Shilit | Article - Tablets in Trauma: Using Mobile Computing Platforms to Improve Patient Understanding and [...] (2023)

Tablets in trauma: using mobile computing platforms to improve patient understanding and experience

Bennie GP And then,

,Oliver J. Bradford,Maurice P. Paterson

Published: March 1, 2013

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orthopedics, Band 36, S. 205-208;https://doi.org/10.3928/01477447-20130222-06


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Abstract:The Cutting Edge Nicholas D. Furness, BSc, MBBS, MRCS; Oliver J Bradford, MBChB, MRCS, MSc; Maurice P. Paterson, FRCS Pills are becoming commonplace in healthcare. Patients often ask to see their x-rays after trauma. This can be a challenge, especially in immobile patients. The authors conducted a prospective, questionnaire-based study to assess inpatients' desire to view X-rays on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Allowing trauma patients to view their images on a tablet is worthwhile as it improves patient involvement in decision-making, satisfaction, perceived understanding and the overall experience. The authors are from the Department of Trauma and Orthopedics, Royal United Hospital Bath NHS Trust, Combe Park, Bath, UK. The authors have no relevant financial relationships to disclose. Correspondence should be sent to: Nicholas D. Furness, BSc, MBBS, MRCS, Department of Trauma and Orthopedics, Royal United Hospital Bath NHS Trust, Combe Park, Bath, UK BA1 3NG ([email protected]). Mobile computing devices such as tablets are increasingly being used to facilitate medical care. Tablets have been shown to be acceptable to patients when used by their physicians to access clinical information and patient data during consultation1,2; however, no literature evaluates the use of pills in the treatment of patients who have suffered trauma. Trauma patients often request to be able to see their X-rays during their hospital stay, but this may not be possible when the patient is bedridden and there are no facilities to show the patient the images. Tablets are a mobile medium on which X-ray images can be displayed and patients can be shown at the bedside. The authors' hypothesis was that patient satisfaction and understanding of the injuries and the proposed treatment plan on admission would be improved by the use of tablets to allow bedside viewing of X-rays. The objectives of this study were to evaluate patient-reported outcomes to confirm whether there was a desire to see x-rays after admission for trauma treatment; determine whether this was perceived by patients as beneficial to their experience, understanding, and involvement in decision-making about their injury and the proposed treatment plan; and if so, quantify any improvement in these parameters after viewing the x-rays. Two cohorts of 50 consecutive patients admitted to a district trauma ward of a general hospital after a traumatic injury requiring radiographic evaluation by radiographs, computed tomography, or magnetic resonance imaging were prospectively selected for enrollment. All patients 18 years or older or parents or guardians accompanying an adolescent or child were included. Patients who, due to acute or chronic confusion, such as B. Head trauma or dementia who could not demonstrate ability or who did not give informed consent were excluded. Approval for the study was granted by the Institutional Review Board. Patients in the preintervention cohort completed a questionnaire after being seen by the orthopedic on-call physician in a standard post-trauma ward. (A follow-up visit is a visit conducted by the specialist who was on duty the previous day. It is when the specialist examines patients for the first time since admission.) The questionnaire included questions from the UK. National Health Service 2011 with inpatients and was adjusted to include visual analog scales (VAS) and multipoint Likert scales to assess patient satisfaction, understanding, and involvement in explaining their injury and the proposed treatment plan.3Questions were also included to assess whether patients felt that being able to view their X-rays as part of the visit would have affected these variables. During the use of the questionnaire, patient demographics were collected, including age, gender, and the type of injury sustained. Patients in the post-intervention cohort had the opportunity to view their X-rays as part of the specialist's post-traumatic ward. During the consultation, images relevant to the acute injury were displayed on a Motion C5t tablet PC (Motion Computing, Austin, Texas). The consultant was informed in advance that the patient would be offered the opportunity to view their X-rays during the consultation, but it was up to the consultant and the patient how those images would be used during the discussion of the injury and the proposed treatment plan. After the post-assessment evaluation, patients received the same questionnaire as the pre-intervention cohort, with additional questions to assess the impact of their X-rays on their satisfaction, understanding, and involvement in explaining their injury and the proposed treatment plan. All analyzes were performed using SPSS version 19 software (IBM Corporation, Armonk, New York). The data were evaluated using the Shapiro-Wilk normality test. A logarithmic transformation was then applied to nonnormal data prior to analysis. Normally distributed variables were presented as means, which were compared using Student's test.Ttest. Significance of differences for categorical data (reported as medians) was assessed using Mann-WhitneyOfExams. APa value less than 0.05 was considered statistically significant. The preintervention cohort included 21 women and 29 men, whose mean age was 59 years (range, 18 to 96 years). The post-intervention cohort included 27 women and 23 men, with a mean age of 67 years (range, 4 to 98 years). No significant difference was found in age (P=.5) or gender (P=.2) between the two cohorts. The results comparing survey responses with and without taking the pill in the follow-up ward are summarized in Tables 1 and 2. Table 1: Comparison of responses on the Likert scale Table 2: Comparison of responses on the visual analogue scale Median score of 7.3 (interquartile range [IQR], 5.3-9.1) out of 10 for involvement in decisions about their care and treatment. 42 patients said they received just the right amount of information about their condition or treatment. 46 patients stated that they had been informed of their diagnosis by the specialist during the follow-up visit. Of the remaining 4 patients, 1 patient had already been informed about the diagnosis upon admission, 1 did not want to know the diagnosis and 2 were not informed about the diagnosis. The median value for whether the diagnosis was explained clearly was 8.9 (IQR, 7.4-9.8). 49 patients stated that they had spoken to a specialist during their hospital stay. Of these 49 patients, 47 reported having had the opportunity to ask questions. 44 patients had no opportunity to view their X-rays and 6 patients had their images shown to them by the inpatient team before the follow-up visit. Of the 44 patients, 32 said viewing the images would help them understand what they were being told about the diagnosis and treatment plan. All 6 patients who viewed their images reported that it helped them understand what the doctor in the aftercare unit had said. The median for counselor explaining the injury was 8.3 (IQR, 6.8-9.4) and the median for explaining the treatment plan was 8.4 (IQR, 7.0-9.4). Compared to the pre-intervention cohort, patients in the post-intervention cohort whose X-rays were shown to the ward after collection reported significant improvement (P= 0.0001) on perceived involvement in decisions about their care and treatment, with a mean score of 9.2 (IQR, 7.9–9.7). There was also an improvement in the number of patients who said they had received the right amount of information about their condition or treatment (46 pill users versus 42 pill non-users). All 50 patients stated that they had been informed of their diagnosis by the specialist during the follow-up visit. There was no difference between the pre- and post-intervention cohorts for diagnosis that should be explained to the patient, with a median score of 9.1 (IQR, 8.3-9.8) for the post-intervention cohort. intervention (P=.33). 46 patients stated that they had seen their pictures in the aftercare ward. One patient reported not showing the images and 3 patients refused to see the images. Of these 3 patients, 1 reported that it did not help in understanding the injury, 1 reported that he was nauseous and did not want to see the images, and 1 said it was a reminder of how unfortunate it was to dislocate the hip and that he or she had seen x-rays of an anterior hip replacement. Of the 46 patients who saw their images, 45 reported that it helped them understand what the counselor said. Compared to the preintervention cohort, median satisfaction with how well the counselor explained the injury improved from 8.3 (IQR, 6.8-9.4) to 9.1 (IQR, 8.0-9.7 ) (P= 0.02) and the median score for management plan explanation improved from 8.4 (IQR, 7.0–9.4) to 8.7 (IQR, 8.0–9.7), although this only lies at the limit of statistical significance (P= 0.05). Of the 46 patients who saw their images, 35 said that explaining their injury would not have been as effective if they had not been shown their images, 3 were unsure, and 8 said it would have been just as effective . Of the 46 patients who viewed their images, 44 said it had a positive impact on their overall hospital care and 2 were unsure. No negative experiences while viewing images have been reported. Mandatory data collection in orthopedics is increasing. The UK Department of Health requires the pre-operative and 6-month post-operative registration of Oxford and EuroQol scores for all elective hip and knee replacement surgeries, as well as procedure and implant data at the time of surgery for the Joint Registry.4Other patient-reported outcome measurements and clinical research tools are also used to facilitate regional and national level audits and surveys. Holzinger and others5reported that survey data collection is facilitated by the use of tablets. The data entered by the patients can be automatically transferred to a database and are immediately available to the doctors during the consultation. For example, when a patient completes an Oxford Hip Score questionnaire in the waiting room, the score is automatically calculated and can be viewed when the patient is scanned and uploaded to the national database at the same time. The elimination of manual data entry by physicians or research staff is time and cost efficient. The benefits have also been demonstrated in other clinical settings where significant time savings have been demonstrated through the introduction of pills in the ICU for data entry, including record scoring tools and patient side observations.6,7judges and others8reported a patient preference for using tablets over entering paper-and-pencil data for questionnaires, including patients with little computer skills and those with disabilities. Data collection from patients with insufficient language skills and health skills can also be facilitated by using tablets.9Tablets can be used to improve the logistics of daily patient contact in clinical settings. They facilitate efficient access to computer records and x-rays, reduce the need to repeatedly log in and out of static computers, and eliminate the need to switch back and forth between the patient and the computer workstation. Horn and others10showed a statistically significant reduction in logins and the time spent accessing the emergency room patient information system compared to using a static computer. This can potentially improve the throughput (i.e., the time it takes to review patient results and images, make decisions about their treatment, and decide whether to admit or discharge them) of patients in a busy clinical setting by reducing the Contact logistics with patient and computer access is facilitated. Tablets have proven useful in facilitating patient and doctor education. Published work has demonstrated the usefulness of tablets in providing information to patients and training physicians to perform procedures including bronchoscopy and ear, nose and throat surgery.11–13To the authors' current knowledge, this is the first study to examine trauma-related pill use and the impact on patient-reported outcomes of their treatment. Although well accepted by patients, the proposed use of pills may require additional time and effort on the part of the surgical team. The authors acknowledge that due to time constraints in trauma care, the pill use suggested in this study is not always feasible. However, the explanation process was often more efficient with the help of images displayed on the tablet. Using tablets in the trauma setting to allow patients to view X-rays of their injuries improves patient engagement, explanation of the injury as part of the consent process, and the overall experience of care. Combined with facilitating data collection and better patient contact, tablets should be considered an integral part of the trauma unit hardware. Comparison of Likert Scale Responses Comparison of Visual Analogue Scale Responses Table 1: Comparison of Likert Scale Responses Table 2: Comparison of Visual Analogue Scale Responses 10.3928/01477447-20130222-06 Editor's discretion. We reserve the right not to post comments that contain unsolicited information about medical devices or other products. At no time is Healio used for medical advice to patients.

Keywords: patient satisfaction/management plan/radiographs/decision making/trauma/pre-intervention cohort/patient assessment/proposed management/post-intervention

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