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Critical Care

, 8:R414

First Online: 14 October 2004Received: 13 August 2004Accepted: 02 September 2004

Abstract

IntroductionCritical 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.

MethodsFour 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.

ResultsTen 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.

ConclusionAn 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.

Keywordsclinical computer critical care decision support systems handheld internet point-of-care systems practice guidelines simulation AbbreviationsICUintensive care unit

IQRinterquartile range.

Electronic supplementary materialThe online version of this article doi:10.1186-cc2967 contains supplementary material, which is available to authorized users.

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Autor: Stephen E Lapinsky - Randy Wax - Randy Showalter - J Carlos Martinez-Motta - David Hallett - Sangeeta Mehta - Lisa Burry

Fuente: https://link.springer.com/







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