Prescott Oliver, Millar Eoghan, Nimmo Graham, Wales Ann, Edgar Simon
NHS Lothian Medical Education Department, Royal Infirmary of Edinburgh, Edinburgh, UK.
Department of Intensive Care Medicine and Clinical Education, Ward 20 Intensive Care Unit, Western General Hospital, Edinburgh, UK.
BMJ Simul Technol Enhanc Learn. 2017 Apr 5;3(2):60-64. doi: 10.1136/bmjstel-2016-000157. eCollection 2017.
In starting a new clinical placement, doctors in training must become aware of and apply standard operating procedures, as well as learn guidelines, simultaneously adjusting to new patient presentations, environments and personnel. This transition is thought to correlate with increased risk to patient safety, notably during the annual UK changeover. Mobile technologies are increasingly commonplace throughout the National Health Service. Clinicians at all levels are employing medical technology and applications (apps) with minimal local guidance. We set out to test the feasibility and utility of offering medical apps to out-of-hours (OOH) practitioners as an aid to clinical decision-making at point of patient contact. The theorised benefits were threefold: clinical education-real time support for clinical decision-making as one component of deliberate practice to build expert performance; decreased administrative burden-updating and accessing current guidelines; and service development-readily accessible feedback from users.
We provided 32 devices in our emergency departments and OOH environments. The devices were preloaded with apps approved by our medical education department and clinical service leads to be used in support of care delivery.
We surveyed 123 clinical staff prior to the pilot discovering that 65% had used mobile apps to aid their decision-making. During our project, we saw the number of clinical users expand with our data series, suggesting the apps most useful to care delivery for this group of service providers.
There was huge enthusiasm for the project and we hope to maintain a clinician-led environment.
在开始新的临床实习时，实习医生必须了解并应用标准操作程序，学习指南，同时适应新的患者情况、环境和人员。这种转变被认为与患者安全风险增加相关，尤其是在英国每年的交接期间。移动技术在国民医疗服务体系中越来越普遍。各级临床医生在几乎没有当地指导的情况下使用医疗技术和应用程序（应用）。我们着手测试为非工作时间（OOH）从业者提供医疗应用程序以辅助患者接触点的临床决策的可行性和实用性。理论上的好处有三个方面：临床教育——作为刻意练习的一个组成部分，为临床决策提供实时支持以培养专家表现；减轻行政负担——更新和获取当前指南；以及服务发展——从用户那里容易获得反馈。
我们在急诊科和非工作时间环境中提供了32台设备。这些设备预先安装了经我们医学教育部门和临床服务负责人批准用于支持护理提供的应用程序。
在试点之前，我们对123名临床工作人员进行了调查，发现65%的人使用过移动应用程序来辅助他们的决策。在我们的项目期间，随着我们的数据系列，临床用户数量有所增加，这表明这些应用程序对这组服务提供者的护理提供最有用。
对该项目有极大的热情，我们希望保持以临床医生为主导的环境。
