We have read with interest several recent letters to Anaesthesia concerning the clinical applications of smartphones [1, 2], and agree that the potential for future innovation using this technology is considerable. In February 2010, we conducted a national, online questionnaire survey of anaesthetists to quantify iPhone usage (Apple Inc., Cupertino, CA, USA), assess application (app) use and identify future areas for anaesthesia-specific app innovation.
We received 918 responses, of whom 59% owned an iPhone (50% consultants, 41% trainees and 9% non-consultant career grades). Of the iPhone users, medical apps had been used by 80%, with 60% finding anaesthesia-specific apps useful for clinical practice and 47% for educational purposes. Medical calculators were the most frequently used category of app. Respondents also stated that (inexpensive) country-specific apps could be developed, particularly Royal College compliant logbooks, and the Royal College of Anaesthetists/Association of Anaesthetists of Great Britain and Ireland should consider developing apps. There remains difficulty in accessing apps due to existing hospital telecommunication policies.
The number of respondents represents only 8% of anaesthetists working in England and those responding were likely to be a self-selecting group of technology-aware anaesthetists; however, anecdotally we feel that smartphone usage is widespread among anaesthetists, leading one respondent to comment that ‘surgeons find iPhones very useful, because they come with an anaesthetist attached’.
Smartphone technology is changing the way that medicine is learnt and practised in the developed world, with users becoming increasingly more likely to access convenient, regularly updated, web-based literature than refer to hard copies of books or journals . Anaesthetists use apps to access material difficult to use or unavailable in hard copy form, such as medical calculators, logbooks, resuscitation algorithms and demonstration videos. Compatible apps exist for other proprietary operating systems (Table 2).
|App name||Description||Cost of download; £|
|iGasLog (iMobileMedic, Swindon, UK)||Anaesthetic logbook||17.99|
|iResus (iMobileMedic, Swindon, UK) ||Up-to-date resuscitation, provided by Resuscitation Council (UK)||Free|
|MedCalc (MedCalc Software bvba, Mariakerke, Belgium||Medical calculator||Free (Pro version 4.99)|
|Epocrates (Epocrates, Inc.San Mateo, CA, USA)||US drug reference resource||Free|
|Oxford Handbook of Anaesthesia (2nd edn) (Medhand International ab at http://www.medhand.com/index.php?site=drc&width=1676&height=817&||Concise clinical guide to anaesthesia from popular Oxford Handbook series||34.99|
|AirStrip Technologies||Remote patient monitoring (conditional)||Free|
|SonoAccess (SonoSite Inc., Bothell, WA, USA)||Interactive ultrasound learning resource from SonoSite||Free|
|Paeds ED (iED Ltd at http://iedapps.com/)||Age/weight/situation-specific paediatric drug and dosage calculator||1.19|
|ECG Guide (QxMD software at http://www.qxmd.com/company/contact)||Teaching guide to ECG interpretation + examples||0.59|
Possibly of the greatest interest to anaesthetists is the potential for innovative developments in patient care and monitoring, using what are effectively very powerful mobile computers. The potential for tele-consultation, together with remote monitoring, has been reported in anaesthetic practice . Anaesthetists have also used smartphones to reduce anxiety during the inhalational induction of anaesthesia in children , and assess depth of sedation by using two-choice visual reaction time testing . In future, apps similar to AirStrip (AirStrip Technologies, San Antonio, TX, USA) may facilitate basic monitoring and real-time parameter analysis, including in remote locations or during emergencies .
We would encourage future entrepreneurial app development by anaesthetists and professional bodies, with the aim of improving the patient experience, patient safety and medical education.