Introduction: Improving communication between all providers involved with rural trauma and urgent care patients may be beneficial. In our proof of concept study, we examine the potential of an open architecture and flexible smart phone system, utilizing an affordable, off-the-shelf and secure application called Wickr.Methods: Two patient scenarios were constructed to test the capabilities of the Wickr application for data transfer. Roles were distributed between three players: one represented the transport medical doctor, another played the air medical crew, and the final assumed all the other roles. As the two scenarios unfolded simultaneously, phone conversations, text messages, pictures, and imaging files were conducted between the players by smart phones via downloaded Wickr applications. Upon completion, players answered nine questions on a 5-point Likert scale that focused on the quality of the videos, texts and pictures shared, as well as indicators that we deemed essential to transport communication systems from our experience.Results: Scores on video, picture and sound quality ranged from good to excellent. Scores on user friendliness, task suitability, speed, information discretion and customizable data retention ranges from somewhat agree to agree. Conclusion:Wickr was quick, user friendly, and well suited for the clinical communication during simultaneous patient scenarios. Whether it is a capable system for a busy helicopter emergency medical service has not been evaluated.
There is no consensus on how effective patient handover in the pediatric intensive care unit should occur. Complex patients with rapidly moving clinical trajectories are difficult to summarize and comprehend. We aimed to redesign our current handover instrument to encourage higher-level cognitive interactions, questioning and understanding for pediatric residents. Through an iterative process with five pediatric intensive care unit intensivists, the current hardcopy handover tool was reviewed and compared to other formats published in medical and non-medical domains. Several handover formats on the iPad were created and proposed, but continual feedback from intensive care unit physicians led to a selection, and further revisions were made. A mock handover with completed data fields allowed pediatric residents to provide the final feedback in both a semistructured group review and a survey with responses on a 1-5 Likert scale (1 = strongly disagree; 2 = disagree; 3 = neither agree or disagree; 4 = agree; 5 = strongly agree). A novel two-axis data grid combining the 'systems' and 'problem list' approach was developed, with read back prompts, and off the shelf applications such as "burn notices". Residents found ease with the organizational format (4.0 ± 0.67 Likert scale response) and the transition to the iPad device (4.3 ± 0.67). Improving physician handovers may be achieved efficiently and economically through physician led iterative processes. Pediatric residents were at ease when the novel handover was combined with newer iPad technologies and applications.
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