Dr Udesh Naidoo is a consultant geriatrician at Frimley Park Hospital and a Foundation Training Programme Director.
When did you realise you needed to do something to improve the situation and the clinical guidelines?
There were a number of clinical incidents where junior doctors were managing patients on the wards, and the protocols of treatment that they were using we found had been incorrect and not as accurate.
Guidelines existed on the hospital intranet, it’s also available on the internet for doctors to use, but in pressurised situations, and especially when the hospital is extremely busy, finding the time to actually go to a computer, log on, look through the internet, access that information, takes a lot of time.
When these junior doctors are extremely busy, they want something in their hands, in their pockets, that with a click of a button, a swipe of a screen, they can access the information, readily use it for their patients, and then move on to the next patient.
When did Anna get involved on the project?
One of our junior doctors was quite progressive in her thinking, and she’s very hard-working, she’s well-organised, and we elected for her to modify the paper version of the guidelines.
She took on the project. It was a great success. She contacted all the consultants, so we had an up-to-date version of our guidelines.
Thinking of moving on, and moving forward from this, is when we decided to put the updated paper version of the guidelines in an app form, and I think it’s progressed really well.
You were thinking of a book first and then went for the app. Did you have a range of options you were looking at when you were thinking about improving the guidelines?
The initial plan was for us to update the paper version of the guidelines, and have a paper version for the junior doctors to have in their possession and on the various wards.
We took the proposal to the clinical governance committee. The chief executive happened to be present in the committee, and he decided at that particular point, “Why not create an app version of your guidelines?” Which is how we developed the app and took the project forward. With great success, if I may add.
Did you have any concerns about getting the app developed?
One is obviously a little bit of finance, and make sure we contact the right people to get the money sorted out for the app, to pay the app developer.
Also about restructuring the guidelines, and making sure that the guidelines are up-to-date. I think that was one of the main barriers to developing the app.
Actually, making the app look professional I think was probably a major concern for us. You want to create something that’s user-friendly.
You want to create something that’s easy to use, but also, if it had to be scrutinised by people outside the hospital, you want it to come across as being professional, up-to-date, with information that’s easily accessible.
That was my major concern, this app being looked at by individuals outside of our institution, and critiquing us regarding it looking professional, but also whether the information was up-to-date and user-friendly, essentially.
We fortunately had some input from a gentleman called Mark Terry at the foundation school. He downloaded the app when it was still in the developmental stage, and looked at it, and gave us very positive feedback. He was actually quite encouraging.
He put some information regarding the app on the foundation website. We have been contacted by other Trusts regarding developing a similar app for the other hospitals in the region, and we would like to take this forward.
What was the result? Were your concerns justified?
I think the initial anxiety of the app being unprofessional, with corrupt and incorrect information, has proven to be a worry that was unfounded in reality.
With the various consultants from the various departments getting involved in updating the clinical guidelines, we now find that the guidelines are up-to-date, they’re very accurate, and the essential details that they as consultants require for their patients in their specialities, the essence is captured on the app.
That’s easy for the junior doctors to access, and easy for the junior doctors to manage their patients in the absence of a consultant, in a very busy on-call situation.
Anything you would like to add?
I think it’s essential for junior doctors to remain up-to-date with the changes in medical knowledge, with medical information. Also, when you manage patients you may have one perspective of what you were taught in medical school. These change over time. Guidelines evolve.
The purpose of having the clinical guidelines in an app form on your mobile telephone is it is easy to access, and the information that you can access is accurate.
It will help you and guide you in managing complicated and difficult patients, such that we have no serious and untoward events, less litigation.
You can feel reassured as a junior doctor that you have managed the patients to the best of your ability, and that’s backed up by the information present in the app.