Prospective evaluation of an internet-linked handheld computer critical care knowledge access system.
No Thumbnail Available
Date
2004-11-29
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
INTRODUCTION Critical care physicians may benefit from immediate access to medical reference material We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit ICU to multiple community based ICUs METHODS Four community hospital ICUs with 17 physicians participated in this prospective interventional study Following training in the use of an internet linked updateable handheld computer knowledge access system the physicians used the handheld devices in their clinical environment for a 12 month intervention period Feasibility of the system was evaluated by tracking use of the handheld computer and by conducting surveys and focus group discussions Before and after the intervention period participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed as well as the speed and quality of their decision making Participants generated admission orders during each scenario which were scored by blinded evaluators RESULTS Ten physicians 59 used the system regularly predominantly for nonmedical applications median 32 8 month interquartile range IQR 28 3 126 8 with medical software accessed less often median 9 month IQR 3 7 13 7 Eight out of 13 physicians 62 who completed the final scenarios chose to use the handheld computer for information access The median time to access information on the handheld handheld computer was 19 s IQR 15 40 s This group exhibited a significant improvement in admission order score as compared with those who used other resources P 0 018 Benefits and barriers to use of this technology were identified CONCLUSION An updateable handheld computer system is feasible as a means of point of care access to medical reference material and may improve clinical decision making However during the study acceptance of the system was variable Improved training and new technology may overcome some of the barriers we identified