App leads to falling death rates in hospitals

You can do almost anything with phone applications these days. Measuring your breathing, analyzing sleeping patterns and recording your calorie intake are easy tasks for apps commonly available on smartphones. 

One app is benefiting health at a different level in the UK, though, as an app tracking patients' vital signs has led to falling death rates in hospitals.

Smartphones and iPods could be used in hospitals to record and monitor patients' vital signs with a new app.

Staff at the Queen Alexandra Hospital in Portsmouth and University Hospital Coventry started using handheld computers with a specialist app called VitalPAC to record patients' health indicators, such as blood pressure, oxygen levels and pulse.

The app automatically calculates whether a patient's condition is deteriorating and will inform nursing staff if a patient requires increased monitoring or even immediate attention from a doctor or rapid response team.

Over the course of a year, VitalPAC reduced death rates by 15% at the Queen Alexandra Hospital - representing more than 400 lives being saved - a paper published in BMJ Quality and Safety found.

This is an excellent example of a well-engineered IT solution with a happy ending. One that was clinically led, developed to design out human error when collecting and documenting important clinical data and supports ward staff to take appropriate action, resulting in improved quality of care and safer patients.

Signs of a 'mobile revolution'?

The app was developed in a collaboration between clinical staff at the Portsmouth hospital and the health improvement company, The Learning Clinic, in an attempt to improve upon traditional methods of recording patients' details on paper charts.

Information entered by a member of the nursing staff is used by the app to work out an Early Warning Score (EWS) for a patient, indicating the severity of a patient's condition. A high EWS will trigger an alert with the nursing staff.

Information recorded onto the handheld devices was made available to all clinical members of staff on any device connected to the hospital network by being uploaded to a hospital-wide system. This enabled staff to monitor the health of patients across the entire hospital.

The app was first introduced to the Queen Alexandra Hospital in 2005, followed by University Hospital Coventry in 2007. Using mortality rates from the year preceding the app's introduction, the researchers calculated an estimate with which to compare the actual number of deaths in the hospitals once the app had been rolled out.

They found that over the duration of 2010, 397 fewer patients than expected died at the Queen Alexandra Hospital. At University Hospital Coventry, 372 fewer patients died.

These findings suggest that implementation of technology specifically designed to improve the processes around the recognition of, and response to, patient deterioration can change both process and patient outcomes.

Recognizing deterioration and acting fast

The authors state that one of the major causes of avoidable death in hospitals is the failure to recognize and respond to patient deterioration. The introduction of a well-designed computer system could improve how the vital signs are recorded and reduce the risk of potential error that comes with a paper-based system.

In an accompanying editorial, experts from Brigham and Women's Hospital in Boston, MA, describe the study's findings as "a truly dramatic improvement." David W. Bates and Eyal Zimlichman believe that "the use of more effective monitoring promises to reduce mortality rates substantially for hospital patients."

Not everyone is as enthusiastic about the paper's findings, however. Michael Adams, associate head of the School of Nursing, Midwifery and Social Work at Birmingham City University, UK, believes that recognizing deterioration is important, but that handheld devices should not be necessary.

"I find it slightly depressing that nurses need a phone (or other electrical device) to tell them to call a Doctor," says Adams. "On our program here (at Birmingham City University) we absolutely focus on spotting physiological signs that someone is becoming ill - and acting on it."

Although it might be preferable that handheld devices were not used - especially as wholesale implementation could be costly - the results of the study are impressive and illustrate the potential benefits of mobile technology in health care.

Previously, IT technicians reported on a 'pocket doctor' phone app that could measure Parkinson's progression.