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
Inefficiencies to Managers
Kalraiya A; Kennedy A; Watson L; Chadha P
Ashish Kalraiya (Corresponding Author) - West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex, TW76AF
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
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.
Communication, Inefficiency, Mobile app, Resources
To technologically integrate the app into a hospital and ascertain
what positive changes occurred.
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.
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.
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
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.
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.
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.
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.
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.
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.
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
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The Journal of mHealth