Context.— Physicians need easy access to evidence for clinical decisions while
they care for patients but, to our knowledge, no investigators have assessed
use of evidence during rounds with house staff.
Objective.— To determine if it was feasible to find and apply evidence during clinical
rounds, using an "evidence cart" that contains multiple sources of evidence
and the means for projecting and printing them.
Design.— Descriptive feasibility study of use of evidence during 1 month (April
1997) and anonymous questionnaire (May 1997).
Setting.— General medicine inpatient service.
Patients.— Medical students, house staff, fellows, and attending consultant.
Intervention.— Evidence cart that included 2 secondary sources developed by the department
(critically appraised topics [CATs] and Redbook), Best Evidence, JAMA Rational Clinical Examination series, the Cochrane Library,
MEDLINE, a physical examination textbook, a radiology anatomy textbook, and
a Simulscope, which allows several people to listen simultaneously to the
same signs on physical examination.
Main Outcome Measures.— Number of times sources were used, type of sources searched and success
of searches, time needed to search, and whether the search affected patient
Results.— The evidence cart was used 98 times, but could not be taken on bedside
rounds because of its bulk; hard copies of several sources were taken instead.
When the evidence cart was used during team rounds and student rounds, some
sources could be accessed quickly enough (10.2-25.4 seconds) to be practical
on our service. Of 98 searches, 79 (81%) sought evidence that could affect
diagnostic and/or treatment decisions. Seventy-one (90%) of 79 searches regarding
patient management were successful, and when assessed from the perspective
of the most junior team members responsible for each patient's evaluation
and management, 37 (52%) of the 71 successful searches confirmed their current
or tentative diagnostic or treatment plans, 18 (25%) led to a new diagnostic
skill, an additional test, or a new management decision, and 16 (23%) corrected
a previous clinical skill, diagnostic test, or treatment. When the cart was
removed, the perceived need for evidence rose sharply, but a search for it
was carried out only 12% of the time (5 searches performed out of the 41 times
evidence was needed).
Conclusions.— Making evidence quickly available to clinicians on a busy medical inpatient
service using an evidence cart increased the extent to which evidence was
sought and incorporated into patient care decisions.