Emergency medicine handbook application

A case study from May 2016 on the design and use of this application (app).

Who wrote this case study?

Angela Hall [email protected] from Royal Liverpool and Broadgreen University Hospitals NHS Trust (2016).

Who asked? 

I was approached by both an Emergency Department (ED) Consultant and the Director of Medical Education.

What did they say? 

I was asked if I would project manage the conversion of our emergency medicine handbook into a mobile app. The Handbook, a 580 page document covering 21 specialties and contributed to by 48 clinicians throughout the Trust had resided on our Hospital intranet for several years.

The handbook covered the management of common acute conditions that may be presented by either in-patients or people arriving at the Emergency Department. It links in with relevant Trust Policies and protocols, useful contact information and also local, regional and national guidelines.

As the ownership of smart phones is almost universal among NHS clinicians, they wanted to provide this information in a more portable format, providing easy access to the evidence base, available when and where our clinicians needed it most, at the point of care, where rapid answers are required by clinicians to improve safety as timely intervention improves outcomes for patients.

What did you do? 

Having established that our own information technology (IT) department didn’t have the capacity to tackle such a project in the allotted time and given that the Director of Education had agreed to allocate funding for such a project, I made contact with 3 companies.

Based on price, experience and location, we chose a company based in Warrington called Appitized who already had experience of producing 10,000 apps worldwide.

The app development process is listed below.

1. App Project Specification agreed and signed off.
2. Initial App Designs completed.
3. App Design feedback/changes (if required).
4. App Designs approved by customer.
5. App Development begins.
6. Testing of first app version.
7. Bug fixing (if required).
8. App complete.

We were given an estimated time of 12 weeks to complete the app. However, in reality, it took 6 months. This was mainly due to delays whilst I liaised with several departments within our Trust, for example, our Risk Department in allowing us to have Trust policies made available outside of the Trust; our Data Protection Office to ensure that non-disclosure and information sharing agreements were signed by all relevant parties; our legal department in authorising our disclaimer notice; the time it took to get our app enrolled in the App Developer Program in order for it to get hosted on the app stores.

The app is now freely available to download for both iPhone and Android devices on the iTunes and Google Play stores. The app can be searched by keyword, phrase or category. Bookmarks can be created for easy access to favourite sections. Users can provide feedback for each page or section.

At the heart of the app is a simple to use Content Management System which means that both the android and iPhone operating system (iOS) Apps’ clinical content can be updated as and when required, for example, if a Trust Policy is updated or the management of a condition changes, then, in real-time, we can instantly send out a Push notification to all users of the app to notify them of any changes. We have also ensured we can view statistics on downloads and usage data at ‘App Annie’ – a programme which provides app analytics.

I had a marketing campaign to promote the app producing newsletters and 6 foot pull-up banners strategically placed throughout the Trust. I’ve made presentations to junior Doctors at induction and other educational meetings. We produced a a short video of the app of the app which is available via YouTube.

Bay television (TV) Liverpool, an Internet-based TV Channel, picked up the story and came to the hospital to do a news piece on our innovative creation.

How did it help? 

We have had nearly 6,000 downloads in 86 countries, suggesting that the app is being used to provide the correct care in environments where there may be limited access to this information.

As a result of this, the app. has won a national Marketing on Mobile (MOMA) award for the best marketing of an app in the public sector, beating the Ministry of Defence. Locally, it has also been awarded the ‘Chief Executive’s Award’ and the ‘Star of the Night’ award in the Royal Liverpool and Broadgreen University Hospitals NHS Trust’s annual ‘Make A Difference’ Awards ceremony.

More recently, in 2016, we have entered it for the patient safety and congress awards and are eagerly awaiting the outcome.

Please see also the article in Downloads. A full-length version of an article that appeared in the Health Libraries Group newsletter (HLG) Newsletter, volume 33 number 2, June 2016.