ORIGINAL

Educational apps to support patient safety in hospitals: a technology perspective

Léia Arcanjo Mendes1, Clarissa Costa Antunes1, Thais Favero Alves1, Bruna Figueiredo Manzo1

1Federal University of de Minas Gerais, Belo Horizonte, MG, Brazil

ABSTRACT

Objective: To examine mobile applications developed to guide healthcare professionals, patients, and their caregivers regarding patient safety interventions in the context of hospitalization. Methods: A technological prospection was conducted in the virtual stores App Store and Google Play and through the Google search tool. Inclusion criteria included applications focused on patient safety in the context of hospitalization without temporal limitations. Results: 25 applications were included in the study and analyzed. The Most applications were mobile, developed in English, and focused on healthcare professionals. In addition, they had limitations and weaknesses related to design and playful features. Conclusions: The study may contribute to developing of new patient safety education applications that promote increased engagement in error prevention interventions.

Descriptors: Patient Safety; Health Education; Mobile Apps.

INTRODUCTION

Patient safety (PS) is the reduction to an acceptable minimum of the risk of preventable harm associated with healthcare(1). Adverse events (AEs), on the other hand, are failures associated with healthcare that result in patient harm or even death, most of which are preventable(1). These events affect the patient's health status, resulting in longer hospital stays, increased morbidity and mortality, and higher healthcare costs(2).

The responsibility for PS lies with all parties involved in healthcare(3), and patient- and family-centered care is an important strategy for preventing AEs and thereby improving PS(4). Furthermore, this care involves a partnership between healthcare professionals, patients, and their caregivers in healthcare interventions, including participation in care practices and decision-making(4).

For this partnership to occur and for this strategy to be successful, healthcare professionals must provide educational interventions for patients and their caregivers(5). However, patient education is often neglected by healthcare professionals(6). Therefore, it is important to educate healthcare professionals about the importance of and ways to educate patients and their caregivers(3).

Health education effectively involves patients, families, and professionals in the care process(3). In addition, communication and health education have gained prominence as caregivers increasingly seek information about health care and the patient’s clinical situation(7). Improved health communication fosters respectful and trusting relationships between professionals and patients/caregivers, patient engagement in care(7), reduced stress and length of hospital stay, and prevention of adverse events (AEs)(8).

Educational interventions can be conducted digitally, promoting flexible and accessible knowledge(9). The field associated with using and developing digital technologies is known as digital health(10). This field aims to improve the healthcare context, increase access to information, and influence improvements in professional routines and the safety of patient care(10).

Digital health includes using information and communication technologies(10), such as mobile applications and web applications. Mobile applications are software available on mobile devices such as smartphones and tablets, while web applications are designed to run within Internet browsers, eliminating the need for software installation(12).

In the healthcare context, both mobile applications and web applications can support decision-making, clinical tracking, and education, benefiting patients, their caregivers, and healthcare professionals at any time and from any location(11).

Thus, mobile applications can contribute to educational support for PS, benefiting healthcare professionals, patients, and their caregivers. Considering the potential of mobile applications for PS and the existing knowledge gap regarding the available applications in virtual stores, it is important to understand the existence of this technology. This can lead to improving and refining its use while highlighting gaps or limitations in the field.

Therefore, this study aims to investigate mobile applications developed to guide professionals, patients, and their caregivers regarding patient safety actions in the context of hospitalization.

METHOD

It is a technological prospection to explore emerging technologies and identify discoveries and developments related to a specific topic(13). Therefore, this research was conducted by the following steps: 1) defining the research questions and objectives of the search; 2) establishing inclusion and exclusion criteria; 3) defining search strategies; 4) searching virtual stores and the Google search tool; 5) selecting applications; categorizing the results; 6) analyzing the data; 7) presenting the results; 8) concluding and reflecting on the implications of the data analysis(14). In addition, the standards proposed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) were followed(15).

As a first step, the following research questions were formulated based on the study objective What are the applications developed to guide patient caregivers in patient safety actions in the context of hospitalization? What are the applications developed to guide healthcare professionals on patient safety actions in the context of hospitalization? Based on this, the following inclusion criteria were established: mobile applications and web applications focused on patient safety in the context of hospitalization, without a time limit; developed to educate patients and their caregivers or healthcare professionals; available on iOS and/or Android systems and/or websites. Exclusion criteria included: applications in languages other than Portuguese, English, and Spanish; those not related to the topic; repeated on the same platform; or with a purpose other than education.

The search for applications was conducted in April 2022 in the virtual stores App Store and Google Play, using two personal smartphones of the researchers, and the Google search tool using two personal computers of the researchers. The following terms were used in the search: Patient Safety; Seguridad del Paciente; Health Education; Educación en Salud; Patient Education and Safety; Jogo Online para Segurança do Paciente; Aplicativo para Segurança do Paciente; Jogos para prevenção de Erros de Saúde. The applications were selected independently by two researchers, with disagreements analyzed by a third researcher.

For the organization and analysis of the results, the selected applications were categorized into figures using Microsoft Excel format, including information such as technology name, availability location, original language, category, acquisition type (free or paid), features, user ratings, and current version. The data underwent a comparative qualitative analysis to identify the features developed, their potential, and limitations for use in the hospital context. The analysis was based on primary literature studies related to the study context. Descriptive strategies and figures were used for the final presentation of the results. This prospective study is part of a larger project with the primary goal of developing a mobile application for pediatric patient safety.

The project is based on Resolution 510/2016 and was submitted and approved by the Research Ethics Committee (RES), receiving the number CAAE: 55983222.9.3001.5129. The protocol containing the methodology used in this prospection was evaluated and validated by experts in health technologies and is registered on the Open Science Framework (OSF) platform with the DOI identifier 10.17605/OSF.IO/PJBGN.

RESULTS

The searches identified 14,570 apps in the online stores and the Google search tool. The steps outlined in the research protocol were then carried out as follows: analysis of the app title to verify compliance with the research questions and the inclusion and exclusion criteria; evaluation of the app characteristics. In this process, 20 mobile apps and 05 web apps were selected for further analysis, including full reading of the descriptions and analysis of their eligibility. From this evaluation, 25 different apps were included in the study, as shown in Figure 1.

Source: PRISMA-ScR flowchart adapted from Tricco et al., 2018.

Figure 1 – Flowchart of the application selection stages. Belo Horizonte, MG, Brazil, 2022

The applications were described by name, store where they were available, language, store category, acquisition mode, features, user ratings, and current version, as shown in Figures 2, 3, and 4.

Figure 2 - Characterization of applications included as guidance for health professionals in Technological Foresight. Belo Horizonte, MG, Brazil, 2022

Figure 3 - Characterization of the applications included as guidance to patients and their companions in the Technological Prospecting. Belo Horizonte, MG, Brazil, 2022

Figure 4 - Characterization of the applications included as guidance for patients and their companions and health professionals in the Technological Prospecting. Belo Horizonte, MG, Brazil, 2022

It is important to highlight that in the present study sample, there are 07 applications available in both virtual stores. Thus, the overall analysis of the applications was performed by quantifying them as a single occurrence for comparative qualitative analysis, resulting in a total of 25 applications. Only in the analysis of the release year of the applications these 07 applications were not considered duplicates, since 02 of them were launched in different years in the Apple Store and Google Play. Therefore, in the analysis of the year of release, the applications were considered separately, resulting in a final total of 32. The analysis of the applications available on the App Store platform considered the year of release of the first version, except for 03 applications that did not provide this information. The applications from the Google search tool did not contain any information about the year of release. As a result, 03 (9.37%) applications released between 2010 and 2013 were observed, 06 (18.75%) between 2014 and 2017, and finally 15 (46.87%) between 2018 and 2021.

Of the 25 applications analyzed, 16 (64%) are aimed at guiding healthcare professionals (Figure 2), while 06 (24%) are aimed at patient caregivers (Figure 3) and 03 (12%) have content for both (Figure 4). Considering only the 20 applications found in the virtual stores, 10 (50%) were present only on the Google Play platform, 03 (15%) were found only on the Apple Store, and 07 (35%) were available on both platforms.

It was observed that the majority of applications are based on English as their primary language, with 12 (48%) applications in this category, while 10 (40%) are presented in Portuguese and 03 (12%) in Spanish. In addition, it was found that 05 (20%) applications did not have rating and size fields, and 06 (24%) applications did not include information about the current version.

Among the selected applications, 02 (08%) were specifically designed for specific areas of care, one for professionals working in pediatrics and the other for neonatology.

Regarding the acquisition model, 20 (80%) applications were provided free of charge, while 05 (20%) were available for purchase.

Regarding the format of the applications, it was observed that 10 (40%) were games, of which 07 (28%) were aimed at health professionals, 01 (4%) at patients and their caregivers, and 02 (8%) were aimed at both audiences, health professionals and patients with their caregivers.

During the observation of the applications, 03 similar applications were identified, namely “Health Safety & Patient Care”, “Patient Care & Health Safety”, and “Patient Care Health Safety Flash Cards”. Finally, when analyzing all the selected applications, it was found that most of them had design limitations and lacked audiovisual resources and playful features.

DISCUSSION

The conducted technological prospection has allowed the identification of applications developed with the purpose of providing support for healthcare professionals, patients, and their caregivers to play an active role in patient safety actions and the prevention of Adverse Events (AEs). It is noteworthy that patient caregivers, when properly oriented and empowered, play a crucial role in preventing health risks for patients(16). Supporting this notion, research highlights the lack of dissemination and guidance on safe care for patients and their families, recommending the adoption of mobile applications as tools to promote greater integration between healthcare professionals and patients, emphasizing the importance of co-participatory health care(17). However, it is relevant to emphasize that few healthcare institutions invest in developing educational actions for patient caregivers(16). Thus, the results of this study reveal that the majority of applications were developed for healthcare professionals, indicating the need to create applications as educational tools intended for patient caregivers.

Mobile applications provide access to a wide range of information that can be useful during healthcare professionals’ clinical practice, serving as a reference tool(18) or educational facilitators(19). The scientific literature highlights the benefits of this technology, such as increased safety in medication administration, improved care management, AE reporting, enhanced communication, and error prevention barrier systems(20). However, despite being available, having supporting evidence, and being recommended in the literature, this tool is not yet widely adopted in practice by healthcare professionals(20). This disconnect between what is prescribed and what is implemented reveals the need for professionals to embrace health technologies more fully(20), from the development phase to the use of these tools in support of safe care.

How healthcare professionals deal with technologies can impact the achievement of the objectives of these tools, such as the quality of healthcare(21). On some occasions, it is possible to observe that professionals focus more on using equipment related to diagnosis and treatment while underestimating the importance of listening and dialogue(21). Therefore, it is suggested that applications be used as a support for healthcare professionals in the development of educational activities. This reinforces the importance of combining the use of applications with personal interactions, which are considered lightweight technologies(21) and play a crucial role in the success of health care promotion practices.

When used in complementary ways by patients and their caregivers, applications have shown positive results in reducing health risks and improving care quality(22). Furthermore, they facilitate information exchange, increased knowledge, and engagement of patients and their caregivers in healthcare(23). However, for this to happen, it is essential that the information provided by these tools be evidence-based(24).

Validation is closely related to the quality and accuracy of the data and its closeness to reality(25), as it is based on scientific evidence. Therefore, an important highlight of the results of this study was the lack of information on the content and clinical validation of the applications, which may compromise the quality and usefulness of these tools(25). The lack of information on the validation process of the applications analyzed limits the features that determine their quality, which affects the accuracy of the information and the usability of the tool.

The study also shows an increase in the number of applications available in the last 4 years compared to the last 12 years, indicating a growing availability and adoption of digital tools. In addition, English is the predominant language in the selected applications, which is consistent with findings from other studies(22,26). These data suggest the need to develop applications in Portuguese, as the use of mobile applications has increased in Brazil in recent years, similar to the international scenario(11).

The updating of applications available on different platforms is a current concern(27), as it optimizes the usefulness of the tool. Mobile application stores generally provide tools that allow for quick updates(27). However, as pointed out in this study, some applications do not provide information about their updates(28), which can affect the user experience and raise questions about the reliability of the data.

Regarding the availability of applications to the public, the main virtual stores are Google Play and the Apple Store(29), a result similar to that found in this study. However, it should be noted that making applications available in these stores requires specific programming for each platform, and this process is more complex than making web applications available, which work on different platforms and devices, are easier to manage, and do not require space to download(12). The scientific literature also points to efforts to develop web applications(12).

In this study, it was possible to identify applications with different names but similar characteristics. In addition, the presence of applications with limited interactivity, limited design, and limited functionalities was noted. This finding is in line with another study that also identified limitations in the availability of information(28), suggesting that these applications may be in the early stages of development(28), which affects the user experience. An application must provide an appropriate level of detail and animation to stimulate and familiarize users. In addition, a well-designed application contributes to advances in scientific knowledge, social innovation, economics, and public policy, which in turn improve the quality of life of the population(30).

Game-based applications represented the largest proportion of the types analyzed and are characterized as interactive and motivational resources for users(31). In the healthcare context, this approach has shown positive results(31), including increased knowledge, greater adherence to suggested actions(32), and stress reduction(33). In addition, games have shown superior results compared to traditional teaching methods(34).

In the digital environment, the user experience is crucial, as it is essential to consider the needs and realities of the users(35). Therefore, it is important to establish a design and functionalities that appeal to the users’ senses(35), as familiarity and comfort are crucial factors to consider(23). Analyzing the results of this study, a minority of applications have been developed for specific care scenarios, highlighting the need for applications aimed at specific audiences, given the different characteristics of each group.

It is important to note that the present study has limitations related to the scarcity of information available on the app distribution platforms, as this information may be incomplete.

CONCLUSION

There was a lack of applications developed to address PS, particularly with a focus on patients and their families. Within the selected applications, it was found that the majority were available on virtual storefronts and targeted at healthcare professionals, with content predominantly in English and covering different healthcare areas. This analysis highlights the need to develop accessible and interactive patient safety applications for patients and their caregivers, considering the specificities of each care setting.

Therefore, the present study can provide valuable insights for strategic decisions related to healthcare and the development of new applications. This will make a significant contribution to patient safety education, promoting engagement in preventive measures and improving the quality of care for patients and their families.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

FUNDING

This paper was carried out with the support of the National Council for Scientific and Technological Development (CNPq). Process No. 403078/2021-0.  

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Submission: 01/14/2023

Approved: 08/07/2023