES a) To technologically integrate the MediShout app onto the surgical wards of a busy district general hospital in North London. b) To ascertain whether ward staff will engage with the MediShout app to report ward-based issues. c) To identify whether messages generated contributed to positive changes on the ward. METHODS This prospective study started in May 2013 in a busy district general hospital in London when the app was deployed for a time-span of eight weeks. It was run in collaboration with the Surgical Matron and was trialled on the hospital’s five surgical wards. All messages were rece ived by the Surgical Matron as her extensive experience, hospital knowledge and contacts made her best placed to solve problems directly, or delegate out to other staff members who could help. Sent messages were instantly updated to the MediShout application’s dashboard which the Surgical Matron could access, and additionally were sent to her Trust email account. The mobile phone application was integrated into the wards by publicizing its inception to all ward staff and developing the required communication pathways with the managers who can create change, namely the Surgical Matron. Inclusion Criteria Only doctors were approached during this study because the authors had a closer daily interaction with them, making it easier to initially promote the app. A cohort of seventeen doctors who worked on the surgical wards were approached to use the MediShout app, though it was limited to those with Apple iPhones. Users registered using a secure Trust or NHS email in order to be identifiable in the unlikely event the app was misused. Users were given instructions at the beginning to explain how the app worked and that it was not a substitute for Datix incident reporting but an adjunct for reporting routine ward issues that occurred in their daily work. Users were strictly warned not to use any patient identifiable information in the app. The data generated was encrypted and secure. Hospital management were given a secure login to access the MediShout website and see what messages had been generated. Data For comparative purposes, we initially asked the Surgical Matron and Ward Managers involved how many ward-based issues had been communicated to them by doctors in the eight weeks prior to app deployment. Then, after the eight weeks that the app was used, all the messages generated as seen on the MediShout website were collected. These was analyzed in conjunction with the Surgical Matron to recognize what positive changes had occurred on the wards as a consequence. It was then established whether those changes saved staff time, resources or money. After the study closed, user perception of the app was analyzed using a brief questionnaire. Open questions were asked to determine what operating system their smartphones were running on, whether staff approved of the concept of the app, what aspects of the app were particularly positive and what possible improvements could be implemented in future builds. RESULTS a) Integration of The Mobile App Technology The MediShout app was deployed across five surgical wards over a total of eight weeks. Seventeen junior doctors were approached to install the application with ten taking part in the trial, all of whom Continued on page 42 The Journal of mHealth 41