44 Trainee Perception of a Point of Care Clinical Evidence Module for Bronchiolitis

Abstract

Bronchiolitis, a viral induced acute inflammation of the lower respiratory tract is a common reason for hospital admission in infants. A bronchiolitis evidence based clinical module (EBM) was created and applied to the physician order entry (POE) system at an academic paediatric centre. To evaluate trainee perception of a point of care evidence module used to improve physician management of children admitted with bronchiolitis. Questionnaire completed by clinical trainees. Academic pediatric centre. A clinical evidence summary, contained in the Clinical Evidence™ product of BMJ Publishing Group, based on bronchiolitis management was integrated into the Medical Logic Module of the hospital POE system (Sunrise Clinical Manager™; Eclipsys). A 12 question survey examining trainee's use and satisfaction of the module was distributed at the conclusion of the clinical rotation during the peak bronchiolitis admission period (November 01, 2000 and March 31, 2001). We achieved a 90% response rate (50 of 52 surveys). Clinical level of trainees were: third year medical students – 62%; non-pediatric residents – 12%; and pediatric residents – 26%. At least one patient with bronchiolitis was admitted by 94% of the trainee's within the previous month. Despite its easy accessibility on the Bronchiolitis order entry set of the POE system, only 52% of trainees stated that they were aware of the EBC module. Medical students were less likely, while pediatric residents were more likely to have reviewed the EBM (absolute difference 0.58; 95% CI 0.26, 0.76 p<0.001). However, the medical student group were more likely to report that the review was clinically helpful. All groups agreed that point of care evidence was a useful practise and would have additional merit if expanded to other clinical conditions. Point of care evidence has immense capability in clinical care settings to enhance quality and safety of care. More experienced trainees were more likely to utilise readily accessible clinical evidence at the point of care but were less likely to report enhanced educational value compared with less experienced trainees. Methods to increase its adoption and utilisation need to be explored.