How smartphones and apps are changing emergency department care

A mainstay of the “Star Trek” TV and movie franchise is the medical tricorder. This versatile piece of technology allows doctors to scan a patient and instantly receive a complete diagnosis of their injury or illness.  

Though we don’t yet have tricorders, we have access to sophisticated information-gathering and diagnostic programs in our emergency department. And one of our most vital pieces of equipment is something many of us have in our pockets or purses: the smartphone. With access to the internet and dedicated medical apps wherever we are, we can spend more time with patients and less time searching books for medical information. These tools help us make specific medical recommendations for each patient.  

In my experience, patients appreciate that we double-check our recommendations with medical apps and additional research. It’s comforting to them to know that there’s additional evidence supporting medical decisions besides an emergency-department doctor they’ve never met before telling them they’re OK or that they need additional treatment. 

Patients appreciate that we double-check our recommendations with medical apps and additional research. -Dr. Jeffrey Dubin via @MedStarWHC

The transition away from medical books

It’s simply not possible for doctors to memorize every piece of medical information needed to treat patients. That’s especially true in the emergency department, where we care for everything from cases of heart attacks,  trauma and burns and everything in between, as well as other conditions that just can’t wait for a doctor’s visit in the morning.

When I was doing my medical training, and for a number of years after that, every emergency department used to have reference books. These textbooks were there for doctors to refer to when they needed to refresh their memories on how to do a procedure or treat a condition. But nobody does that anymore.

The internet has replaced the old practice of reading pages of dense medical textbooks to find the snippets of information we need. Medical textbooks are available online, and they’re searchable, which saves us valuable time. Many e-book versions of medical textbooks include embedded videos that demonstrate procedures. Videos of many procedures are available online specifically for doctors’ reference.  

Powerful medical apps for smartphones

Our emergency department doctors spend less time finding information and more time treating patients thanks to mobile medical apps. We’ve incorporated some of these clinical decision-making tools into our electronic medical record to help us make patient care decisions.  

Mobile medical apps let emergency-department doctors spend less time finding information and more time treating patients. via @MedStarWHC

I don’t like cluttering my phone with screen after screen of medical apps. I tend to find one or two apps that do the jobs I need and stick with them. Two I use frequently are MDCalc and Epocrates.  

MDCalc

MDCalc provides a range of clinical decision-making tools that include calculators for determining patients’ risks for various conditions and rules for when to order diagnostic tests or provide treatments.

A good example of how I use MDCalc is when a patient comes in after a car accident. Cars are so well-built these days that they usually absorb all the forces from a typical fender-bender. Most people walk away with no significant injuries, but they may want to get X-rays to make sure nothing’s broken.

MDCalc has collected clinical decision rules from published research doctors for determining when someone who’s been in a car accident actually needs to have X-rays taken and when we shouldn’t to minimize the person’s radiation exposure. If I need to double-check these rules, it’s really easy. I just open the app, type in the rule I’m looking for and refer to it during the patient’s exam.  

Some other features of MDCalc that I use include:

  • A list of questions to determine if a person has a problem with drinking alcohol
  • Scoring systems for a person’s risk for stroke
  • Key identifiers that a patient may have appendicitis  

Epocrates

Epocrates is a database of medications and their safety information, including dosing, side effects and potential interactions with other medications. I can pull up a specific medication’s listing and walk the patient through its possible side effects.  

Epocrates also is useful for comparing a patient’s symptoms to their listed medications. I often have patients come in and tell me they feel dizzy or have an itchy rash, and sometimes those are side effects of a new medication or a possible interaction between two medications.  

We no longer have to refer just to textbooks from 10 or 15 years ago for clinical data. With smartphone apps built specifically for doctors, we can access the most accurate, up-to-date information to help us make accurate recommendations for our patients. These and other innovations will continue to improve the way emergency department doctors like me practice medicine and care for our patients. 

Chair, Department of Emergency Medicine, MedStar  Washington Hospital Center 

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