Survey of mobile device and Medical App use in emergency care

The use of mobile devices (smartphones and tablets) and apps is widespread in the general population. The use of these devices allows on-the-go access to information ranging from internet, apps and email like never before. The use of this technology as part of patient care is common among junior medical staff in the UK. In healthcare the use of mobile devices and medical apps has been shown to be a positive development in improving patient care. This revolution started with the release of Apple’s iPhone in 2007 signalling the birth of the smartphone. The next pivotal step was the launch of the Apple Appstore in 2008. This allowed users to download specific software applications “apps” from an online shop and other companies soon followed with their own offerings. Currently little is known how this advance in technology is applied to emergency care. The aim of this work was to investigate the current role of mobile device and medical apps in emergency care in English and German speaking countries in Europe and to provide an overview of how departments and individual clinicians engage with this technology as part of their daily work.Die Verwendung von Mobilgeräten und Apps ist in der Bevölkerung weitverbreitet. Die Benutzung dieser Technologie erlaubt den jederzeitigen Zugriff auf Informationen (Beispiele: Internet, Emails, Apps) wie das zuvor nie möglich war. In Großbritannien ist die Benützung dieser Technologie bei Assistenzärzten als Teil ihrer Arbeit und der Patientenbetreuung weitverbreitet. Im medizinischen Bereich hat sich die Verwendung dieser Technologie als eine positive Entwicklung in der Patientenbetreuung gezeigt. Diese Revolution fing mit der Einführung des Apple iPhone 2007 an. Der nächste entscheidende Schritt war die Eröffnung des Apple Appstore 2008. Dieser erlaubte das Herunterladen von spezifische Softwareprogrammen sogenannten “Apps” von einem Online-Geschäft und andere Unternehmen folgen bald darauf mit ihren eigenen Apps und Geschäften. Momentan ist nicht bekannt wie weit diese Technologie in der Notfallmedizin verbreitet ist und genutzt wird. Ziel dieser Arbeit ist die momentane Rolle von Mobilgeräten und medizinischen Apps in der Notfallmedizin im englisch- und deutschsprachigen Raum in Europa zu beschreiben und eine Übersicht zu bekommen wie medizinische Fachkräfte diese Technologie in ihrer täglichen Arbeit in der Notfallmedizin einsetzen

Prescribing in a paediatric emergency: A PERUKI survey of prescribing and resuscitation aids

Aim: The aim was to investigate the use of paper-based and electronic prescribing and resuscitation aids in paediatric emergency care from a departmental and individual physician perspective. Methods: A two-stage web-based self-report questionnaire was performed. In stage (i), a lead investigator at PERUKI sites completed a department-level survey; in stage (ii), individual physicians recorded their personal practice. Results: The site survey was completed by 46/54 (85%) of PERUKI sites. 198 physicians completed the individual physicians' survey. Individual physicians selected the use of formulary apps for checking of medication dosages nearly as often as hardcopy formularies. The APLS WETFLAG calculation and hardcopy aids were widely accepted in both surveys. A third of sites accepted and half of the individual physicians selected resuscitation apps on the personal mobile device as paediatric resuscitation aids. Conclusion: Our survey shows a high penetrance of the British National Formulary app, a success of NHS digital policy and strategy. Despite potential advantages, many physicians in our survey do not use resuscitation apps. Reluctance to engage with apps is likely to be multifactorial and includes human factors. These obstacles need to be overcome to create a digital healthcare culture

Towards developing a consensus assessment framework for global emergency medicine fellowships

Abstract Background The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees. Main body In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments. Conclusion There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training

Mobile device and app use in paediatric emergency care: A survey of departmental practice in the UK and Ireland

Introduction Mobile devices and medical apps are used by healthcare professionals in adult and paediatric emergency departments worldwide. Recently, there has been a drive toward increased digitalisation especially in the UK. This point prevalence survey aims to describe hardware and software provision and their use in paediatric emergency care in the UK and Ireland.Methods A web-based self-report questionnaire of member sites of an international paediatric emergency research collaborative was performed. A lead site investigator completed the survey on behalf of each site.Results Of the 54 sites, 46 (85%) responded. At 10 (21.7%) sites, the use of a personal mobile device at the bedside was not allowed; however, this was only enforced at 4 (8.7%) of these sites. Apple iOS devices accounted for the majority (70%) of institutional mobile devices. Most sites provided between 1 and 5 medical apps on the institutional mobile device. The British National Formulary (BNF/BNFc) app was the app which was most frequently provided and recommended. No site reported any harm from medical app use.Conclusion The breadth of app use was relatively low. There was variability in trust guidance on app use and challenges in accessibility of Wi-Fi and devices

A survey of mHealth use from a physician perspective in paediatric emergency care in the UK and Ireland

Abstract: There has been a drive towards increased digitalisation in healthcare. The aim was to provide a snapshot of current apps, instant messaging, and smartphone photography use in paediatric emergency care. A web-based self-report questionnaire was performed. Individual physicians working in paediatric emergency care recorded their personal practice. One hundred ninety-eight medical doctors completed the survey. Eight percent of respondents had access to institutional mobile devices to run medical apps. Eighty-six percent of respondents used medical apps on their personal mobile device, with 78% using Apple iOS devices. Forty-seven percent of respondents used formulary apps daily. Forty-nine percent of respondents had between 1–5 medical apps on their personal mobile device. Respondents who used medical apps had a total of 845 medical apps installed on their personal device, accounted for by 56 specific apps. The British National Formulary (BNF/BNFc) app was installed on the personal mobile device of 96% of respondents that use medical apps. Forty percent of respondents had patient confidentiality concerns when using medical apps. Thirty-eight percent of respondents have used consumer instant messaging services, 6% secure specialist messaging services, and 29% smartphone photography when seeking patient management advice. Conclusion: App use on the personal mobile devices, in the absence of access to institutional devices, was widespread, especially the use of a national formulary app. Instant messaging and smartphone photography were less common. A strategic decision has to be made to either provide staff with institutional devices or use software solutions to address data governance concerns when using personal devices.What is Known:• mHealth use by junior doctors and medical students is widespread.• Clinicians’ use of instant messaging apps such as WhatsApp is the widespread in the UK and Ireland, in the absence of alternatives.WWhat is New:• Personal mobile device use was widespread in the absence of alternatives, with the British National Formulary nearly universally downloaded to physicians’ personal mobile devices.• A third of respondents used instant messaging and smartphone photography on their personal mobile device when seeking patient management advice from other teams in the absence of alternatives

Traumatic chylothorax in a young child: Case report and management

Introduction: A chylothorax is an uncommon feature of paediatric chest trauma. Case report: We report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20 mL per 12 hours and she made a full recovery. Discussion: Initial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax

Fifteen minute consultation: When can I use a medical app?

Advances in mobile device technology and internet connectivity have created powerful new mobile health (mHealth) and telemedicine capabilities. The guidelines regarding mHealth use in the clinical environment can be conflicting, which has resulted in some reluctance by institutions and medical staff to fully embrace these advances due to privacy and patient confidentiality concerns among others. The COVID-19 response has led to departments to reconfigurate care and revisit mHealth as a tool to allow social distancing and remote care. This article reviews mHealth guidance in practice and describes its use and interpretation as rapid decision-making aid and in telehealth

Towards developing a consensus assessment framework for global emergency medicine fellowships

© 2019 The Author(s). Background: The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees. Main body: In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments. Conclusion: There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training