Personal digital assistants change management more often than paper texts and foster patient confidence

Authors: 
Rudkin, S. E., Langdorf, M. I., Macias, D., Oman, J. A., Kazzi, A. A.
Journal: 
Eur J Emerg Med
Publication Date: 
2006 Apr
Volume: 
13
Issue: 
2
Pages: 
92-6
  • HIT Description: Decision support, clinical guidelines More info...
  • Purpose of Study: To assess feasibility and patient acceptance of personal digital assistants (PDAs) and effects on change in care in the emergency department (ED)
  • Years of study: Not Available
  • Study Design: Pre-post
  • Outcomes: Impact on health care effectiveness and quality, impact on patient satisfaction, impact on efficiency, utilization and costs
Summary:
  • Settings: Urban university hospital Level 1 trauma care center
  • Intervention: Prospective, random, cross-over time-motion study of emergency physicians, comparing efficiency measures and impact on management decisions when using PDAs with drug database and clinical references, versus paper versions
  • Evaluation Method: direct observation, surveys of patients and MDs
  • Description: Handera 330 PDA with 8 megabytes of RAM, a Palm-base operting system with preloaded pharmacopeias, a general disease text, an infectious disease text, an infectious disease drug guide, and a medical calculator
  • Strategy: PDAs were used for 3 months before the time-motion study to foster rapid access.
  • Financial Context: Patient mix: 30% self-pay, 30% Medicaid, 15% Medicare, 25% commercial insurance, including HMO
  • Facilitators: 50% of patients reported more confidence in their MDs with a PDA. Only 5% reported less confidence. Also, median MD baseline comfort with computer use was 4 'comfortable' on a 5 point scale.
  • Barriers: 10% of PDAs broke the first year
  • Cost of HIT systems: Each PDA cost $340, including software
  • Long-term Cost: Batteries for each unit cost $36 per year; technical support provided by a faculty member (software loading, trouble shooting, etc) is 4 hours per PDA per year
  • Quality of Care and Patient Safety Outcome: PDAs changed drug choice in 21.5% of patients, and changed other management (diagnosis, treatment, or disposition) in 8.3% of patients.
  • Changes in efficiency and productivity: Mean access times were 9.3 seconds for PDA and 9.4 seconds for paper. 80% of MDs agreed that PDAs increased efficiency.