Providing personal mobile computers to medical residents increases their efficiency, reduces delays in patient care and enhances continuity of care, according to a "research letter" in the March 12, 2012, issue of the Archives of Internal Medicine.
In November 2010, the University of Chicago Medicine became the first hospital in the country to provide 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," said the study's first author, 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 close look at data collected from the hospital's electronic medical record system 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 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 p.m., 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. One of the residents, Nancy Luo, MD, contacted the iPad's maker "to see if maybe Apple wanted to help us out," she recalled.
Late at night on Aug. 25, 2010, Luo emailed Steve Jobs, the late co-founder and CEO of Apple. At 5:21 the next morning, an Apple executive responded: "your e-mail was forwarded to me for follow up from Steve." The company's medical-market manager came to the hospital that afternoon to meet with the team.
The hospital invests about $650 on each iPad, including insurance, protective covers, straps and software. To keep patients' personal information safe, the devices are password-protected. They provide access to the hospital's wireless network but do not store records. Applications on each unit include access to medical journals and a clinical calculator. Required links include Pub Med, the hospital paging directory, journal club, a scheduling tool and a list of discount drug prices.
"We were encouraged to see that this technology could enhance patient care in the setting of restricted resident duty hours," said Christopher Chapman, MD, current chief resident of the internal medicine residency program at the University of Chicago Medicine.