How searching under time pressure impacts clinical decision making.

Anton Van Der Vegt,Anthony Deacon,Guido Zuccon,Bevan Koopman

doi:10.5195/jmla.2020.915

Abstract

Objective:Clinicians encounter many questions during patient encounters that they cannot answer. While search systems (e.g., PubMed) can help clinicians find answers, clinicians are typically busy and report that they often do not have sufficient time to use such systems. The objective of this study was to assess the impact of time pressure on clinical decisions made with the use of a medical literature search system.Design:In stage 1, 109 final-year medical students and practicing clinicians were presented with 16 clinical questions that they had to answer using their own knowledge. In stage 2, the participants were provided with a search system, similar to PubMed, to help them to answer the same 16 questions, and time pressure was simulated by limiting the participant's search time to 3, 6, or 9 minutes per question.Results:Under low time pressure, the correct answer rate significantly improved by 32% when the participants used the search system, whereas under high time pressure, this improvement was only 6%. Also, under high time pressure, participants reported significantly lower confidence in the answers, higher perception of task difficulty, and higher stress levels.Conclusions:For clinicians and health care organizations operating in increasingly time-pressured environments, literature search systems become less effective at supporting accurate clinical decisions. For medical search system developers, this study indicates that system designs that provide faster information retrieval and analysis, rather than traditional document search, may provide more effective alternatives.

Highlights

Clinicians routinely raise clinical questions related to their patient interactions that they are unable to answer with their own knowledge [1]
The British Medical Association’s tracker survey, which follows medical staff across the United Kingdom, shows that 68% of general practitioners and 44% of consultants find their workload unmanageable [19]. This evidence prompts the question: how effective are medical literature search engines (e.g., PubMed) at supporting time-pressured clinicians in making better clinical decisions? This study aimed to address this question through the following two specific research questions (RQs):
MEDLINE/PubMed usage was similar for physicians and students (2.9) but lower for nurses (2.1.)

Summary

Introduction

Clinicians routinely raise clinical questions related to their patient interactions that they are unable to answer with their own knowledge [1]. Studies conducted with primary care physicians show that on average, between 0.07 and 1.85 questions are generated per patient encounter, a little under 1 question per hour [2]. Of these questions, many are often left unanswered, as demonstrated by 3 studies in the United States where 63.8% (702/1,101), 44.9% (477/1,062), and 70.2% (207/295) of medical questions raised by clinicians were left unanswered [3,4,5]. Westbrook et al found that the introduction of a medical literature search system significantly improved the correct answer rate from 29% (174/600) without the system to 50% (298/600) with the system [13]. Hersh et al found that a MEDLINE-only search system improved the correct answer rate from 32% (104/324) to 46% (150/324) [14]

Methods

Results

Conclusion