Mobile device ownership among emergency department patients.

BACKGROUND: The landscape of mobile devices is changing and their present use by patients for healthcare purposes is unknown. An understanding of current attitudes and usage may help increase patient engagement through mobile applications. This study sought to determine characteristics of mobile device ownership among Emergency Department patients, patients' feelings regarding their use in healthcare, and desired functionality in mobile applications. METHODS: A cross-sectional survey was undertaken at a single urban tertiary care academic center. A convenience sample of adult English-speaking patients in the Emergency Department were surveyed from June 21 st, 2017 to December 30th, 2017. A secondary analysis of the data was performed based on demographic and socioeconomic factors. RESULTS: 260 patients were approached for participation, 11 patients declined, and one patient was excluded. The 248 participants had a median age of 49 (interquartile range 28-62) and 54% were female. 91% of those surveyed own smartphones, 58% owned tablets, and 77% of these patients were comfortable using mobile devices. Those without mobile devices were older (p < 0.001) and held less commercial insurance (p = 0.01). A majority of patients were interested in using applications to enter information, track their visit, view results, and communicate with providers during their visit. Following care, there is interest in viewing information about their visit and receiving reminders for appointments and medications. Patients are also interested in using applications for learning about medical conditions and managing medications. Though there are mixed feelings regarding the protection of privacy by apps, they are felt to be safe, effective, useful, and not difficult to use. CONCLUSION: Ownership of smartphones is high across the Emergency Department population and patients are enthusiastic about using mobile devices as part of their care. Further study can elucidate opportunities to further integrate mobile device applications into patient care.

Anesthetist-Directed Sedation Favors Success of Advanced Endoscopic Procedures.

OBJECTIVES: Sedation is required to perform endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) given the duration and complexity of these advanced procedures. Sedation options include anesthetist-directed sedation (ADS) vs. gastroenterologist-directed sedation (GDS). Although ADS has been shown to shorten induction and recovery times, it is not established whether it impacts likelihood of procedure completion. Our aim was to assess whether ADS impacts the success of advanced endoscopy procedures. METHODS: We prospectively assessed the sedation strategy for patients undergoing ERCP and EUS between October 2010 and October 2013. Although assignment to ADS vs. GDS was not randomized, it was determined by day of the week. A sensitivity analysis using propensity score matching was used to model a randomized trial. The main outcome, procedure failure, was defined as an inability to satisfactorily complete the ERCP or EUS such that an additional endoscopic, radiographic, or surgical procedure was required. Failure was further categorized as failure due to inadequate sedation vs. technical problems. RESULTS: During the 3-year study period, 60% of the 1,171 procedures were carried out with GDS and 40% were carried out with ADS. Failed procedures occurred in 13.0% of GDS cases compared with 8.9% of ADS procedures (multivariate odds ratio (OR): 2.4 (95% confidence interval (CI): 1.5-3.6)).This was driven by a higher rate of sedation failures in the GDS group, 7.0%, than in the ADS group, 1.3% (multivariate OR: 7.8 (95% CI: 3.3-18.8)). There was no difference in technical success between the GDS and ADS groups (multivariate OR: 1.2 (95% CI: 0.7-1.9)). We were able to match 417 GDS cases to 417 ADS cases based on procedure type, indication, and propensity score. Analysis of the propensity score-matched patients confirmed our findings of increased sedation failure (multivariate OR: 8.9 (95% CI: 2.5-32.1)) but not technical failure (multivariate OR: 1.2 (0.7-2.2)) in GDS compared with ADS procedures. Adverse events of sedation were rare in both groups. Failed ERCP in the GDS group resulted in a total of 93 additional days of hospitalization. We estimate that $67,891 would have been saved if ADS had been used for all ERCP procedures. No statistically significant difference in EUS success was identified, although this sub-analysis was limited by sample size. CONCLUSION: ADS improves the success of advanced endoscopic procedures. Its routine use may increase the quality and efficiency of these services.