Quantitative evaluation of patients' digital capability evaluated in an emergency department setting: a cross-sectional study

OBJECTIVES: The main aim of the study was (1) to assess digital literacy among acutely admitted patients in an ED, (2) to provide quantitative data relating to the 'inverse information law'. We hypothesised that a large proportion of acutely admitted patients are digitally incapable, and there is a link between age, frailty, hospital admittances and digital incapability.

DESIGN: This study is a single-centre, cross-sectional, prospective case-controlled questionnaire study. Clinical Frailty Scale (CFS), gender and age were collected from the patients' electronic medical reports. Information regarding smartphone usage, ability to access public mail/communication, educational level, living situation and number of admittances the last year were patient-reported bedside. Subsequently, ability to use a digital platform was tested.

SETTING: A secondary care ED in Denmark, with a high level of broadband penetration, allows easy digital access.

PARTICIPANTS: A total of 588 patients were assessed for eligibility, hereof 468 patients were included. Inclusion criteria were age above 18 years, admitted for treatment of an internal medicine or surgical problem, triaged non-emergent in a stable condition, informed oral and written consent.

MAIN OUTCOME MEASURES: The proportions of acutely admitted patients who were digitally capable versus incapable whether there is a link between age, frailty, hospital admittances and digital incapability.

RESULTS: Among patients included, 57% (n=265) had high digital literacy, while 43% (n=203) had low literacy Δ%=14. The high digital capability group was significantly younger by 23% (15.3, 20.5) p<0.001 and had lower CFS than the low digital capability group 2.3 versus 4.2 (1.7, 2.3) p<0.001. The low digital capability group had 1.6-fold more admittances the previous year (0.5, 1.2) p<0.001.

CONCLUSIONS: The proportion of digitally illiterate patients is high (43%), and they are older, frailer and have more hospital admittances and less high education than digitally literate patients. There is a significant digital divide that needs to be considered in health care.