Evaluating the use of a handheld electronic paediatric emergency medicine reference by emergency physicians

Abstract

Background: Use of handheld electronic devices for reference and clinical decision support in medical care has increased significantly over the past decade. Many of these applications have been developed and tested in resource-rich settings and their feasibility and utility in resource-limited settings is unknown. A paediatric Emergency medicine software program has been donated for use to Emergency Department-Muhimbili National Hospital (EMD-MNH) by an international Non-Government Organization (NGO) and is integrated in clinical care since early 2013. Problem Statement Most of the applications for handheld devices are made and studied in resource rich nations but little is known about the feasibility and utility of it in a resource limited setting. Study Rationale This study will enable us to document use and establish provider views on the utility of electronic decision support software in our setting. Aim To identify the components of paediatric emergency medicine software most often accessed and found to be the most useful by doctors in the Emergency department at Muhimbili National Hospital (MNH). Materials and Methods Physician usage and opinions on program were evaluated by direct observation, surveys, interviews. Budget: The budget for this study was$1500 (TSHS 2,460,000) Results: All 28 doctors in MNH-EMD were screened of which 26 had smart phones and 25 consented for the study. On average, each provider used PEMSoft app 1.4 times per shift which is the same frequency as asking the supervisor, for clinical referencing. The top three diagnoses accessed in the app were the same as those seen in our department at MNH-EMD. Most accessed component was disease reference and the least accessed was calculation support. 94.7% rated the app as easy to use while 86.8% felt that it made difference to patient care. Conclusion and Recommendation: A paediatric emergency medicine reference program on a handheld platform was deemed easy to use at the point of care by physician providers in an urban tertiary emergency department in Dar es Salaam. Most participants felt that the program helped in patient care but the effect on patient care was not measured.