Helen Barlow, The Rotherham NHS Foundation Trust Library & Knowledge Service and Jocelyn Matthews, York Teaching Hospital NHS Foundation Trust
York: Postgraduate Education Manager
Rotherham: Director of Medical Education
What did they say?
The Trust had purchased a smartphone app for Junior Doctors and a Clinical Improvement Fellow had been asked to add clinical content on to the app and needed support to find and adapt suitable clinical documents and then load them on to the app platform.
The premise was to provide junior doctors with access to the latest key clinical information from the Trust Intranet in an easy and simple way when faced with a medical emergency when on-call.
The documents are referenced to the full policy or procedure held on the Trust Intranet, so that the junior doctors can read the full policy/procedure after the emergency situation has passed.
The Rotherham NHS Foundation Trust had also purchased the Ignaz Handbook. Our Leadership Fellow had promoted Ignaz and consulted with junior doctors on key content required for the app. She had begun organising summary guidelines and populating the app.
The Director of Medical Education asked the Library and Knowledge Service (LKS) to become involved to support the Leadership Fellow to add content. When the Leadership Fellow went on maternity leave in January 2015, the LKS was asked to take on a lead role in launching the app in February 2015 and continuing to work with clinical authors to add additional content and develop mechanisms to keep the app up-to-date.
In Rotherham we have focused on using Ignaz to make local clinical guidelines and policies easily available to junior doctors in a bite-sized format even when they don’t have access to a PC or wifi. Once the app is downloaded the content can be viewed offline and needs to be resynched every 21 days to ensure it stays up-to-date.
What did you do?
I started working in October 2015 with a Clinical Improvement Fellow and over the following ten months we managed to find, adapt and load over 120 documents in 22 categories.
The Clinical Fellow made a list of the type of medical emergencies faced by junior doctors and we started to search the Trust intranet for the relevant policy. Some polices were found and then adapted so that the content was suitable for an app. In cases where a policy wasn’t available, the Clinical Fellow (or a colleague) developed a pathway which had to be signed off by the relevant Consultant. In some cases these new documents were then loaded onto the Trust intranet.
In another instance, some new referral pathways were developed for patients presenting at A&E and the Team involved wanted an easy accessible platform for doctors to use, this was seen to be the smartphone app and now these pathways have been loaded on the app.
The original Clinical Improvement Fellow has now left the Trust and part of the role is to keep the documents on the App up-to-date as the original policies are updated. We are also aware that more policies and procedures are being developed and that there are gaps of information in terms of categories available or documents needed and so a further part of the role is to find other junior doctors to work with, to make sure that the app is as comprehensive as possible.
A final part of the role is in promoting the app and this includes promoting the app at junior doctor inductions; writing articles for Trust publications and doing short presentations at appropriate meetings such as the Patient Safety Improvement Forum.
In January 2015 the LKS took on responsibility for editing, providing easy access to local guidelines, promoting and providing training on the app and ensuring app development follows the standard operating procedure.
I made use of the list of priority areas developed by the Leadership Fellow to make links with authors, advise on the summarising of guidelines and upload content. I encouraged feedback and worked to identify authors for content in new areas.
We promoted the app in a variety of ways, emails to new junior doctors, stands at the inductions in August and February and presentations to groups of staff.
Mechanisms have also been developed to monitor the content and alert authors when content needs to be updated.
The app now has 22 sections with over 120 documents. New sections added include emergency medicine, children & young people, cardiology, laboratory investigations and diabetes. In the 2 months following rotation for doctors in training we had 54 (Aug /Sept 2015) and 22 (Feb / Mar 2016) new users, this compares to 107 (50.5%) and 47 (46.8%) new doctors starting in the trust. 95% of our users are returning users with an average of 48 returning users per month.
How did it help?
It has provided a means for junior doctors to access key clinical information quickly and easily, and so contributed to the wider patient safety agenda.