1. Utility of Daily Mobile Tablet Use for Residents on an
Otolaryngology – Head & Neck Surgery Inpatient Service
Matthew G Crowson MD*, Russel Kahmke MD*, Marisa Ryan MD, Richard L Scher MD
Division of Otolaryngology – Head & Neck Surgery, Department of Surgery, Duke University Health System
Matthew G. Crowson, MD
DUMC 2824, Durham, NC 27710
Email: matthew.crowson@dm.duke.edu
Phone: 919-681-6588
Contact
1. Boruff, J.T. and D. Storie, Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other
mobile devices to find information. J Med Libr Assoc, 2014. 102(1): p. 22-30.
2. Sclafani, J., T.F. Tirrell, and O.I. Franko, Mobile tablet use among academic physicians and trainees. J Med Syst, 2013. 37(1): p. 9903.
3. Patel, B.K., et al., Impact of mobile tablet computers on internal medicine resident efficiency. Arch Intern Med, 2012. 172(5): p. 436-8.
4. Walsh, C. and P. Stetson, EHR on the move: resident physician perceptions of iPads and the clinical workflow. AMIA Annu Symp Proc, 2012.
2012: p. 1422-30.
References
• Mobile device technology use, specifically tablets and
smartphones, is widespread amongst medical students and
trainees1,2
• Internal Medicine residency programs at the forefront
• A recent University of Chicago survey-based study of 114
Internal Medicine residents3 demonstrated:
• 84% believed the devices were a good investment for
the program in both educational and clinical productivity
purposes.[3]
• 78% noted that they were more efficient on the wards,
with a self-reported time saving of one hour a day
• 56% felt that they could attend more conferences by
using their iPads
• 68% reported that patient care delays were averted
• A study from the Columbia University Internal Medicine
Residency program demonstrated that there may be direct
benefits to patient care with the use of tablets during
bedside rounds notably as a non-disruptive means to access
the most current patient data4
• Exists at noticeable paucity of similar studies conducted in
surgical residency settings
• Most published data describes qualitative metrics
without significant mention to quantitative measures like
discharge rates, order input efficiency, or monies saved.
Introduction
• During the two-week pre-intervention period, 607 pieces of
paper (>50% double sided) was used for patient care and
hand-offs
• Pre-rounding prior to formal rounds during the pre-
intervention period lasted 30.71 minutes (standard deviation
10.35) versus 37.69 minutes (SD 10.33) in the post-
intervention period (p=0.046)
• The duration of formal rounds was shorter in the post-
intervention period at 67 minutes (SD 67 minutes) compared
to 125 minutes (SD 83 minutes) before intervention (p=0.02)
• There was a trend toward residents needing to leave formal
rounds to answer a clinical question less frequently during
the post-intervention period
• 2.21 times in pre-intervention (SD 3.72) versus 0.62
times (SD 1.39) in post-intervention, p=0.08
• Residents believed that the tablet device allowed them to
document more detail in the medical record (p=0.02),
facilitate a faster (p=0.03) and more detailed (p=0.04)
transfer of information during sign-out through the use of a
tablet device
• There was no significant difference in the number of patients
discharged prior to 11 a.m. using tablet devices in the post-
intervention period (p=0.28).
Objectives
• Prospective cohort study, 4 consecutive weeks
• 2-week pre-intervention period, survey
• Implementation of mobile tablet devices
• 2-week post-intervention period, survey
• During the pre-intervention period, a tablet or related mobile
device was not used by any member of the rounding team
• During the post-intervention period, tablet devices were
used to place orders, look up pertinent clinical data, and
facilitate education and patient data transfers (handoffs)
• Survey to assess resident reported educational and clinical
productivity
Methods and Materials
• By extrapolating these numbers for a full 52-week year,
15,782 pieces of paper would be used
• Paper and ink cost savings
• Security for protected patient health
• Pre-rounding took about 7 minutes longer using tablet
devices
• Could be related to the novelty of tablet device use
• Inpatient rounding was 50% shorter with the use of tablets
• Pull real-time data at point-of care for each patient
• Non-significant trend (p=0.08) in the number of times a
resident had to leave rounds to look up data when a
tablet was provided
• A study with tablet device use in an Internal Medicine
residency program found a similar benefit and deemed
the tablet as a valuable and non-disruptive tool for
bedside data retrieval4
• 50% of residents believed that tablet devices allowed them
to attend more educational conferences
• 70% of the residents felt that the tablets helped them spend
more time with patients
• 80% of the residents felt tablets improved morale
• Concerns about planned or unforeseen EMR or device
downtime resulting in detriment to patient care
Discussion
• Investigate the effects of mobile tablet technology on
resident clinical productivity in an inpatient surgical setting,
resident education, and resource utilization
• Evaluate potential economic benefits of the use of mobile
tablet technology in place of traditional paper ‘patient list’
formats
Results
• Thirteen Otolaryngology – Head & Neck Surgery residents
serving on the Duke University Medical Center inpatient
service
• General Otolaryngology, Head & Neck cancer, Laryngology,
Rhinology, Pediatrics, and Otology subspecialties
• Experience levels included residents from Post-Graduate
Year (PGY) 1 through PGY-5.
Participants
Mean% (Std. Dev)
Pre-Intervention Post-Intervention p-value
“I am excited to use the tablet” 1.69 1.60 0.38
“Having a tablet facilitated faster patient discharges” 2.46 2.20 0.24
“I feel that having a tablet facilitated more detailed transfer of
information during sign-out to peers” 2.54 1.70 0.04
“I feel that having a tablet facilitated faster transfer of information
during sign-out to peers” 2.54 1.80 0.03
“I feel that I now document more detail in the medical record through
the use of a tablet for EMR access” 2.77 1.89 0.02
“I feel that I am able to execute treatment plans more quickly for
inpatients now that I have a tablet” 2.08 1.78 0.23
“I feel that I am more likely to look up radiological or laboratory
studies on inpatients more often now that I have a tablet” 2.08 1.56 0.09
“I feel that I am more likely to order tests or radiological studies on
patients more often now that I have a tablet” 3.00 2.50 0.11
Mean (Std. Dev)
Pre-Intervention Post-Intervention p-value
Duration of Pre-Rounds 30.71 mins (10.35) 37.69 mins (10.33) 0.05
Duration of Formal Rounds 2:05 hours (1:23) 1:07 hours (1:07) 0.02
#of inpatients 5.64 (1.65) 4.85 (1.68) 0.11
# of consult patients 10.54 (2.15) 8.85 (2.44) 0.04
# of times rounds left to
answer clinical question 2.21 (3.72) 0.62 (1.39) 0.08
# of discharges pending in
24h period 1.57 (1.50) 1.62 (1.66) 0.47
# of discharges completed
prior to 11:00am. 0.71 (0.91) 1.00 (1.47) 0.28
Conclusions
• The utility of mobile tablet devices coupled with the
electronic medical record appeared to have both
quantitative and qualitative improvements in clinical
efficiency and education
• In the era of duty hour restrictions and higher clinical
volumes, time saved on daily rounding and in the handoff
process can be repurposed for more important clinical and
educational responsibilities
• Considering the potential benefits outlined above, we feel
that tablets should be encouraged but not mandated for
clinical and educational use