Evaluating the Impact of Smartphones on Nursing Workflow: Lessons Learned.

ABSTRACT: Although smartphone use in the workplace by physicians has been well documented, such use by nurses warrants further examination. In particular, there is a lack of research regarding the effects of smartphone use on nursing efficiency and workflow satisfaction. Our organization developed a pilot program to introduce the use of hospital-issued smartphones by direct care nurses in the pediatric ICU (PICU) and a satellite ED and created an implementation team to carry this out. Our research team thought it important to measure and evaluate nursing efficiency and workflow both before and after these phones were issued. The original plan included three primary measures: pre- and postimplementation surveys (both units), time-on-task studies (both units), and interruption observations (PICU only). Because of technical difficulties, the PICU pilot arm was abandoned after the smartphones were introduced. The ED arm completed the postimplementation time-on-task studies and the postimplementation survey nine months after implementation. The postimplementation survey results showed that nurses preferred other methods of communication over smartphones, and smartphones were scored lower than all other forms of communication for ease of integration into the workflow. Time-on-task results indicated texting was faster with smartphones than it was when using T9 texting (predictive texting) with the wireless Ascom phones in the PICU. Making calls with the smartphone took ED nurses significantly longer, and many preferred their traditional communication methods. Further research is needed to determine whether smartphones can be optimized to enhance nursing workflow, increase efficiency, and improve patient outcomes. This article provides vital information for nurses and others considering a transition to the use of smartphones or similar devices in the workplace.

Utilization of Acupuncture Services in the Emergency Department Setting: A Quality Improvement Study.

PURPOSE: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management. METHODS: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered acupuncture services based on their emergency severity index (ESI; range: highest severity [1] - lowest severity [5]), reason for visit, and physician approval. Paired t-tests were used to examine mean differences between pre- and post-acupuncture pain, stress, anxiety, and nausea scores (range: none [0] - worst [10]). Multivariable regression models also were constructed. RESULTS: A total of 379 patients received acupuncture. Patients presented predominately with an ESI score of 3 (68.9%) or 4 (24.8%); 46.4% received opioids in the ED. Mean pre- and post-acupuncture pain scores significantly differed (6.5 vs 3.4; P<0.001); receiving opioids during the ED visit was not associated with improved pain scores (P=0.948). Stress (5.7 vs 1.9), anxiety (4.8 vs 1.6), and nausea (1.6 vs 0.6) scores also improved (P<0.001) following acupuncture. CONCLUSIONS: Emergency department acupuncture significantly decreased pain, stress, anxiety, and nausea. Our findings support a larger randomized controlled trial to further assesses the impact of acupuncture for acute pain in other ED settings.