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Prospective evaluation of an internet-linked handheld computer critical care knowledge access system.
Crit Care. 2004 Dec; 8(6):R414-21.CC

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.

Links

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Authors+Show Affiliations

Lapinsky SE
Technology Application Unit, Mount Sinai Hospital & Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada. stephen.lapinsky@utoronto.ca
Wax R
No affiliation info available
Showalter R
No affiliation info available
Martinez-Motta JC
No affiliation info available
Hallett D
No affiliation info available
Mehta S
No affiliation info available
Burry L
No affiliation info available
Stewart TE
No affiliation info available

MeSH

Academic Medical CentersComputer User TrainingComputers, HandheldCritical CareDecision Support Systems, ClinicalDiffusion of InnovationFeasibility StudiesFocus GroupsHealth Care SurveysHospitals, CommunityHumansInformation ServicesIntensive Care UnitsInternetOntarioPoint-of-Care SystemsSoftware

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15566586

Citation

Lapinsky, Stephen E., et al. "Prospective Evaluation of an Internet-linked Handheld Computer Critical Care Knowledge Access System." Critical Care (London, England), vol. 8, no. 6, 2004, pp. R414-21.
Lapinsky SE, Wax R, Showalter R, et al. Prospective evaluation of an internet-linked handheld computer critical care knowledge access system. Crit Care. 2004;8(6):R414-21.
Lapinsky, S. E., Wax, R., Showalter, R., Martinez-Motta, J. C., Hallett, D., Mehta, S., Burry, L., & Stewart, T. E. (2004). Prospective evaluation of an internet-linked handheld computer critical care knowledge access system. Critical Care (London, England), 8(6), R414-21.
Lapinsky SE, et al. Prospective Evaluation of an Internet-linked Handheld Computer Critical Care Knowledge Access System. Crit Care. 2004;8(6):R414-21. PubMed PMID: 15566586.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective evaluation of an internet-linked handheld computer critical care knowledge access system. AU - Lapinsky,Stephen E, AU - Wax,Randy, AU - Showalter,Randy, AU - Martinez-Motta,J Carlos, AU - Hallett,David, AU - Mehta,Sangeeta, AU - Burry,Lisa, AU - Stewart,Thomas E, Y1 - 2004/10/14/ PY - 2004/08/13/received PY - 2004/09/02/accepted PY - 2004/11/30/pubmed PY - 2006/1/31/medline PY - 2004/11/30/entrez SP - R414 EP - 21 JF - Critical care (London, England) JO - Crit Care VL - 8 IS - 6 N2 - 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. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/15566586/Prospective_evaluation_of_an_internet_linked_handheld_computer_critical_care_knowledge_access_system_ DB - PRIME DP - Unbound Medicine ER -