App-Driven Care for Parents of Children Undergoing Surgery

When parents take their children home after surgery, certain symptoms — such as fevers or a lot of pain — may worry them enough to call their doctor in the middle of the night.

While families are usually sent home with paper instructions that address many of the most common concerns and questions, the format often is not easily searchable or tailored to them.

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But having the same information at their fingertips through a smartphone app may be a valuable alternative, a small pilot study finds.

Most parents and caregivers found an app designed for post-surgery care after a tonsillectomy more helpful than paper handouts, according to the findings published in JAMA Otolaryngology-Head & Neck Surgery.

The app, developed by a pediatric otolaryngology team at University of Michigan's C.S. Mott Children's Hospital and the U-M Medical School, provides simple instructions for care and guides families after children have their tonsils removed. The app takes parents through step-by-step instructions after they type in a specific question or symptom, such as persistent pain, fevers or earaches.

"Very helpful"

The Michigan Medicine study, which involved 117 families, found that the app was associated with fewer parents calling the clinic with questions. A greater proportion of parents graded the smartphone app as "very helpful" and "very easy to use" compared with paper instructions.

"Based on the phone calls we were getting from families, it was obvious that we needed to do a better job of providing them with information they needed to take care of their children after surgery," says lead author Ahmed Ali, a Michigan Medicine resident.

"Our patients have come to rely on smart devices as an integral part of their lives, and health care delivery should be offered through this venue as well."

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Of the 64 families who participated in the first phase of the study involving paper instructions after surgery, 20 (31 percent) called the clinic to discuss their child's post-operative care. Their calls were most commonly related to pain control and challenges getting children to take medication.

Of the 53 families who participated in the second phase of the study, 36 (68 percent) used the app and 32 of those families (89 percent) preferred using the app over traditional paper instructions. The simplicity of the app's format, helpfulness of photographs (such as what the back of a throat typically should look like after surgery) and easy access to instructions were cited as top advantages.

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Seven families who used the smartphone app called the clinic with questions or concerns. Among the 17 families who did not use the app, 10 forgot to download, four did not follow instructions, and three did not download for miscellaneous reasons.

"Most families seemed to favor a smartphone platform for relaying post-operative instructions and used it more frequently because of ease and helpfulness. This format allows families to receive personalized information from providers they trust," Ali says.

"Smartphone-based communication should be offered routinely to patients as part of instructions from their health care team," he says.

Future of post-operative care

Because of the prototype's success and positive feedback from parents, the authors hope to expand the app's functionality.

In the future, "smart" post-operative instructions ideally would be tailored to a person's post-operative experience based on data entered by patients and families during recovery, the authors say. For example, the app might be able to provide reminders for medication timing or other post-operative wound care measures.

"We hope to utilize the technology to not only provide and process information but guide patient recovery," Ali says.

Evolving typical routines and using technology to communicate with patients may be especially important in the post-operative care setting, the team says. An increasing number of surgical procedures are transitioning from inpatient to outpatient, providing less time for direct care from health professionals.

"The ways our patients and families obtain information have changed dramatically, yet we continue to rely solely on physical, printed material and verbal instructions regarding post-surgery care," says study senior author Marc Thorne, M.D., pediatric otolaryngologist at Mott.

"Application-driven materials allow us to provide patients with the information they need in the palm of their hand," Thorne says. "As we continue to study and build upon this type of technology, we'll be able to further enhance the quality of the patient's recovery following surgical procedures."

The app is currently available through iTunes and Google Play. Because of the prototype's success and positive feedback from parents, the authors hope to expand the app's functionality.