Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore.
Singapore Med J. 2012 Feb;53(2):116-20.
Clinical questions often arise at daily hospital bedside rounds. Yet, little information exists on how the search for answers may be facilitated. The aim of this prospective study was, therefore, to evaluate the overall utility, including the feasibility and usefulness of incorporating searches of UpToDate, a popular online information resource, into rounds.
Doctors searched UpToDate for any unresolved clinical questions during rounds for patients in general medicine and respiratory wards, and in the medical intensive care unit of a tertiary teaching hospital. The nature of the questions and the results of the searches were recorded. Searches were deemed feasible if they were completed during the rounds and useful if they provided a satisfactory answer.
A total of 157 UpToDate searches were performed during the study period. Questions were raised by all ranks of clinicians from junior doctors to consultants. The searches were feasible and performed immediately during rounds 44% of the time. Each search took a median of three minutes (first quartile: two minutes, third quartile: five minutes). UpToDate provided a useful and satisfactory answer 75% of the time, a partial answer 17% of the time and no answer 9% of the time. It led to a change in investigations, diagnosis or management 37% of the time, confirmed what was originally known or planned 38% of the time and had no effect 25% of the time.
Incorporating UpToDate searches into daily bedside rounds was feasible and useful in clinical decision-making.
临床问题经常在日常医院查房时出现。然而，关于如何促进寻找答案的信息却很少。因此，这项前瞻性研究的目的是评估整体效用，包括将流行的在线信息资源 UpToDate 搜索纳入查房中的可行性和实用性。
医生在三级教学医院的普通内科和呼吸病房以及内科重症监护病房的查房期间，针对任何未解决的临床问题搜索 UpToDate。记录问题的性质和搜索结果。如果搜索能够在查房期间完成，则认为是可行的；如果提供了令人满意的答案，则认为是有用的。
在研究期间共进行了 157 次 UpToDate 搜索。从初级医生到顾问的各级临床医生都提出了问题。搜索是可行的，有 44%的时间可以立即在查房期间进行。每次搜索的中位数时间为三分钟（第一四分位数：两分钟，第三四分位数：五分钟）。UpToDate 提供有用且令人满意的答案的时间为 75%，提供部分答案的时间为 17%，没有答案的时间为 9%。它导致改变调查、诊断或管理的时间为 37%，确认了最初已知或计划的内容的时间为 38%，没有影响的时间为 25%。
将 UpToDate 搜索纳入日常床边查房是可行的，并且对临床决策具有实用性。
