Smartphones and tablets have become a vital tool for so many of us. They help us learn new information, communicate with others and sometimes just pass the time.
Now, it seems, they can help us recover from surgery too. That’s what researchers from Boston Medical Center (Boston, Massachusetts) learned when testing an app they designed for postsurgical patients.
Frustrated by low compliance with the organization’s “ICOUGH” care protocol for preventing postoperative pulmonary complications, a small team at Boston Medical Center had a big idea: create an app that could show patients what they needed to do and also motivate them to do it. That’s just what the team did.
Results from the organization’s initial pilot study of the app are quite promising. Patients found the app to be empowering, remarking that it allowed them to take greater control of their recovery. Staff also liked the app, finding it to be a helpful adjunct to the care they provide. Early results show that use of the app led to improved adherence to the care protocol without increasing the burden on medical staff.
This innovative initiative earned the Boston Medical Center team ECRI Institute’s 2018 Health Devices Achievement Award. The Award was presented to the project leaders in June during a meeting of top hospital management.
The Challenge: Promoting Patient Compliance
Postoperative pulmonary complications are a common and costly issue. Instances of pneumonia, unplanned intubations or failure to wean the patient from mechanical ventilation can hinder a patient’s recovery and prolong the patient’s hospital stay. Such complications can have a profound effect on the patient’s health. Additionally, the costs to the health care facility can be significant.
Boston Medical Center had instituted an effective protocol to reduce the incidence of adverse pulmonary outcomes among surgical patients. The ICOUGH protocol, as it is called, stresses the importance of incentive spirometry, coughing and deep breathing, oral hygiene, and activities such as getting out of bed and walking around the care area. The organization found that the protocol decreased postoperative pneumonia by 38 percent, unplanned intubations by 40 percent and all adverse outcomes by 40 percent.
However, Boston Medical Center found the success of the protocol to be difficult to sustain in its acute care, safety-net hospital setting – in part because of the demands placed on staff to guide patients through the protocol. Clinicians, who were already burdened with heavy workloads, could not easily incorporate the protocol into their everyday workflow. The challenge was exacerbated by the hospital’s patient mix, which includes many older, higher-risk patients and patients who do not speak English – groups that often require more time and attention per nurse.
The hospital needed a way to promote patient compliance with its pulmonary care protocol without overburdening staff. The solution proposed by two Boston University School of Medicine students, Andrew Chu and Samir Haroon, was to develop a smartphone application to support the ICOUGH protocol. Led by Pamela Rosenkranz, director of clinical quality and patient safety, a small team was formed to bring the idea to fruition.
The team developed an app that incorporated a variety of features to help improve adherence to the ICOUGH protocol:
Eligible patients were recruited to use the app during a pilot project. Participating patients downloaded the app, completed an onboarding process with the research staff, and then used the app while on the inpatient floor following their surgery. Upon discharge, the patients completed a brief qualitative survey and an audio-recorded interview regarding their experiences with the app.
As noted above, results from the organization’s initial pilot study were very promising. One key to success is that the app transferred more responsibility and accountability for recovery to the patient, while providing the patient with the knowledge and tools needed to succeed. This combination has helped increase adherence to the protocol, and it has done so in a way that has not overburdened medical staff.
Although the sample size was small (the study included only 17 patients), experience to date suggests that apps like this one could yield significant benefits for health outcomes and for a hospital’s bottom line. Dr. David McAneny, vice chair of the Boston Medical Center department of surgery and the principal investigator of the original ICOUGH study, sums up the app-development effort this way: “This clever tool is an example of how innovative young minds can re-shape approaches to old challenges.”
Also Deserving Recognition …
In addition to honoring the team from Boston Medical Center, ECRI Institute recognized five organizations as finalists for the 2018 award. We’ll highlight those organizations in next month’s issue.
Next year, it could be you. If your organization has engaged in a health technology management project that deserves recognition, ECRI Institute wants to hear about it. The nonprofit research institute presents its annual Health Devices Achievement Award to the member health care facility that has carried out the most exceptional initiative to improve patient safety, reduce costs or otherwise facilitate better strategic management of health technology.
ECRI Institute will begin accepting submissions for next year’s award in October 2018.
This article is adapted from ECRI Institute’s membership website. The full article features additional details about the Boston Medical Center project and about other honorees.
For more information, visit www.ecri.org/HDAwardwinner; call (610) 825-6000; or e-mail firstname.lastname@example.org.
© 2018, TechNation Magazine. Site designed by MD Publishing, Inc.