Emergency Medicine Resident Patient Care Documentation Using a Hand‐held Computerized Device

Abstract

Abstract. Objective: To determine whether emergency medicine (EM) resident documentation of procedures, patient encounters, and patient follow-ups improved after implementation of a personal digital assistant (PDA) hand-held recording system. Methods: All first-year EM residents were provided a PalmV (Palm, Inc., Santa Clara, CA) PDA. A customized patient procedure and encounter program was constructed using Pendragon Forms (Pendragon Software Corporation, Libertyville, IL) and loaded into each PDA. Residents were instructed to enter information on patients who had any of 21 procedures performed or were considered to be clinically unstable. These data were downloaded to the residency coordinator's desktop computer. The mean number of procedures, encounters, and follow-ups performed per resident were then compared with those of a group of 36 historical controls from the three previous first-year resident classes who recorded the same information using a handwritten card system. Data from the historical controls were combined and the means of each group were compared by Student's t-test. Results: Mean documentation of three procedures was significantly increased in the PDA group versus the index card system: conscious sedation 5.8 vs. 0.03 (p < 0.000005), thoracentesis 2.2 vs. 0.0 (p = 0.002), ultrasound 6.3 vs. 0.0 (p = 0.002). The mean numbers of pericardiocenteses and unstable pediatric surgical patient evaluations were significantly decreased in the hand-held group [from 1.2 to 0.4 (p = 0.03) and from 9.1 to 2.2 (p = 0.02), respectively]. Patient follow-up documentations were not statistically different between the two groups. Conclusions: Use of a hand-held PDA was associated with an increase in first-year EM resident documentation in three of 20 procedures and a decrease in one procedure and the number of unstable surgical pediatric patient resuscitations. The overall time savings in constructing a resident procedure database, as well as the other uses of the PDAs, may make transition to a hand-held computer-based procedure log an attractive option for EM residencies.

Assessing medical residents’ usage and perceived needs for personal digital assistants

“…We regularly observe medical house staff carrying hand-held devices, or personal digital assistants (PDAs), while on rounds, consulting with other staff, or writing patient summaries and this use is similar to previous reports [1][2][3][4][5][6][7][8][9][10][11][12]. At the time of this study, our institution's computerized hospital information systems included physician workstations, used primarily for order--entry and to access laboratory results, operative notes and other documentation.…”

Boundary Objects, Social Meanings and the Success of New Technologies

“…Unsurprisingly, therefore, a substantial literature on organizations and technologies has documented the barriers that occur when a technology is introduced, and how these may be countered. For example, in a study of novel communication technology, Bird and Zarum (2001) concluded that successful innovation matched work tasks and satisfied user demands. Rosen and Gabbay (1999) found that managers were unimpressed by technical advantages, and evaluated a new technology in terms of its impact on the organization.…”

Handheld Computing in Medicine

“…33 Bird and coworkers found that the use of a handheld device was associated with an increase in first-year emergency medicine residents' documentation in three of 20 procedures. 34 The mean number of procedures, encounters and followups performed per resident using a handheld device was compared with a historical control group. It was concluded that the overall time savings in using a resident procedure database may result in a transition to a handheld computer-based procedure log.…”