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Patient-centred perioperative mobile application in Cesarean delivery: needs assessment and development

  • Janny Xue Chen KeEmail author
  • Ronald B. George
  • Lori Wozney
  • Jill L. Chorney
Reports of Original Investigations

Abstract

Purpose

Cesarean delivery (CD) is the most commonly performed inpatient surgery in Canada, with 103,425 performed in 2016–2017. Mobile technology can contribute to patient-centred perioperative care. Our aim was to involve patients and anesthesiologists in designing a mobile application to enhance the perioperative care of CD patients.

Method

We completed an exploratory qualitative study involving three iterative design cycles. Individual structured phone or in-person interviews with CD patients (n = 15) and anesthesiologists (n = 9) were conducted. Thematic analysis was used to 1) assess gaps and opportunities in the anesthesiology care after CD, 2) identify roles and limitations of mobile application technology in bridging perioperative care, and 3) to solicit feedback on a prototype mobile application for the anesthesiology postoperative care of elective CD patients.

Results

Patients and anesthesiologists were in favour of adding mobile applications to the interdisciplinary perioperative management of patients undergoing CD, particularly for providing reliable information, identifying and following patients with complications, and research in perioperative outcomes. Medical–legal issues, privacy, workflow, and payment policy frameworks are barriers for mobile technology linking patients and anesthesiologists. Our final prototype was refined to focus on timely, concise education and self-monitoring.

Conclusion

The participant-driven changes in direction of the prototype showed the importance of involving key stakeholders early. This study provides guidance on further iterative development and implementation of an interdisciplinary mobile platform for patient-centred perioperative care and outcomes research.

Évaluation des besoins et mise au point d’une application mobile périopératoire centrée sur la patiente accouchant par césarienne

Résumé

Objectif

L’accouchement par césarienne est la chirurgie avec hospitalisation la plus fréquemment réalisée au Canada, atteignant 103 425 cas en 2016–2017. La technologie mobile pourrait contribuer aux soins périopératoires centrés sur la patiente. Notre objectif était d’impliquer les patientes et les anesthésiologistes pour mettre au point une application mobile afin d’améliorer les soins périopératoires des femmes accouchant par césarienne.

Méthode

Nous avons réalisé une étude qualitative exploratoire comprenant trois cycles itératifs de conception. Des entretiens individuels structurés par téléphone ou en personne avec des patientes subissant une césarienne (n = 15) et des anesthésiologistes (n = 9) ont été menés. Une analyse thématique a été utilisée pour 1) évaluer les écueils et les opportunités dans les soins anesthésiques après une césarienne, 2) identifier les rôles et les limites de la technologie d’application mobile pour combler les besoins des soins périopératoires, et 3) demander une rétroaction concernant un prototype d’application mobile pour les soins anesthésiques postopératoires des patientes subissant une césarienne planifiée.

Résultats

Les patientes et les anesthésiologistes étaient en faveur de l’ajout d’applications mobiles à la prise en charge périopératoire des patientes subissant une césarienne, particulièrement pour offrir des informations fiables, identifier et faire le suivi des patientes souffrant de complications, et effectuer de la recherche sur les pronostics périopératoires. Les questions médicolégales, le respect de la vie privée, la charge de travail et les cadres de politiques de paiement constituent des obstacles à la connexion des patientes et des anesthésiologistes via la technologie mobile. Notre prototype final a été amélioré afin de se concentrer sur des outils de formation concis et opportuns et sur l’auto-monitorage.

Conclusion

Les changements proposés au prototype par les participants ont démontré l’importance d’impliquer les principaux intéressés tôt dans le processus. Cette étude offre des pistes quant à la mise au point et la mise en œuvre progressives d’une plateforme mobile interdisciplinaire pour des soins périopératoires centrées sur les patients et la recherche sur les pronostics périopératoires.

Notes

Acknowledgements

We would like to thank our exceptional research staff including Lorraine Chiasson, Robin Lake, Kimberly Vella, and Brianne Lindsay. We are also grateful for funding from the Dalhousie University Department of Anesthesia, Pain Management, and Perioperative Medicine. We thank Optio Publishing Inc. for working with us to build the mobile application.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Janny Xue Chen Ke, Ronald B. George, Lori Wozney, and Jill L. Chorney contributed to all aspects of this manuscript, including study conception and design, analysis and interpretation of data, and drafting the article.

Disclosures

This work was funded by the Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University.

Supplementary material

12630_2019_1392_MOESM1_ESM.pdf (380 kb)
eFig. 1 Screenshot from cycle 1. eFig. 2 Screenshot from cycle 2. eFig. 3 Screenshot from cycle 3. Supplementary material 1 (PDF 380 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Pain Management, and Perioperative MedicineDalhousie UniversityHalifaxCanada
  2. 2.IWK Health CentreHalifaxCanada

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