Inspiration
Informed consent is a basic tenet of principled medical practice. Even the simplest procedures — unless performed in an emergency situation — necessitate a discussion of potential risks and benefits. The glaring exception to this practice often arises when we ask patients about their preferences with regard to resuscitation status (Wallace, 2009).
Absence of a DNR order may preclude attention to appropriate end-of-life care (Hayes, 2013) and expose the patient to invasive unsuccessful interventions that are highly likely to increase the patient's suffering (Wallace, 2009).
Adult Resuscitation Plan forms are required in the emergency department. Many patients find it difficult to understand the medical terms and the responses are often biased based on the administering doctor or nurse’s opinion. The pathways of communication between the doctor and patient need to be opened up and the patients need the ability to make informed decisions. An Australian point prevalence study found that only 11.9% of inpatients over 18 years had completed a resuscitation plan (Mills et al., 2017).
What it does
Explains the terms used in the NSWHealth Resuscitation Plan form to enable informed consent from patients and/or their family members. Easy to understand text, pictures, and video will explain the medical intervention options listed in the form, such as pharyngeal suction. The app will consider culturally and linguistically diverse (CALD) patients, differently abled patients (e.g. sight or hearing impaired), and people with differing educational backgrounds.
How we built it
The web app is currently built using WordPress, including custom themes and plugins. An accessibility plugin that assists people with changing text size and contrast has also been added. The site is responsive and will work on all devices.
Challenges we ran into
Tapping into NSW Health is difficult, so we have started with a stand alone informative site. Future integration into hospitals will require privacy and security safeguards. It will need access to the hospital intranet behind their firewalls. The ability for patients to login to an account with their saved details would be a desired feature but would mean the consideration of security issues. A potential solution would be to pair with MyGov, like the Organ Donation Register.
Accomplishments that we're proud of
We are solving a real, everyday problem impacting on patient centred care by improving communication between patient and healthcare professional. The app will improve patient outcomes, reduce cost burden and improve healthcare professional efficacy.
What we learned
There is an evidence practice gap in the execution of the steps for the Resuscitation plan. The conversation is difficult for both the patient and doctor/nurse, with limitations in the communication of vital information.
As a team we learnt the importance of curiosity, collaboration, and courage.
What's next for Explain It To Me: Adult Resuscitation Plans
Work with hospitals to integrate the information and patient into the electronic medical records. Work with nursing homes to help patients and their families before they get to hospital. There are plans to expand the app into a series focusing healthcare situations such as organ donation and anaesthesia.
References
Australian Bureau of Statistics (2016) 4329.0.00.001 - Cultural and Linguistic Characteristics of People Using Mental Health Services and Prescription Medications, 2011. Canberra: ABS
Australian Institute of Health and Welfare 2016. Emergency department care 2015–16: Australian hospital statistics. Health services series no. 72. Cat. no. HSE 182. Canberra: AIHW.
Hayes, B. (2013), Clinical model for ethical cardiopulmonary resuscitation decision-making. Intern Med J, 43: 77–83. doi:10.1111/j.1445-5994.2012.02841.x
Mills, A., Walker, A., Levinson, M., Hutchinson, A. M., Stephenson, G., Gellie, A., Heriot, G., Newnham, H. and Robertson, M. (2017), Resuscitation orders in acute hospitals: A point prevalence study. Australas J Ageing, 36: 32–37. doi:10.1111/ajag.12354
Wallace CK. In-hospital cardiopulmonary resuscitation (Author Reply). New England Journal of Medicine 2009; 361: 1708.
Wechkunanukul, K., Grantham, H., Teubner, D., Hyun, K. H., Clark, R. A. (2016) Presenting characteristics and processing times for culturally and linguistically diverse (CALD) patients with chest pain in an emergency department: Time, Ethnicity, and Delay (TED) Study II. International Journal of Cardiology, 220: 901-908.
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