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Prospective evaluation of an internet-linked handheld computer critical care knowledge access system
Stephen E Lapinsky1, Randy Wax, Randy Showalter
1Technology Application Unit, Mount Sinai Hospital & Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada. stephen.lapinsky@utoronto.ca
Critical Care (London, England)
|November 30, 2004
Summary
A handheld computer system for accessing medical information is feasible for critical care physicians. While system acceptance varied, it showed potential to improve clinical decision-making at the point of care.
Area of Science:
- Medical Informatics
- Critical Care Medicine
- Health Technology Assessment
Background:
- Critical care physicians require rapid access to medical reference materials.
- A handheld computer knowledge access system was developed to link academic and community intensive care units (ICUs).
Purpose of the Study:
- To evaluate the feasibility and potential benefits of a handheld computer-based knowledge access system for critical care physicians.
- To assess the impact of the system on clinical decision-making speed and quality.
Main Methods:
- A prospective interventional study involving 17 physicians across four community hospital ICUs.
- Physicians used an internet-linked handheld computer system for 12 months.
- Feasibility was assessed via system usage tracking, surveys, and focus groups. Simulated patient care scenarios were used to evaluate decision-making before and after the intervention.
Main Results:
- Ten physicians (59%) used the system regularly, with most usage for non-medical applications.
- Medical software was accessed less frequently (median 9/month).
- Physicians using the handheld system for information access showed significant improvement in admission order scores (P = 0.018) compared to those using other resources. Median information access time was 19 seconds.
Conclusions:
- An updateable handheld computer system is feasible for point-of-care medical reference access and may enhance clinical decision-making.
- System acceptance and usage patterns were variable among physicians.
- Improved training and technological advancements may address identified barriers to adoption.