The moment where a patient’s pulse slips from faint to absent or the rise and fall of their chest becomes imperceptible is perhaps the most stressful, emotionally charged situation in medicine. It naturally, therefore, lends itself to chaos – and chaos plus emotion does not lead to good outcomes. A recent study suggests that medical apps could help help providers overcome these two obstacles during medical emergencies, potentially improving outcomes for patients.
A few months ago, we covered a randomized controlled trial which suggested that an ACLS app, iResus, improved physician performance in code situations. A recent publication in Resuscitation by Flanigan et al suggests that yet another app for emergency situations, in this case PICU Calculator, also improves clinical performance.
PICU Calculator is an app that is designed to calculate doses and infusion rates for critical care medications such as vasopressors. Pediatrics faces the unique challenge that most medications must be dosed with consideration given to everything from age, weight, height, and more. That increased difficulty creates yet another opportunity for error in emotionally charged emergency situations.
In this study, physicians were asked to prescribe vasopressors in two simulated situations of shock. In one simulation, they used the British National Formulary for Children, a quick-reference tool designed for this situation. In the other, they used the PICU Calculator app. The order in which the simulations were done for this relatively small group of about 30 at a single site was randomly generated.
The results are pretty impressive. While only 30% of the providers were able to prescribe the correct medication using BFNC, 100% were able to do so using the PICU Calculator. Also of note, usage of the PICU Calculator also required far less time (almost five minutes), a feature that would presumably allow the physician to spend more time focusing on the patient.
There are several important limitations to this study. First, its a small group – only 30 providers at a single institution. Second, it does not seem to account for more advanced infusion pumps which can simplify parts of this process. Finally, its primary author is among the contributors to the app itself – though he apparently does not have any financial interest in the app, it certainly does open the findings up to questions of bias.
In any case, what we seem to be seeing is a growing interest in bringing medical apps into the mainstream of medical practice by proving their value. As with any new intervention, the earliest trials are small and limited. These early results will, hopefully, lead to larger studies that will help the medical community understand how best we can implement medical apps in mainstream practice to improve outcomes for our patients.