Wearables are on the rise, and increasingly sophisticated biosensing devices have hit the market in recent years. Though the evidence on the best uses of wearable devices in improving outcomes for different populations is somewhat mixed, a recent case study published in the Annals of Emergency Medicine shows that a wearable activity tracker and smartphone app assisted emergency department (ED) staff when treating a man in his 40s in the midst of a self-limited grand mal seizure.
When the man came in to the ED, the staff noticed he had on a wearable device that tracks pulse rate. From there, they used the data to determine the timing of an arrhythmia episode and choose a rhythm conversion treatment approach. Typically in this kind of situation, the physician has to go on the patient’s self-reported symptoms to determine treatment. But in this case, having the pulse rate readings helped the medical team determine a more precise diagnosis and treatment course. Unlike a medical monitor that can identify the type of arrhythmia present, the wearable device only determined the pulse rate. However, other mobile apps can determine rhythm as well as pulse.
According to the case study, this was the first known instance of an ED team being able to use the information from an activity tracker to assist in specific medical decision-making. The increased use of these devices has the potential to provide physicians with objective information that could help guide diagnosis and treatment quicker.
Related: The need for improved emergency department decision aids has garnered attention in recent months. Another development that may help emergency department professionals is improved shared decision-making tools. Although shared-decision making between physicians and patients is common in outpatient visits, where physicians can share pamphlets, interactive computer programs, or risk calculators, the ED is sometimes considered a less-conducive environment for that type of collaboration. EDs often are chaotic and fast-paced in nature. But there is increasing evidence that decision-making tools can be useful in the ED, especially in non-life threatening situations. These may include patients with acute appendicitis who may be treated with antibiotics instead of surgery, adults with chest pain who are not having a heart attack and who may opt against more extensive tests, and mild head injuries that may not require imaging.
The Society for Academic Emergency Medicine is hosting a conference in May to identify which diseases and conditions seen in the ED would benefit most from shared decision-making aids. The Mayo Clinic is also developing such aids. The Mayo Clinic’s Chest Pain Choice includes information on the diagnosis, displays a 45-day risk of heart attack, and options for care such as observation testing. Early testing has shown that patients who use the tool increased their knowledge of options and were less likely to receive cardiac testing, without putting their health at risk. The Patient Centered Outcomes Research Institute (PCORI) authorized in the ACA to improve the quality and relevance of evidence available to help health care stakeholders make informed health decisions, recently announced funding for ED decision-making aids as well.
(Source: Joshua Rudner et al, “Interrogation of patient smartphone activity tracker to assist arrhythmia management,” Annals of Emergency Medicine, April 2016; Laura Landro, “New tools help patients make tough decisions in the ER, Wall Street Journal, April 25, 2016)
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