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The CLAS App


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There is a high potential for mobile learning and support applications in the health domain. In this paper we introduce the CLAS App, a mobile application to support handover procedures based on the improvement of writing skills. Handover of patient care is a time of particular risk and it is important that accurate, reliable and relevant information is clearly communicated between one caregiver to another. Improperly conducted handovers lead to wrong treatment, delays in medical diagnosis, life threatening adverse events, patient complaints, medical litigation, increased health care expenditure, increased hospital length of stay and a range of other effects that impact on the health system. The CLAS App helps standardise and improve handover communication between hospital and community healthcare.

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The CLAS App

  1. 1. The CLAS AppA mobile training tool to improve handover procedures between hospital interface and family doctors Simple mobile innovations 1
  2. 2. What is a HANDOVER?
  3. 3. What is a HANDOVER?
  4. 4. What is a HANDOVER?Shorter hospitalizations, more frequent patient transitionsà high demands on the quality of clinical handovers
  5. 5. The Problem‘In many cases of avoidable maternaldeath identified in the UK ConfidentialEnquiry, care was hampered by a lack ofcross-disciplinary or cross-agencycooperation and communicationproblems, ...’WHO Patient Safety Curriculum Guide, 2011 4
  6. 6. Discharge summaries often did not ... • Share Information with patients 91% • Tests pending at discharge 65% • Diagnostic Test Results 38% • Identified Hospital Dr 25% • Treatment/hospital course 22% • Discharge medications 21% • Main diagnosis 18% • Follow-up plans 14% • Physical Findings 11%Kripalani et al., (2007) Deficits in Communication and Information Transfer BetweenHospital-Based and Primary Care Physicians. Implications for Patient Safety andContinuity of Care. JAMA. 2007;297(8) 831-841. 5
  7. 7. WHO High 5 Patient SafetyThe World Health Organization (WHO) listsaccurate handovers as one of its High 5Patient Safety initiatives.Training of handover skills would appear to bea promising approach to improve the qualityof patient continue care.WHO Patient Safety Curriculum Guide.Published October 2011. 6
  8. 8. Related mobile health projects
  9. 9. Related mobile health projects
  10. 10. Process mapping
  11. 11. Process mapping
  12. 12. Process mapping Handover info
  13. 13. Challenge 1: Information Quality 30
  14. 14. Challenge 2: Access 30
  15. 15. Challenge 3: Standardize • General • Name • Address • MRN • DOB • Hospital • Ward • Consultant • Speciality • Date admission • Date of discharge • GP’s name 30
  16. 16. The Cork Letter-WritingAssessment Skills (CLAS) 13
  17. 17. The CLAS App
  18. 18. The CLAS App
  19. 19. Pilot study at UCC •  80 m• 80 medical students (4th yr) •  Patie given teach• Patient casenotes (fictional) given •  40 st to students in advance of on th teaching session write (25 m• Experimental group (n=40) students received instruction on •  Cont disch the CLAS scale. Asked to write a patient discharge letter (25 instr mins)• Control group (n=40) wrote discharge letter without CLAS instruction 15
  20. 20. Pilot study at UCCMaher, B., Henn, P., Gaffney, R. (2012). Teaching medical students How to Write PatientDischarge Letters – Development of an i-Phone application. AMEE conference 2012,Lyon, France. 16
  21. 21. Challenge to prove that mobile educational interventions improve handover • Lack of research describing / assessment of educational interventions to improve handover. • Transfer of skills to workplace - some evidence • Improved Patient Safety - no evidence Gordon M, Findley R. Educational interventions to improve handover in health care: a systematic review. MEDICAL EDUCATION 2011; 45: 1081–1089 17
  22. 22. Conclusions1.Use of checklists can improve the overall quality, content, structure and clarity of hospital discharge letters written by medical students.2.Medical students benefit from formal instruction in letter-writing skills.3.Use of the CLAS app at point of practice may improve the quality of hospital discharge letters. 18
  23. 23. Future Research and Development• Extending the idea of apps tosupport handover processes(communication, awareness,reflection competences).• Extending the handover appapproach to empower patients• NFC• Linked Data (ICD9, SNOMED_CT) 19
  24. 24. Future Research and Development• Extending the idea of apps tosupport handover processes(communication, awareness,reflection competences).• Extending the handover appapproach to empower patients• NFC• Linked Data (ICD9, SNOMED_CT) 19
  25. 25. Future Research and Development1. Analysis of 200 hospital discharge letters from 5different GP practices using CLAS scale2. Extending the handover app approach to empowerpatients3. Pilot phase for CLAS and other mobile apps in thePATIENT project -> TARGET: train 600 students peryear with mobile learning tools for handover 20
  26. 26. Thank you for attending this lecture!This silde is available at: hendrik.drachsler@ou.nlSkype: celstec-hendrik.drachslerBlogging at: http://www.drachsler.deTwittering at: 21