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

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.

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

CONSORT flowchart.

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

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.