Evaluating the use of computerised clinical guidelines in the accident and emergency department

To investigate the pattern and frequency of use of computerised clinical guidelines (CCG) in an accident and emergency department.

A software program was written to record information on a central database each time the CCG were used. Data were collected prospectively for a six month period. Users were blind to the study. The date, time of use and guidelines consulted were recorded.

1974 individual sessions were logged comprising of 10204 "hits". The CCG were used for a median of 10 sessions per day (range 1-38, SD 5.49). A median of three subjects were accessed during each session (range 1-39, SD 5). The CCG were used most often during peak daily activity; 11 am (609 hits), 5 pm (678 hits) and 12 pm (604 hits) and on Sundays (1875 hits), Thursdays (1770 hits) and Saturdays (1608 hits). The most frequently used guidelines concerned orthopaedics and fracture management (1590 hits), wound care (546 hits), poisoning (473 hits), medical emergencies (267 hits) and radiological policy (148 hits).

In this department CCG have become easily integrated as part of normal day to day working practice. The CCG are accessible 24 hours a day. They can also be easily updated according to best evidence, local policy or national guidelines. The results of this study have helped the authors to focus education to areas of clinical need.