Delirium is a common medical condition with a high prevalence in hospital settings, with rates ranging between 6 and 56 % depending on the patient population . If not recognized early, delirium leads to increased morbidity and mortality . Despite its prevalence and serious sequelae, it often goes unrecognized. Moreover, effective delirium management requires a multi-component intervention, including the use of interprofessional teams and evidence-based interventions at the point of care .
Given the need for improved delirium recognition and collaborative management, there has been an increasing focus on delirium education interventions. However, inter-professional delirium training is typically offered as a one-time educational intervention . Whilst these conventional programs might be effective in providing clinicians and healthcare professionals with increased knowledge and skills pertaining to the recognition and the treatment of delirium, prior studies have highlighted the inherent limitations of such one-time intervention . Recent studies and reviews have recommended the development of point of care practice tools that clinicians across professions could use in addition to other delirium education components . It is believed that with such tools, clinicians will be more competent in managing delirium, resulting in improved health outcomes.
One vehicle for increasing access of delirium practice tools at the point of care is E-health . The World Health organization defines E-health as the process in which health resources and healthcare are being communicated and transferred by electronic media . Over the last decade, there has been a massive advance in E-health, which has led to the creation of multiple online learning platforms for clinicians and allied healthcare professionals to stay abreast of the latest treatment algorithms and guidelines. Since 2010, there has been an accompanying advancement in M-health as well, which refers to the usage of mobile and smartphone technologies in healthcare. With the growth and advancement in M-health, smartphone are being increasingly used medical disciplines , surgical disciplines  and psychiatry . It is thus not surprising that with the introduction of smartphones, healthcare professionals are beginning to turn to smartphone applications to aid them in clinical assessment and management . Prior studies have highlighted the utility of smartphone applications as quick and interactive platforms that are time saving and allow for increased confidence and accuracy, as well as error reduction in the detection and management of various clinical conditions . By providing instant access to medical information, it is postulated that applications not only improve communication amongst staff, but help healthcare professionals in decision-making. The cumulative effect of these factors would be the reduction in the overall economic costs incurred by the healthcare organization .
A review of the current published literature using the keywords “Delirium, smartphone” revealed that there are only three studies published to date about the perception of the usefulness of a smartphone application. Zhang et al.  described the development of a delirium educational resource application that contains guideline-based information on the assessment and management of delirium. This delirium application also includes practice tools developed to assist clinicians at a Canadian healthcare institution. Initial results, based on a sample of 19 clinicians and allied healthcare professional demonstrated that there was a shift in the confidence level of the participants after they used the smartphone applications . Zhang et al.  also managed to acquire healthcare user perceptions about the application in their study. Tieges Z et al. (2015)  described the potential of a smartphone application in the objective detection of attentional issues in delirium. Sangha S et al. (2015)  highlighted how a smartphone application could potentially be helpful in terms of cognitive assessment. Whilst there are to-date only these published studies, there are a multitude of delirium related applications on the respective application stores. It would be timely if there were a scoping review or a content analysis looking into the individual features of these applications and evaluating their information quality.
There are limitations that could potentially impact the receptiveness of smartphone technology in healthcare. Baig et al. (2015)  reviewed a series of mobile healthcare applications (aside to delirium applications) and identified several limitations that could impact the receptiveness of smartphone applications in medicine. These challenges include issues related to reliability, efficiency and acceptability. Their review identified the need for smartphone applications to be user-centered in design in order for them to be more widely used and accepted. In addition, the availability of the same application on different platforms could potentially increase its use in practice. To date, most of the smartphone applications are programmed specifically for an individual platform. Other factors such as security and privacy also limit the use of smartphone applications in medical settings.
The purpose of this current study was to evaluate users’ perceptions of the utility, feasibility and effectiveness of a smartphone application for delirium care in a general surgery unit. The general surgery unit was selected due to its high prevalence of delirium and the unit’s prior exposure to an inter-professional delirium training program . In particular, we aimed to elucidate the potential challenges with implementing this application. Our study used qualitative methods to explore the following research questions:
What are the perspectives of healthcare professionals regarding the implementation and availability of a delirium educational smartphone application?
What are some of the key challenges and limitations with regard to the implementation and utilization of such a smartphone application for clinical care?