The idea for an app that would improve physician-patient communication came from a surprising source: hospital infection control checklists.
“Checklists are a great tool because they make you focus on work processes,” says Peter Pronovost, MD, PhD, senior vice president of patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Hospital.
“We built on this idea to see if we can enhance physician communication, especially around patients having surgery,” Pronovost says. “They’re frightened, confused, get ambiguous information beforehand, and leave confused about a variety of things.”
For example, patients pre-surgery often are confused about when they can shower. Also, patients sometimes receive conflicting instructions.
“One patient told me they had bowel preparation instructions in the mail that differed from what the doctor told them to do,” Pronovost says. “So, even if you read the instructions, it often is quite complex.”
Pronovost and colleagues built an app called Doctella to improve communication and family-centered care. The app provides each patient with pre-op information and can put specific instructions on the patient’s electronic calendar with an automatic reminder and notification.
Any person can download the app for free, but there is a fee for healthcare providers.
“We’re in the pilot testing,” Pronovost says.
Researchers are learning what users like about the app and how easily patients can use it. They’re also studying its effect. Early, unpublished outcomes data suggest the app is producing positive outcomes, reducing surgery cancellations by 60%, Pronovost says.
Pilot testing includes a partnership with the online health education website Krames. The education site’s platform is easy for patients to use, and now its content is embedded on the app’s platform.
“Our vision is that some people want written material, some want a checklist, some want to watch a video or podcast,” Pronovost says. “Once you have this platform, we can impart any content you want, but, most importantly, give it to patients so they access the format that’s most meaningful to them.”
The piloting phase is expected to conclude by fall. But so far, it appears that the app would work well in an ASC setting. Also, it is a time-saver for physicians and office staff. The redundant patient instructions no longer must be given orally. The app gives patients the necessary pre-surgery information and contains built-in reminders for when they need to act on the information, Pronovost says.
The app provides a generic checklist for various procedures. The generic checklist would give patients information to discuss with their surgeon prior to surgery, and it tells them what they might worry about after surgery. Physicians can customize the checklist, Pronovost notes.
“Doctors then can make their own specific checklist because everyone has a different way of doing things,” Pronovost says. “The specific checklist can give much more details.”
For example, it could tell patients precisely when to stop eating and explain what they need to do. It can provide them with education and suggest questions to ask their surgeons.
The app also can be interactive, giving patients a forum in which to write down questions for their surgeons.
“The app has secure texting, so you can text your doctor a question,” he says. “And if the doctor sends you a text, it automatically goes on your calendar.”
Then, patients will receive a cellphone alert that tells them to take their pre-op medication or what they need to do next to prepare for surgery.
When surgeons use the app to communicate specific instructions, they also receive feedback about when a patient took the action.
“The point really is to get the doctor and patient focused on information that is important for the patient,” Pronovost says.