The Role of Clinician-Developed Applications in Promoting Adherence to Evidence-Based Guidelines: Pilot Study.

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.