Doctors' views on iPads at the bedside

A small study of a group of doctors who used iPads on ward rounds shows that while they like the device and used it to access clinical data, they still preferred to share information verbally with their patients.

The study, conducted at St Vincent's Hospital in Sydney by a team from the University of NSW's Australian Institute of Health Innovation (AIHI), followed 10 doctors on their ward rounds and studied their interaction with patients while equipped with an iPad.

The iPads allowed the doctors read-only access to the hospital's MediWeb results reporting system and the MedChart medications management program, as well as a number of patient education apps that they were free to use. Full access to MediWeb, MedChart and the hospital's Web DeLacy computerised provider order entry system was available from a number of laptop and desktop computers on the wards.

As manoeuvring a laptop on a trolley was deemed impractical by doctors, the idea of this study was to see whether senior doctors would use the iPad to share information such as test results with their patients during ward rounds, and to explore both patients' and doctors' experiences of information sharing events.

What the study showed was that doctors thought information sharing was critical, but they preferred to talk their patients through the results rather than show them.

Visually sharing information with patients has been shown to be effective in other studies in general practice and with physiotherapy students in the hospital setting, but as hospital rounds are usually brief, the study concludes that the iPad at the hospital bedside might not be the appropriate context for patient engagement.

The study doctors were given a 30-minute training session on the iPad 4 as well as training on how to access MediWeb and locate patient lists and patient data.

The research team observed the medical team interacting with patients on routine rounds, with the average doctor-patient interaction lasting four minutes. Computers were used in 61 per cent of these interactions, with the iPad itself used in 15 per cent.

“When doctors used the iPad, they continued to speak while using the device,” the researchers report. “No instances were observed where a doctor stopped speaking in order to attend to the iPad.

“However, use of the iPad did require doctors to break eye contact with the patient and view the screen, which was, in the majority of cases, positioned in such a way that the patient could not see what was being done.

“In only one case was an iPad screen shown to a patient during ward-rounds for the purpose of sharing information (i.e. a test result).”

Seven of the participating doctors were interviewed, and while they thought sharing information with their patients was important, they thought it was better done verbally.

“I didn’t really use it as much interacting with the patient, because with my patient population I prefer to talk to them,” one doctor said.

Another said, “I predominantly use the rounds as a chance to talk to the patient. I don’t think reference material is that helpful, there is so little time, so when you see patient, you don’t want to waste time waiting for something to load or reading through it.”

Some did see the value in using the iPad, with one saying it is a familiar and fun device for patients that was easier to use than a laptop.

Patients were surveyed as well, with the majority saying they were engaged with their care generally and that the use of the iPad had not affected this level of engagement, although “the one patient who was shown information on the iPad reported that they thought the device had increased their engagement in care processes,” the researchers say.

They say iPads might be better when used for patient education outside of ward rounds when doctors are less time pressured.

“Overall, our findings show that iPads were used by clinicians to support their work during ward-rounds. However, the ward-round may not present the most appropriate context for the iPad to support clinicians and patients in information sharing and education.”

The study, led by the AIHI's Melissa Baysari, Johanna Westbrook and Ric Day, is published in the Internal Medicine Journal.

Posted in Australian eHealth

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