Prakash Madhu Prita, Thiagalingam Aravinda
Department of Haematology, Westmead Hospital, Corner Darcy Rd and Hawkesbury Rd, Westmead, Sydney, 2145, Australia, 61 413787632.
Westmead Applied Research Centre, University of Sydney, Sydney, Australia.
JMIR Cardio. 2024 Dec 31;8:e55958. doi: 10.2196/55958.
Computerized clinical decision support systems (CDSS) are increasingly being used in clinical practice to improve health care delivery. Mobile apps are a type of CDSS that are currently being increasingly used, particularly in lifestyle interventions and disease prevention. However, the use of such apps in acute patient care, diagnosis, and management has not been studied to a great extent. The Pathway for Acute Coronary Syndrome Assessment (PACSA) is a set of guidelines developed to standardize the management of suspected acute coronary syndrome across emergency departments in New South Wales, Australia. These guidelines, which risk stratify patients and provide an appropriate management plan, are currently available as PDF documents or physical paper-based PACSA documents. The routine use of these documents and their acceptability among clinicians is uncertain. Presenting the PACSA guidelines on a mobile app in a sequential format may be a more acceptable alternative to the current paper-based PACSA documents.
This study aimed to assess the utility and acceptability of a clinician-developed app modeling the PACSA guidelines as an alternative to the existing paper-based PACSA documents in assessing chest pain presentations to the emergency department.
An app modeling the PACSA guidelines was created using the Research Electronic Data Capture (REDCap) platform by a cardiologist, with a total development time of <3 hours. The app utilizes a sequential design, requiring participants to input patient data in a step-wise fashion to reach the final patient risk stratification. Emergency department doctors were asked to use the app and apply it to two hypothetical patient scenarios. Participants then completed a survey to assess if the PACSA app offered any advantages over the current paper-based PACSA documents.
Participants (n=31) ranged from junior doctors to senior physicians. Current clinician adherence to the paper-based PACSA documents was low with 55% (N=17) never using it in their daily practice. Totally, 42% of participants found the PACSA app easier to use compared to the paper-based PACSA documents and 58% reported that the PACSA app was also faster to use. The perceived usefulness of the PACSA app was similar to the perceived usefulness of the paper-based PACSA documents.
The PACSA app offers a more efficient and user-friendly alternative to the current paper-based PACSA documents and may promote clinician adherence to evidence-based guidelines. Additional studies with a larger number of participants are required to assess the transferability of the PACSA app to everyday practice. Furthermore, apps are relatively easy to develop using existing online platforms, with the scope for clinicians to develop such apps for other evidence-based guidelines and across different specialties.
计算机化临床决策支持系统（CDSS）在临床实践中越来越多地被用于改善医疗服务。移动应用程序是CDSS的一种类型，目前其使用越来越广泛，尤其是在生活方式干预和疾病预防方面。然而，此类应用程序在急性患者护理、诊断和管理中的应用尚未得到充分研究。急性冠状动脉综合征评估路径（PACSA）是一套为规范澳大利亚新南威尔士州急诊科疑似急性冠状动脉综合征的管理而制定的指南。这些指南对患者进行风险分层并提供适当的管理计划，目前以PDF文档或纸质PACSA文档的形式提供。这些文档的常规使用情况及其在临床医生中的可接受性尚不确定。以连续格式在移动应用程序上呈现PACSA指南可能是当前纸质PACSA文档更可接受的替代方案。
本研究旨在评估一款由临床医生开发的、以PACSA指南为模型的应用程序在评估急诊科胸痛病例时作为现有纸质PACSA文档替代方案的实用性和可接受性。
一位心脏病专家使用研究电子数据采集（REDCap）平台创建了一款以PACSA指南为模型的应用程序，总开发时间不到3小时。该应用程序采用连续设计，要求参与者逐步输入患者数据，以得出最终的患者风险分层。急诊科医生被要求使用该应用程序并将其应用于两个假设的患者场景。参与者随后完成一项调查，以评估PACSA应用程序相对于当前纸质PACSA文档是否具有任何优势。
参与者（n = 31）从初级医生到高级医师不等。目前临床医生对纸质PACSA文档的依从性较低，55%（N = 17）的人在日常实践中从未使用过。总体而言，42%的参与者发现PACSA应用程序比纸质PACSA文档更易于使用，58%的人报告说PACSA应用程序使用起来也更快。PACSA应用程序的感知有用性与纸质PACSA文档的感知有用性相似。
PACSA应用程序为当前纸质PACSA文档提供了一种更高效、用户友好的替代方案，并可能促进临床医生对循证指南的依从性。需要更多参与者进行进一步研究，以评估PACSA应用程序在日常实践中的可转移性。此外，使用现有的在线平台相对容易开发应用程序，临床医生有机会为其他循证指南和不同专业开发此类应用程序。
