Triage and Transfer to a Regional Burn Center—Impact of a Mobile Phone App

2020 ◽  
Vol 41 (5) ◽  
pp. 971-975
Author(s):  
Heather Carmichael ◽  
Kiran Dyamenahalli ◽  
Patrick S Duffy ◽  
Anne Lambert Wagner ◽  
Arek J Wiktor
Keyword(s):  
Mobile Phone ◽  
Mobile App ◽  
Transfer Mode ◽  
Burn Center ◽  
Telemedicine Technology ◽  
Ambulance Transport ◽  
Intermediate Size ◽  
Thermal Injuries ◽  
Level I

Abstract Telemedicine technology can be used to facilitate consultations from nonburn-trained referring providers. However, there is a paucity of evidence indicating these technologies influence transfer decisions and follow-up care. In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic and clinical data to the burn specialist. A retrospective review was performed on consults to our regional burn center from a Level I trauma center approximately 70 miles away with a shared electronic medical record. Patients were considered to be “down-triaged” if they could be managed locally or if the transfer could occur via personal vehicle instead of ground or air ambulance transport. During the 2-year study period, 126 consultations were made for thermal injuries. Eighty-seven patients (69%) were referred using the Burn App. Overall, 49 patients (39%) were transferred. When the subset of intermediate size (1–10% TBSA) burns were considered (n = 48), the Burn App allowed for successful “down-triage” of 12 patients (33%) referred through the app. No patient referred without the app could be “down-triaged” (P = .02). Although 57 patients (44%) were recommended for outpatient follow-up, only 42% followed up. A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow-up and transfer mode. However, only a minority of patients triaged to outpatient management actually follow up with a regional burn center. Telemedicine efforts should focus on improving not only initial triage, but also aftercare.

23 Triage and Transfer to a Regional Burn Center - Impact of a Mobile Phone App

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S18-S18
Author(s):  
Heather Carmichael ◽  
Kiran U Dyamenahalli ◽  
Patrick Duffy ◽  
Anne L Lambert Wagner ◽  
Arek J Wiktor
Keyword(s):  
Mobile Phone ◽  
Call Center ◽  
Demographic Data ◽  
Mobile App ◽  
Burn Injuries ◽  
Visual Component ◽  
Burn Center ◽  
Private Vehicle ◽  
Triage Decisions

Abstract Introduction The ABA designs referral criteria to guide providers in recommending appropriate patients for treatment at specialized burn centers. However, patients are typically triaged at local facilities where providers may not have expertise to assess burn injuries properly. Addition of a visual component to a consultation call can improve local triage decisions, including estimations of total burn surface area (TBSA). In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic data to the burn specialist in a HIPPA-compliant manner, facilitating the consultation. Our hypothesis is that use of the burn app can improve triage decisions, particularly in cases of intermediate TBSA (1–10%). Methods This is a retrospective review of all consults to our ABA-verified burn center from a single Level II trauma center (TC) approximately 70 miles from our institution. Data were integrated from our call center, burn registry, electronic medical record and the mobile app. Burns were classified as large (>10% TBSA), intermediate (1–10% TBSA), or small (< 1%). Patients were triaged to either a) immediate transfer via ground ambulance or helicopter, b) transfer via private vehicle, c) outpatient follow up at the burn center, or d) local facility/primary care management. Patients were considered to be “down-triaged” if they required transfer but could transfer via private vehicle, or if they could be managed locally. Results During the study period, 135 patient consultations were made by the TC for thermal or cold injuries. 82 patients (61%) were referred using the app. Most patients (n=56, 41%) presented with small burns of the hands, feet or face. Overall, 53 patients (39%) were transferred to the burn center. The majority required ambulance transfer (n=44). 60 patients (44%) were recommended for outpatient follow up, but only 43% (n=26) followed up. When the subset of intermediate burns was considered (n=54), the mobile app allowed for successful “down-triage” of 12 patients (30%) referred through the app. No patient referred without the app could be “down-triaged” (p=0.02). Conclusions A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However, less than half of patients triaged to outpatient follow up were actually seen at the burn center. Applicability of Research to Practice Telemedicine can be used to assist in triage decisions and appropriate referral to a regional burn center. This technology could be optimized to assist in outpatient follow up.

scholarly journals MO1054IMUP: THE ROLE OF TELEMEDICINA ON THE HOMECARE OF CHRONIC KIDNEY DISEASE PATIENTS AFFECTED WITH COVID19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Claudia Yuste ◽  
Paula Jara Caro Espada ◽  
Lucia Aubert ◽  
Elena Gutiérrez ◽  
Aida Frías González ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mobile Phone ◽  
Remote Monitoring ◽  
Hospital Care ◽  
Mobile Apps ◽  
General Information ◽  
Mobile App ◽  
X Rays

Abstract Background and Aims COVID19 worldwide crisis has shown the fragility of usually overbooked hospital care, encouraging improvements on the homecare and remote monitoring of patients. IMUP (Intelligent Manager for Ubiquitous Personal Mobile Care) is a Mobile App developed by UPM to follow up  chronic kidney disease (CKD) patients affected with COVID19. Method CKD patients (or their home caregivers) with access to a mobile phone were asked to introduce daily their symptoms (headache, tiredness, short of breath, cough and diarrhea) in addition to blood pressure and temperature. IMUP also allowed: (1) free asynchronous message exchange between patients and physicians, (2) provided general information and guidelines to reduce household COVID19 transmissions, (3) countdown of isolation days, and (4) notified alarms and alerts.  All patients consented to a mobile phone monitor. Physicians categorized clinical situations reviewing IMUP symptoms into: (1) stable, (2) alert, and (3) presential assistance advised. Results A total of 38 patients (9 kidney transplant, 23 haemodialysis, 3 peritoneal dialysis, 3 low clearance)( 58.8% male, age 62.2 ± 15.6 years, 17.6 % diabetics) with confirmed COVID19 infection were followed up with IMUP, 23 after hospitalization (median of 10 [4-16] days) and 15 with complete outpatient follow-up. The mean follow-up with IMUP was 8 [4,17] days. Four houndred and seven daily symptoms were introduced in IMUP, being tiredness the commonest (27%), followed by cough (21.5%) and diarrhea (20.6%).  Reviewing IMUP daily symptoms, 185 clinical situations were categorized in stable and 21 alert. Five patients required presential assistance, 3 of them requiring hospital admission (1 rehospitalization). 81 messages were exchanged, delivering 17 therapeutic recommendations.  IMUP countdown helped to organize isolation on the HD unit (cases and contacts), plus follow up with chest X rays and blood samples. Conclusion The easy and intuitive use of mobile apps makes them widely accepted by the general population. Remote monitoring by mobile phone apps brings a new opportunity to alleviate our overbooked hospital care. Besides, remote monitoring could help to stratify and organize clinical follow up, allowing a closer communication between physicians and patients.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

Analyzing the Adherence of a Mobile App to Follow up Tobacco-Quitting Patients

2017 ◽  
Author(s):  
Marc Pifarre ◽  
Francesc Solsona ◽  
Jordi Vilaplana ◽  
Francesc Abella ◽  
Rui Alves
Keyword(s):  
Mobile App

scholarly journals Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lilian M. N. Kebaya ◽  
Dalton Wamalwa ◽  
Nyambura Kariuki ◽  
Bashir Admani ◽  
Philip Ayieko ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Infant Feeding ◽  
Retention In Care ◽  
Control Group ◽  
Hiv Exposed Infants ◽  
Randomized Controlled ◽  
Phone Calls ◽  
Hiv Exposed ◽  
To Receive

Abstract Background HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Methods In this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p < 0.001 at 10 weeks]. Conclusions These results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. Trial registration PACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3449

Transitioning a randomized controlled trial to a digital registry – experience from the TAILOR-PCI digital follow-up study on onboarding, engagement and geofencing consent rate

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Avram ◽  
D So ◽  
E Iturriaga ◽  
J Byrne ◽  
R.J Lennon ◽  
...  
Keyword(s):  
Clinical Trial ◽  
The United States ◽  
Mobile App ◽  
Funding Source ◽  
Location Tracking ◽  
Main Trial ◽  
Phone Calls ◽  
Effective Manner ◽  
Research Platform

Abstract Background/Introduction TAILOR-PCI is the largest cardiovascular genotype-based randomized trial (NCT#01742117) investigating whether genotype-guided selection of oral P2Y12 inhibitor therapy improves ischemic outcomes after percutaneous coronary intervention (PCI). The TAILOR-PCI Digital Sub-Study tests the feasibility of extending original follow-up of 1 year to 2 years using state-of-the-art digital solutions. Deep phenotyping acquired during a clinical trial can be leveraged by extending follow-up in an efficient and cost-effective manner using digital technology. Purpose Our objective is to describe onboarding and engagement of participants initially recruited in a large, pragmatic, international, multi-center clinical trial to a digital registry. Methods TAILOR-PCI participants, within 23 months of their index PCI, were invited by letters containing a URL to the Digital Sub-Study website (http://tailorpci.eurekaplatform.org). These invitations were followed by phone calls, if no response to the letter, to determine reason for non-participation. A NIH-funded direct-to-participant digital research platform (the Eureka Research Platform) was used to onboard, consent and enroll participants for the digital follow-up. Participants were asked to answer health-related surveys at fixed intervals using the Eureka mobile app and desktop platform. To capture hospitalizations, participants could enable geofencing to allow background location tracking, which triggered surveys if a hospitalization was detected. Result(s) Letters were mailed to 893 of 929 eligible participants across 22 sites in the United States and Canada leading to 226 homepage visits and 118 registrations. There were 107 consents (12.0% of invited; mean age: 66.4±9.0; 19 females [18%]): 47 (44%) participants consented after the letter, 36 (34%) consented after the 1st call and 24 (22%) consented after a 2nd call. Among those who consented, 100 were eligible (7 did not have a smartphone) 81 downloaded the study mobile app and 73 agreed for geofencing (Figure 1). Among the 722 invited participants who were surveyed, 354 declined participation: due to lack of time (146; 20.2%), lack of smartphone (125; 17.3%), difficulty understanding (41; 5.7%), concern about using smartphone (34; 4.7%), concern of data privacy (14; 1.9%), concerns of location tracking (6; 0.8%) and other reasons (57; 7.9%). Conclusion Extended follow-up of a clinical trial using a digital platform is feasible but uptake in this study population was limited largely due to lack of time or a smartphone among participants. Based on data from other digital studies, uptake may also have been limited since digital follow-up consent was not incorporated at the time of consent for the main trial. Figure 1. Onboarding of the digital substudy Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)

Is electronic follow-up using a mobile phone application after mid-urethral sling placement feasible and efficient?

2020 ◽  
Author(s):  
Yang Pan ◽  
Han Chen ◽  
Hualin Chen ◽  
Xiaoxiang Jin ◽  
Yunxiao Zhu ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Mobile Phone Application ◽  
Sling Placement

scholarly journals TControl: A mobile app to follow up tobacco-quitting patients

2017 ◽  
Vol 142 ◽  
pp. 81-89 ◽  
Author(s):  
Marc Pifarré ◽  
Adrián Carrera ◽  
Jordi Vilaplana ◽  
Josep Cuadrado ◽  
Sara Solsona ◽  
...  
Keyword(s):  
Mobile App

Developing a USSD-based mobile phone app to provide adolescents with sexual reproductive health information: A human-centered design approach (Preprint)

2021 ◽  
Author(s):  
Paul Macharia ◽  
Antoni Pérez-Navarro ◽  
Irene Inwani ◽  
Ruth Nduati ◽  
Carme Carrion
Keyword(s):  
Reproductive Health ◽  
Mobile Phone ◽  
Health Information ◽  
Mobile App ◽  
Resource Limited Settings ◽  
Human Centered Design ◽  
On Demand ◽  
Sexual Reproductive Health ◽  
Resource Limited ◽  
Adolescent Reproductive Health

BACKGROUND Adolescent pregnancies and sexually-transmitted infections continue to impact 15 – 19-year-olds across the globe. The lack of sexual reproductive health information in resource-limited settings can often be due to cultural and societal attitudes to adolescent sexual reproductive health. Innovative approaches, including mobile phone technologies, are needed to address the need for adolescent reproductive health information. OBJECTIVE To design and develop a mobile app prototype to provide confidential adolescent reproductive health information on demand and evaluate its usability and user experience. METHODS A human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. Field usability testing enabled the adolescents to provide feedback on the functionality, usability, and usefulness of the app. RESULTS During the usability test, 62 (54.9%) of the adolescents that were followed-up had used the app at least once, 30 (48.4%) of these were male participants and 32 (51.6%) female. The app was described as ‘very interesting’ to use by 44 (70.9%) participants, 20 male and 24 female. The content was deemed to be either ‘perfectly’ or ‘well targeted’ on sexual reproductive health by 60 (96.7%) adolescents, and the app was rated ‘best app’ by 45 (72.6%) adolescents, 27 female and 18 male, with a p-value = 0.011. CONCLUSIONS A mobile phone app is a feasible and acceptable way to deliver adolescent sexual reproductive health information in resource-limited settings. The USSD mobile phone technology could deliver confidential information on demand.

scholarly journals Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Tyler Shelby ◽  
Tyler Caruthers ◽  
Oren Y Kanner ◽  
Rebecca Schneider ◽  
Dana Lipnickas ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mobile Phone ◽  
Sensitivity And Specificity ◽  
Mobile App ◽  
Mixed Methods Study ◽  
Self Report ◽  
Contact Tracing ◽  
Free Text ◽  
Contact Interactions ◽  
University Campus

BACKGROUND Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). OBJECTIVE We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. METHODS We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app (“app pilot”), and the second was for a small electronic “tag” (“tag pilot”). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired <i>t</i> tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey’s free-text responses. RESULTS Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; <i>P</i>&lt;.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; <i>P</i>=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; <i>P</i>=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to “concerns with privacy.” There were no significant differences in self-reported adherence rates across pilots. CONCLUSIONS Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices.

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