A. R. Privette1, L. Roberts1, D. Wilson1, M. Kish1, B. Carter1, E. Woltz1, B. Crookes1, K. Catchpole1 1Medical University Of South Carolina,Charleston, SC, USA
Introduction:
Successful trauma care is dependent upon effective communication and rapid coordination of multiple people in highly complex fast-paced scenarios. Communication and care-coordination is improved through shared access to patient and contextual information prior to patient arrival and during the initial phase of care. Observational and interview studies of trauma teamwork have shown that communicating information about incoming patients to the trauma team and ancillary services (anesthesia, radiology, OR and ICU personnel) is a significant problem. In order to provide timely and accurate information to all team members, we developed a novel trauma teamwork/communication smartphone application that was designed to (i) provide patient and injury details prior to arrival in the ED (ii) allow secure communications (texts and pictures), and (iii) integrate with clinical workflow to reduce disruptive and unreliable phone calls/pages and allow more focused and efficient face-to-face communication. Our intention was to demonstrate the feasibility and potential power of Smartphone App technology to improve communication/teamwork and decrease work flow disruptions utilizing a Human Factors derived study design.
Methods:
This was a pilot study using an interrupted time-series (before / after) design, with a 3 month pre-intervention data collection period, and a 3 month intervention period with post-intervention data collection. We explored general use statistics, usability, and performance. Observers followed 20 cases in each arm. The main outcome measures were: flow disruptions (defined as “deviations from the natural progression of an procedure”), treatment times (total time in ED, time-to-CT, time-in-CT), and teamwork scores (T-NOTECHS and team-related flow disruptions). Ease of use and utility were assessed using the Technology Acceptance Model (TAM) survey. We also collected metrics directly from software analytics on the number of traumas in which the app was used, the type of interactions, and types of software functionality employed (e.g. text messaging, photo messaging, voice messaging).
Results:
The app was used in 367 (87%) trauma activations during the trial period. Significant reductions were observed in the rates of the most severe flow disruptions (p=0.043). Teamwork scores improved significantly (p=0.04). A range of other positive benefits were observed. There was good agreement between SUS and TAM scales with usability rates of high or very high. Perceptions of utility varied across users, with ED staff finding it least useful, trauma staff moderately useful, and OR, ICU and consult teams the most useful.
Conclusion:
Our novel trauma-specific smartphone app, designed to improve teamwork and communication, was successfully adopted and produced improvements in flow disruption and teamwork. The use of appropriately designed smartphone technology has signficant potential for improving the safety and efficiency of trauma care delivery.