National medical societies frequently develop practice guidelines, checklists, and other algorithms. However, adherence is often poor and clinical implementation often involves printed documents, charts, or signs.1 In order to give clinicians better access to guidelines at point-of-care, ASRA has worked together with Vanderbilt University and Mustard Seed Software to develop three smartphone-based applications to implement an electronic solution to some of their most utilized publications.
All 3 apps were developed for iOS (Apple Inc, Cupertino, CA) through a modified Delphi technique to reach consensus for the branching/searching logic as well as an iterative process for user interface design.2,3
The first app, ASRA Coags©, transforms the Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy (Third Edition)4 publication into a searchable and stepwise application. This app dissects these complex recommendations into digestible portions that are more useable in a busy clinical environment. By searching for the drug of interest and the type of procedure being done, the user is given an actionable recommendation as well as a summary of the published text to ensure that the nuances are effectively communicated. In addition, there are links within the app to the entire Executive Summary if more detail is required.
The second app, ASRA LAST© converts the Checklist for Treatment of LAST5 into an interactive algorithm with weight-based dosing for use during a local anesthetic toxicity event. Any rare event can be difficult to manage without cognitive aids. With a smartphone-based app, the individual steps are in a readily available format that is flexible enough to provide the modified ACLS algorithm in real-time for a LAST event. The app contains interactive step-by-step instructions for decision support to aid in the completion of both ACLS and LAST-specific management with cyclical timers that remind the user to recheck pulse, resume CPR, and evaluate for further lipid emulsion at clinically-appropriate times. Lastly, the app provides a mechanism for the clinician to save a PDF report of the time-based events or submit that report to LipidRescue.org for international consolidation.
The third app, ASRA Timeout©, creates an interactive checklist based on A Checklist for Performing Regional Nerve Blocks.6 Pre-procedure timeouts and checklists have been proven to reduce errors such as incorrect patient, procedure, side of procedure, and medication/allergy reactions. The app is an interactive experience that includes all the suggested items from the ASRA publication in a simple to use touch based checklist. In addition, the electronic interface allows for quick links to the ASRA Coags© app and informational popups for greater detail on topics such as aseptic technique and suggested resuscitation equipment.
Smartphone electronic interfaces for medical guidelines provide multiple advantages: easy distribution, quick access at the point of care, flexible interactive interfaces, built-in reporting mechanisms, and the ability to quickly update the information contained in the app from a central location. All the apps are available on the iTunes App Store for immediate use by clinicians. To our knowledge, this is the first demonstration of successful development of clinically-relevant smartphone applications that involved partnership between a national organization and a group of clinicians skilled in the development and testing of smartphone applications, as called for by leaders in patient safety.1
1 Pronovost PJ. JAMA, 2013.
2 McEvoy MD, et al. RAPM, 2014
3 Joseph-Williams N, et al. Med Decis Making 2013.
4 Horlocker TT, et al. RAPM. 2010.
5 Neal JM, et al. RAPM. 2012.
6 Mulroy MF, et al. RAPM. 2014.