Do clinicians use online evidence to support patient care? A study of 55,000 clinicians

Abstract

Objectives: To determine clinicians' (doctors', nurses', and allied health professionals') "actual" and "reported" use of a point-of-care online information retrieval system; and to make an assessment of the extent to which use is related to direct patient care by testing two hypotheses: hypothesis 1: clinicians use online evidence primarily to support clinical decisions relating to direct patient care; and hypothesis 2: clinicians use online evidence predominantly for research and continuing education.

Design: Web-log analysis of the Clinical Information Access Program (CIAP), an online, 24-hour, point-of-care information retrieval system available to 55,000 clinicians in public hospitals in New South Wales, Australia. A statewide mail survey of 5,511 clinicians.

Measurements: Rates of online evidence searching per 100 clinicians for the state and for the 81 individual hospitals studied; reported use of CIAP by clinicians through a self-administered questionnaire; and correlations between evidence searches and patient admissions.

Results: Monthly rates of 48.5 "search sessions" per 100 clinicians and 231.6 text hits to single-source databases per 100 clinicians (n = 619,545); 63% of clinicians reported that they were aware of CIAP and 75% of those had used it. Eighty-eight percent of users reported CIAP had the potential to improve patient care and 41% reported direct experience of this. Clinicians' use of CIAP on each day of the week was highly positively correlated with patient admissions (r = 0.99, p < 0.001). This was also true for all ten randomly selected hospitals.

Conclusion: Clinicians' online evidence use increases with patient admissions, supporting the hypothesis that clinicians' use of evidence is related to direct patient care. Patterns of evidence use and clinicians' self-reports also support this hypothesis.

Figure 1.

Hypotheses regarding patterns of online evidence use by clinicians. H = hypothesis.

Figure 2.

Sampling strategy for statewide clinician survey. Ambulance officers and those clinicians with access to the clinical information access program working outside public hospitals, for example, in community health clinics, were excluded from the survey. NSW = New South Wales; CIAP = Clinical Information Access Program.

Figure 3.

Monthly rates of bibliographic sessions by hospital (N = 181,499). Please note: only the name of every second hospital appears on the graph.

Figure 4.

Time and day of online evidence use.

Figure 5.

Hospital and home use of online bibliographic evidence during the weekdays.

Figure 6.

Hospital and home use of online evidence on the weekend.

Figure 7.

Distribution of patient admissions and bibliographic sessions by day of the week, August 2000 to February 2001.