Supporting clinical practice at the bedside using wireless technology

• HIT Description: Decision support, mobile computing More info...
  
• Purpose of Study: To assess the use of a wirelessly networked mobile computer (MC), to facilitate use of clinical practice guidelines and decision support
  
• Years of study: 2002
  
• Study Design: Randomized controlled trial
  
• Outcomes: Impact on health care effectiveness and quality, Impact on efficiency, utilization and costs
  

• Settings: University hospital emergency department - non-critical areas only.
• Intervention: Each of ten volunteer emergency MDs was randomized to work five shifts in standard fashion (with desktop computer access) and five shifts with a wirelessly networked MC. Work pattern issues and electronic decision aid / guidelines use were compared.
• Evaluation Method: End of shift satisfaction questionnaires were analyzed.
• Description: A large number of electronic support tools were accessible through an intranet web application called eCPG. Tools included an existing emergency department information system (EDIS) a triage and tracking application, patient education sheets, best-practice tools, guidelines, drug dose-calculating interactive order sets, etc. These applications were now available through a wireless mobile computer on a stable wheeled pole with an external fuel cell.
• Strategy: All participating MDs had accumulated more than two years of experience with available decision support tools. Participating MDs were briefed on the use of the mobile computer in a one-on-one training session with the project coordinator.
• Barriers: For users continuously using four applications or more on the mobile computer, a backup fuel cell was occasionally required. The size of the mobile computer and the additional effort required to maneuver it for an 8 hour shift was difficult in the fast-track area of the ED. In addition, the clinical assessment tools were applicable to less tha 10% of the ED patients
• Healthcare Utilization: 80% of MDs used the mobile computer (MC) to access electronic radiographs and share them with patients.
• Quality of Care and Patient Safety Outcome: MDs believed that they used electronic guideline programs more when assigned to the MC (p.03).
• Changes in efficiency and productivity: Despite apparent satisfaction with computing speed, configurability, and availability of the MC, physicians believed that the MC slowed their work. (p.02).