The Effects of Introducing a Mobile App–Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study

Abstract

Background To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU). Objective The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook. Methods This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients’ electronic medical records appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. Results Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the app-based logbook, the percentage of CVC insertions appearing as logbook entries increased from 3.6% (38/1059) to 20.5% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor’s signature before and after the introduction of the app, with 76.3% (29/38) and 83.2% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3% (13/85) to 62.8% (54/86; P<.001). Adherence to one’s logbook was similar in both groups with 60% (6/10) of first-time users in the before group and 79.5% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU. Conclusions The addition of an electronic app-based logbook to a preexisting paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook use observed without a reduction in the quality of logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted.

Effect of a smartphone-based online electronic logbook to evaluate the clinical skills of nurse anesthesia students in Iran: a randomized controlled study

“…The findings of the present research provide support for previous studies on electronic logbooks. For instance, a study conducted by Tamblyn et al [ 10 ] in Australia showed that relative to a paper logbook, a smartphone-based electronic logbook improved the compliance of junior doctors in recording information in the logbook. Also, Barbieri et al [ 5 ] examined the compliance of anesthesiology residents in recording clinical activities in a web-based online electronic logbook.…”

“…By virtue of their fast performance, online electronic logbooks can not only improve the interaction between instructor and student, but also improve the quality of anesthesia education and facilitate evaluation [ 5 ]. Most electronic logbooks have thus far been designed for a computer or a website, and despite the advantages of such logbooks, users cannot always quickly access them [ 10 ]. Recently, the use of smartphone technology among new evaluation methods has won increasing popularity in clinical and educational settings [ 3 ], and applications installed on these phones have been demonstrated to be portable, fast, and accurate tools for recording and maintaining information [ 11 ].…”

Investigating the advantages and disadvantages of electronic logbooks for education goals promotion in medical sciences students: A systematic review

“…Hence, one of the most significant advantages of adding an e-logbook to the mobile phone was quick data entry to save physicians time and energy. 18 The first model was an offline e-logbook without an internet connection. Data were manually entered and saved on the computer using database management software, depending on the available resources.…”

“…Smartphones were available in hospitals, and many clinicians used mobile apps as a source of instant access to information for clinical decision‐making. Hence, one of the most significant advantages of adding an e‐logbook to the mobile phone was quick data entry to save physicians time and energy 18 . Kumar et al investigated the use of an e‐logbook for postgraduate psychiatry training.…”