Prospective evaluation of an internet-linked handheld computer critical care knowledge access system

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.

Figure 1

The internet-based data transfer system. Updated information is downloaded to the handheld device from a study server. Connection to the internet can take place via hardwire synchronization with a desktop computer or using infrared (IR) data transmission to a dial-up modem. ISP, internet service provider.

Figure 2

The study time course.

Figure 3

Comparison of scores for admission orders generated during the baseline and final clinical scenarios. Solid lines connect baseline and final scenario scores of participants who used the handheld device in the final scenario, and dotted lines connect scores of participants who did not use the handheld device (solid circles = scenarios where handheld was not used; open circles = scenarios where the handheld device used). A significant improvement was noted in scores in the handheld group as compared with the nonhandheld group (P = 0.018).