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TEL 4 Health	

"

Simple mobile !
innovations!

Mobile tools to improve patient safety

1
(2012 - 2015)	


(2009 - 2012)	


2
The Problem

• 

In many cases of avoidable maternal
death identified in the UK Confidential
Enquiry, care was hampered by a lack of
cross-disciplinary or cross-agency
cooperation and communication
problems, ...

WHO Patient Safety Curriculum Guide, 2011
3
List of Errors in Patient Safety

•  Share Information with patients
•  Tests pending at discharge
•  Diagnostic Test Results
•  Identified Hospital Dr
•  Treatment/hospital course
•  Discharge medications
•  Main diagnosis
•  Follow-up plans
•  Physical Findings

91%
65%
38%
25%
22%
21%
18%
14%
11%

Kripalani et al., (2007) Deficits in Communication and Information Transfer Between
Hospital-Based and Primary Care Physicians. Implications for Patient Safety and
Continuity of Care. JAMA. 2007;297(8) 831-841.
4
WHO High 5 Patient Safety	

The World Health Organization (WHO) lists
accurate handovers as one of its High 5 Patient
Safety initiatives.
Training of handover skills would appear to be a
promising approach to improve the quality of
patient continue care.

WHO Patient Safety Curriculum Guide, 2011
5
What is a HANDOVER?
Shorter hospitalizations, more frequent patient transitions
à high demands on the quality of clinical handovers
Mobile health projects
Process mapping
Handover
info
3 challenges
for medical practice	


10
Challenge 1: Standardisation
•  General
•  Name
•  Address
•  MRN
•  DOB
•  Hospital
•  Ward
•  Consultant
•  Speciality
•  Date admission
•  Date of discharge
•  GP’s name

30
Challenge 2: Access (mobile)

30
Challenge 3: Information Quality

30
2 challenges are addressed in the
PATIENT project
30
1. Standardisation: (CLAS)

15
2. Mobile Access: The CLAS App
Pilot study of the CLAS App
•  80 medical students (4th yr)
•  Patient casenotes (fictional) given
to students in advance of
teaching session

•  Experimental group (n=40) students received instruction on
the CLAS scale. Asked to write a patient discharge letter (25
mins)

•  Control group (n=40) wrote discharge letter without CLAS
instruction

17
Pilot study at UCC

Maher, B., Henn, P., Gaffney, R. (2012). Teaching medical students How to Write Patient
Discharge Letters – Development of an i-Phone application. AMEE conference 2012,
Lyon, France.
18
Difficult to prove that mobile educational
interventions improve patient safety

•  Lack of research describing / assessment of
educational interventions to improve handover.

•  Transfer of skills to workplace - some evidence
•  Improved Patient Safety - no evidence
Gordon M, Findley R. Educational interventions to improve
handover in health care: a systematic review. MEDICAL
EDUCATION 2011; 45: 1081–1089
19
Conclusions
1. Use of checklists can improve the overall quality,
content, structure and clarity of hospital discharge
letters written by medical students.
• Medical students benefit from formal instruction in
letter-writing skills.
• Use of the CLAS app at point of practice may
improve the quality of hospital discharge letters.

20
Future Research and
Development	

1.  Analysis of 200 hospital discharge letters from 5
different GP practices using CLAS scale
2.  Extending the handover app approach to empower
patients
•  Pilot phase for CLAS and other mobile apps in the
PATIENT project - TARGET: train 600 students per
year with mobile learning tools for handover

21
Upcoming: E-DL App	

•  Extending the idea of apps to
support handover processes
(communication, awareness,
reflection competences).

•  Extending the handover app
approach to empower patients

•  NFC
•  Linked Data
(ICD9, SNOMED_CT)
22
New ap
CPR? What?	


24
Why EMuRgency?
	


•  Appr. 50 reanimations/week by emergency
services in the EMR	


•  8 – 10 people survive	

•  The survival rate could be doubled if	

•  Immediate help by laymen would be in
place	


•  Professional help would earlier be in
place
Why EMuRgency?
	

Chances for survival…
…through immediate cardiac
massage are increased with
the factor 3!
Notification System
Mobile Client
Mobile Client
	


29
Source: http://148apps.biz (Sep. 2013) 	


Study about quality 
usability of mobile apps
	


Medical: 19,487 apps	

Healthcare  Fitness: 23,727 apps
	

30
Study about quality 
usability of mobile apps
	


31
Study about quality 
usability of mobile apps
	

13#apps#included#in#evalua/on#step#II
Pocket#CPR CPR##choking Hands;only 1st#Aid#
St.#John#
SCDF#Choking Emergency
CPR
White#Cross Ambulance#1st#aid CPR#AED First#Aid##
Treatment

Pocket#First#
Aid##CPR

Free#CPR

SOS#
American#
Red#Cross

Leben#reKen

32	


FDNY#
Livesaver#
Beta

Reanima/e
Study about quality 
usability of mobile apps
	


Kalz, et al., submitted	


33
Serious Game: HeartRun
	


34
Serious Game: HeartRun
	

•  Addition to school training	

•  Focus on self-efficacy	

•  Motivational trigger	


35
Serious Game: HeartRun
	

Why mobility?	


•  Location-based 	

•  Role-based	

•  Authenticity	


	


36
Serious Game: HeartRun
	

•  Simulates a real situation 	

•  Requires the recall of BLS
related knowledge immediately and correctly	

•  Integrates tasks and
questions 	


Schmitz, et al., 2013	

37
Public displays
	


Börner,	
  Kalz,	
  	
  Specht,	
  submi7ed	
  
Public displays
Public displays
	


40
Parra et al., submitted	


41
Incident visualisation
Thank you for attending this lecture! 	

This silde is available at:

http://www.slideshare.com/Drachsler


Email:

hendrik.drachsler@ou.nl

Skype:

celstec-hendrik.drachsler

Blogging at: http://www.drachsler.de
Twittering at: http://twitter.com/HDrachsler




Links:


patient-project.eu 

handovertoolbox.eu

43

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Presentation of the SIG TEL 4 Health

  • 1. 
 TEL 4 Health " Simple mobile ! innovations! Mobile tools to improve patient safety 1
  • 3. The Problem •  In many cases of avoidable maternal death identified in the UK Confidential Enquiry, care was hampered by a lack of cross-disciplinary or cross-agency cooperation and communication problems, ... WHO Patient Safety Curriculum Guide, 2011 3
  • 4. List of Errors in Patient Safety •  Share Information with patients •  Tests pending at discharge •  Diagnostic Test Results •  Identified Hospital Dr •  Treatment/hospital course •  Discharge medications •  Main diagnosis •  Follow-up plans •  Physical Findings 91% 65% 38% 25% 22% 21% 18% 14% 11% Kripalani et al., (2007) Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians. Implications for Patient Safety and Continuity of Care. JAMA. 2007;297(8) 831-841. 4
  • 5. WHO High 5 Patient Safety The World Health Organization (WHO) lists accurate handovers as one of its High 5 Patient Safety initiatives. Training of handover skills would appear to be a promising approach to improve the quality of patient continue care. WHO Patient Safety Curriculum Guide, 2011 5
  • 6. What is a HANDOVER? Shorter hospitalizations, more frequent patient transitions à high demands on the quality of clinical handovers
  • 9.
  • 11. Challenge 1: Standardisation •  General •  Name •  Address •  MRN •  DOB •  Hospital •  Ward •  Consultant •  Speciality •  Date admission •  Date of discharge •  GP’s name 30
  • 12. Challenge 2: Access (mobile) 30
  • 14. 2 challenges are addressed in the PATIENT project 30
  • 16. 2. Mobile Access: The CLAS App
  • 17. Pilot study of the CLAS App •  80 medical students (4th yr) •  Patient casenotes (fictional) given to students in advance of teaching session •  Experimental group (n=40) students received instruction on the CLAS scale. Asked to write a patient discharge letter (25 mins) •  Control group (n=40) wrote discharge letter without CLAS instruction 17
  • 18. Pilot study at UCC Maher, B., Henn, P., Gaffney, R. (2012). Teaching medical students How to Write Patient Discharge Letters – Development of an i-Phone application. AMEE conference 2012, Lyon, France. 18
  • 19. Difficult to prove that mobile educational interventions improve patient safety •  Lack of research describing / assessment of educational interventions to improve handover. •  Transfer of skills to workplace - some evidence •  Improved Patient Safety - no evidence Gordon M, Findley R. Educational interventions to improve handover in health care: a systematic review. MEDICAL EDUCATION 2011; 45: 1081–1089 19
  • 20. Conclusions 1. Use of checklists can improve the overall quality, content, structure and clarity of hospital discharge letters written by medical students. • Medical students benefit from formal instruction in letter-writing skills. • Use of the CLAS app at point of practice may improve the quality of hospital discharge letters. 20
  • 21. Future Research and Development 1.  Analysis of 200 hospital discharge letters from 5 different GP practices using CLAS scale 2.  Extending the handover app approach to empower patients •  Pilot phase for CLAS and other mobile apps in the PATIENT project - TARGET: train 600 students per year with mobile learning tools for handover 21
  • 22. Upcoming: E-DL App •  Extending the idea of apps to support handover processes (communication, awareness, reflection competences). •  Extending the handover app approach to empower patients •  NFC •  Linked Data (ICD9, SNOMED_CT) 22
  • 25. Why EMuRgency? •  Appr. 50 reanimations/week by emergency services in the EMR •  8 – 10 people survive •  The survival rate could be doubled if •  Immediate help by laymen would be in place •  Professional help would earlier be in place
  • 26. Why EMuRgency? Chances for survival… …through immediate cardiac massage are increased with the factor 3!
  • 30. Source: http://148apps.biz (Sep. 2013) Study about quality usability of mobile apps Medical: 19,487 apps Healthcare Fitness: 23,727 apps 30
  • 31. Study about quality usability of mobile apps 31
  • 32. Study about quality usability of mobile apps 13#apps#included#in#evalua/on#step#II Pocket#CPR CPR##choking Hands;only 1st#Aid# St.#John# SCDF#Choking Emergency CPR White#Cross Ambulance#1st#aid CPR#AED First#Aid## Treatment Pocket#First# Aid##CPR Free#CPR SOS# American# Red#Cross Leben#reKen 32 FDNY# Livesaver# Beta Reanima/e
  • 33. Study about quality usability of mobile apps Kalz, et al., submitted 33
  • 35. Serious Game: HeartRun •  Addition to school training •  Focus on self-efficacy •  Motivational trigger 35
  • 36. Serious Game: HeartRun Why mobility? •  Location-based •  Role-based •  Authenticity 36
  • 37. Serious Game: HeartRun •  Simulates a real situation •  Requires the recall of BLS related knowledge immediately and correctly •  Integrates tasks and questions Schmitz, et al., 2013 37
  • 38. Public displays Börner,  Kalz,    Specht,  submi7ed  
  • 41. Parra et al., submitted 41
  • 43. Thank you for attending this lecture! This silde is available at:
 http://www.slideshare.com/Drachsler
 Email: hendrik.drachsler@ou.nl Skype: celstec-hendrik.drachsler Blogging at: http://www.drachsler.de Twittering at: http://twitter.com/HDrachsler 
 Links: patient-project.eu 
 handovertoolbox.eu 43