Providing personal mobile computers to medical residents increases efficiency, reduces delays in patient care and enhances continuity of care, according to a research letter in the March 12 issue of the Archives of Internal Medicine.
In November 2010, the University of Chicago Medicine provided residents with tablet computers on a large scale, supplying iPads to all 115 residents in internal medicine. When surveyed in 2011, more than three out of four of the residents reported that the portable computers allowed them to complete tasks quicker and freed them up to spend more time on direct patient care and to participate in educational activities.
"Residents face a vast and increasing workload packed into tightly regulated hours," wrote Bhakti Patel, MD, pulmonary critical care fellow at the University of Chicago Medicine. "They spend much of their time completing documentation and updating patient charts. This study indicates that personal mobile computers can streamline that process."
The study had two components. First was a survey that asked residents how their work was affected by the availability of mobile computers. Almost 90 percent of the residents responded that they routinely used the iPads for clinical responsibilities, 78 percent felt it made them more efficient and 68 percent reported that it averted patient care delays.
Next was a look at data collected from the hospital's EMR on when the residents placed patient-care orders during the first 24 hours of each new hospital admission. The researchers compared order placement from January 2010 through March 2010, before acquiring iPads, with the same three months in 2011, after implementation.
The records confirmed the survey responses. Residents in the study submitted 5 percent more orders before 7 a.m. rounds, at which they update senior physicians about overnight admissions. They placed 8 percent more orders before handing off their responsibilities and leaving the hospital by 1 pm, as required by duty-hour rules.
The impetus for the iPad project came from internal medicine residency program leadership. A task force of chief residents, residents and administrative staff helped coordinate implementation. The hospital invests about $650 on each iPad, including insurance, protective covers, straps and software.
“Unfortunately, the implementation of EHRs actually increases time in indirect care and the need for available computer workstations to advance care,” Patel and colleagues wrote. “These trends, coupled with the growing information needs for patient care, have led to more time spent locating a computer or working on a computer at the expense of time at the bedside or at conference.”
“The implementation of personal mobile computing via iPads was associated with improvements in both perceived and actual resident efficiency,” concluded the authors. “Resident perception of improvement in workflow efficiency seems to be consistent with data demonstrating that orders were placed earlier in a patient’s admission. Furthermore, more orders were entered before the postcall team had to leave the hospital. In addition to enhancing efficiency of residents, the iPads may have facilitated greater continuity of patient care since the primary service was able to advance care for the patients they admitted and will follow before they execute a handoff.”