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There is an App for That: Mobile Technology Improves Complication Reporting and Resident Perception of Their Role in
Christopher R Johnson1, Ali Noorzad1, Amit Pujari1
1Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California.
Abstract:
Morbidity and mortality (M&M) conferences are rooted within the culture of medicine. They serve a role in every training program and have been mandated by the Accreditation Council for Graduate Medical Education in surgical programs since 1983. Despite the patient safety improvements and educational benefits of these conferences, many adverse events are grossly under-reported.
Methods:
We developed a web-based, Health Insurance Portability and Accountability Act-compliant, M&M reporting mobile application based on Research Electronic Data Capture. The list of possible complications was based on the American Board of Orthopaedic Surgery complications list for part II. The interface is accessible through all mobile platforms. All residents were encouraged to use the application for real-time reporting of complications. Using an unpaired T-test, we compared the reporting before and after the implementation of the mobile application. Residents were surveyed using the Agency for Healthcare Research and Quality Patient Safety Culture Survey before and after implementation to evaluate resident perception of the department's culture of safety.
Results:
The application was launched in August 2017. All reported events were tallied from August 2016 through July 2019. Before the implementation of the application, there were 54 adverse events reported, with a mean of 4.0 per month. In the Post-App cohort, a total of 176 adverse events were reported in year 1, with a mean of 14.76 per month, and 236 adverse events were reported in year 2, with a mean of 19.66 per month. Residents were significantly more likely to feel that their input on patient safety was valued by attendings after the implementation of the app (p = 0.0243).
Conclusions:
An anonymous mobile reporting method for M&M significantly increased the reporting of both major and minor complications and improved resident perception of their role in patient safety efforts. This suggests that traditional methods of M&M reporting may grossly underestimate the complication rates which can negatively affect patient safety and quality improvement efforts and that reducing barriers to the reporting of complication may improve resident engagement in patient safety.
Insights
A new mobile application significantly increased the reporting of medical complications during Morbidity and Mortality (M&M) conferences. This anonymous reporting method also improved resident perceptions of patient safety culture.
Area of Science:
- Medical education
- Patient safety
- Health informatics
Background:
- Morbidity and Mortality (M&M) conferences are integral to medical training and patient safety.
- Current reporting methods often lead to under-reporting of adverse events.
- Accreditation Council for Graduate Medical Education mandates M&M conferences in surgical programs.
Purpose of the Study:
- To develop and evaluate a novel mobile application for M&M reporting.
- To assess the impact of the application on the volume of reported complications.
- To evaluate changes in resident perceptions of patient safety culture.
Main Methods:
- A HIPAA-compliant, web-based mobile application was developed using Research Electronic Data Capture.
- The application utilized the American Board of Orthopaedic Surgery complications list.
- Residents used the app for real-time complication reporting; pre- and post-implementation surveys and unpaired T-tests were used for analysis.
Main Results:
- Adverse event reporting increased from a mean of 4.0 per month pre-app to 14.76 and 19.66 per month in the first and second years post-app, respectively.
- A total of 54 events were reported before the app, compared to 176 in year 1 and 236 in year 2 post-app.
- Residents reported significantly higher perceived value of their patient safety input after app implementation (p = 0.0243).
Conclusions:
- An anonymous mobile reporting system for M&M conferences substantially increased the reporting of complications.
- This technology improved residents' perception of their role in patient safety.
- Traditional M&M reporting likely underestimates complication rates, impacting patient safety and quality improvement efforts.
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