Support in everyday hospital life: Optimally networked via app for the operating theatre


Standard Operating Procedures, SOP for short, increase patient safety. However, when you need them most, they are often not at hand. The Cayoo app provides a remedy. With it, all SOPs of a hospital can be viewed by all employees at any time. At the same time, the app also networks the hospitals with each other.

As a newcomer, it is often not easy in the operating theatre. Sachariy Mark, OTA at the Diakoneo Diak hospital in Schwäbisch Hall, knows this from experience. There are around 400 to 500 surgical procedures at his hospital, almost all of which require different positioning, preparations and equipment. "When I started working, I immediately noticed how many OR nurses and OTAs carried around a notebook in their coat pockets. In it, they noted down special features of the individual operations," Mark says. For him, it's no wonder - even good theatre nurses and OTAs usually need 3 to 4 years until they are really trained. As part of his vocational education studies, the dedicated OTA therefore advocated for the introduction of the Cayoo app in his department at the beginning of 2019.


In a few clicks to SOP

Cayoo stands for SOP Healthcare Information Assistant. With this app, doctors and other healthcare professionals have access to all the hospital's standard operating procedures in just a few clicks. For example, they can use it to find out about the standard procedure for almost all operations - from aortic aneurysm to diaphragmatic hernia. "For a hip TEP with a dorsal approach, for example, I can look up which trays, implants, disposables and positioning aids I need," Mark explains, "that's a huge relief given the large number of different operations."

The app has already been established in the anaesthesia department of the Diakoneo Diak hospital in Schwäbisch Hall for about four years. Jan Dreßler, a healthcare and nursing assistant, had tested it for his department. "The young colleagues in particular find the digital support very helpful," reports Dreßler. He sees the advantage of the app above all in the fact that all anaesthesia nurses are always up to date - whether they are new employees, part-time staff or participants in the advanced training in intensive care and anaesthesia. "Most of them already open the app in the morning when they know which operations they are responsible for," says Dreßler. Only then do they prepare the anaesthesia site for the next operation, place the peripheral vein access and set up the materials for the anaesthesia, sometimes also for a central venous access.

Dreßler particularly appreciates the app's ability to integrate multimedia content: All devices relevant to anaesthesia are listed, mostly with photos and videos. If you haven't used a device for a while, for example the cell saver, you can use the app to read through the operating instructions or quickly watch a video - after all, some devices are only used every one or two months. The app can be accessed via PC and smartphone app.


More safety through SOP

Standard Operation Procedures, or SOP for short, means standard procedures. They are mainly used in areas that are associated with a high safety risk, such as the pharmaceutical industry, aviation or the military. A standardised procedure is intended to realise the highest possible safety standard. In aviation, they have been in place for decades. "The SOPs are available electronically in the cockpit at any time in the form of checklists," reports Lufthansa pilot Boris Braun, one of the developers of the Cayoo app. "They are updated regularly and are binding for all employees." German hospitals are still a long way from such a high level of standardisation as in aviation. "SOPs are an increasingly important part of quality management," says Reiner Wäschle, senior physician at the Department of Anaesthesiology at Göttingen University Medical Centre, "but not all hospitals have established them yet." Yet they are an important instrument for quality of care and patient safety, especially in the operating theatre, which is one of the high-risk and high-cost areas of a hospital.

The Department of Anaesthesiology at the University Medical Center Göttingen (UMG) was also the starting point for the Cayoo app. Here, the decision was made as early as 2009 to set down frequently recurring and risky procedures in writing in the form of SOPs. For this purpose, PDFs were first created, which were then sent to every staff member by email and kept in a folder in the central operating theatre for everyone to access. "However, this procedure had a decisive disadvantage," says Sebastian Riech, an anaesthetist and senior physician at UMG. "The PDF were never where you needed them at the time and rarely up to date." A young resident, Benjamin Braun, gave the senior physician the crucial idea: "We need an app that we can access at any time, even without the internet."


First app for SOP in Germany

Thus the idea for the first SOP app in Germany was born, and was realised - in cooperation with Riech, a senior physician in Göttingen - by the company Portamedia. In March 2013, the app was published for the first time and made available to all employees of the UMG. Shortly afterwards, the app was further developed - in the form of a combined app and web-based SOP management system. "This allows the SOPs to be created directly on the online platform, go through a 4-eyes principle and are automatically available to all users once they have been approved," explains Riech. At the same time, all those involved are informed of the update via a push message. The University Medical Center Göttingen (UMG) has already been working with the app for eight years - to the satisfaction of the staff, as an internal survey revealed. The employees were particularly positive about the constant availability, stability and ease of use. The majority of respondents used the app once a week to several times a day. Almost all employees preferred the digital to the paper-based form - no matter how experienced the employees were. "However, it depends on the level of experience how often the app is used," says senior physician Wäschle. Young and new staff in particular benefited from the app.

This was also the case for anaesthetist Anna Braig, who works at the Marienhospital in Stuttgart. She can still remember her time as an assistant doctor. In the evening, the operating schedule for the next day came out and with it the exciting question: Which operations am I assigned to? What do I have to be prepared for? "During the familiarisation period I always had a colleague by my side, but after that I was soon on my own," says the 34-year-old. This situation is typical for anaesthesia, she says: "Here you have to work very independently very early on, and in an area that is potentially threatening." At the Marienhospital, the Cayoo app had been in use for some time at that time. "In the beginning, I used the app almost every day," the anaesthetist recalls. "Back then, I spent many evenings preparing and reading up on upcoming operations." She says the app was a great help - with short, concise information that was always up to the latest professional standards.


Hospitals can use the SOP of other hospitals

Currently, ten hospitals in Germany are working with Cayoo. To support the transfer of knowledge between clinics, the app offers a special function - sharing and migration. This means that clinics can share their SOP and other clinics can revise this content for their own purposes. Each clinic can decide for itself whether and which SOP it makes available to others (sharing). Clinics that have not yet developed any or only a few SOPs can take over this shared content (migration) and adapt it to their needs. Adaptations may be necessary, for example, if other devices or drugs are used. In addition, guidelines of medical societies or instructions for use of medical devices can be included in the app.

A particular advantage of the Sharing and Migration function is that it is permanently updated. This means that when a shared content is taken over by a clinic, adapted and distributed in the clinic, it remains linked to the original SOP in the background. If this original SOP is now changed, all clinics that have migrated the SOP are notified. The shared data are also absolutely legally secure, confirms Stefan Fischer of SOPHIA GmbH. If a clinic decides to share its SOP, the adopting clinic is obliged to check and adapt the SOP and release it for its own use. Clinics that share their SOP are thus legally on the safe side.

Even though it all started with SOP, Cayoo is now used in many other areas, says Fischer. It is more about providing users with the right information, at the right time, in the right place - simply. This is particularly advantageous in situations such as the Corona pandemic, where information has to be passed on quickly. For example, if clinic 1 publishes information on the ventilation of a Covid 19 patient and shares it with other clinics via the app, clinic 2 can take over this content (migration) and adapt it for its own clinic. In the next step, clinic 2 can then pass on the information internally via the app. "You don't have to keep reinventing the wheel," says Fischer.


Digital app with a future

A year and a half ago, the app made a significant leap forward. The German pharmaceutical and medical supplies company B. Braun Melsungen AG became aware of the app and got into talks with Cayoo's developers. In March 2019, a joint venture was established, a corporate cooperation in which B. Braun and Portamedia became equal partners: the SOPHIA GmbH. Prior to this, the entire platform, consisting of the web user interface and app, was optimised as best as possible for user-friendliness and functionality and equipped with a modern, very appealing design.

Cayoo is optimised for institutional use. The price depends on the number of people and is around 5 euros per user and month. Since 2020, international sales have also started, reports Fischer, who initiated the cooperation with Portamedia for B. Braun Melsungen AG. There are already projects with Switzerland, Austria, Great Britain and Saudi Arabia.

At the Diakoneo Diak hospital in Schwäbisch Hall, the app has also been expanded. "At the moment, the operating theatre and anaesthesia nurses as well as the anaesthetists are working with the app," says Sachariy Mark. "The intensive care units were added at the beginning of 2020." Surgeons are also now very interested in working with the app, he says. Mark sees the advantages mainly in the much shorter training period and more efficient way of working. "In the past, you often had to search for a long time or ask around. Now you can find all the relevant information bundled directly in the app. That saves an enormous amount of time and can save lives under certain circumstances," says Mark, who works in trauma surgery in addition to his studies. Despite his several years of professional experience, he also benefits from the tool: "I like to use the app for checking. First I set up the operating theatre and then check with the app whether I have thought of everything.


Functions of Cayoo at a glance

  1. Mit der App können Kliniken ihren Mitarbeitern eine eigene SOP-Bibliothek zur Verfügung stellen.
  2. Die Erstellung einer SOP erfolgt mit wenigen Klicks; alle SOP werden in einem 4-Augen-Prinzip freigegeben.
  3. Über Push-Nachrichten werden die Teammitglieder über neue/aktualisierte SOP sowie externe Inhalte informiert und damit verlinkt.
  4. Die SOP können multimedial unterstützt werden. Dies erfolgt durch das Einbinden von Videos, Sound, Bildern oder PDF.
  5. Die App bietet die Möglichkeit, selbstständig einen News Channel ausschließlich für das eigene Team zu betreiben (Funktion: Schwarzes Brett).
  6. Der Bereich „Migration“ ermöglicht, klinikexterne Inhalte in das eigene Institut zu migrieren und diese zu verändern.
  7. Die App ist auf allen Endgeräten nutzbar. Auch besteht die die Möglichkeit direkt über den Webbrowser auf die Cayoo Plattform.



Teigeler B: Unterstützung im Klinikalltag: Per App OP-timal vernetzt. Passion Chirurgie. 2020 Oktober, 10(10): Artikel 04_05.

BDC – Berufsverband der Deutschen Chirurgen e.V.