Clinical utility of an electronic poisons information and clinical decision support tool☆
Introduction
Medical informatics have become increasingly accepted into the Emergency Department (ED) workplace and toxicology information systems have been at the forefront of this development. In New Zealand, the National Poisons Centre (NPC) has for several years provided hospitals with a computer CD ROM substance database, the New Zealand Poisons Centre Substance Database (NZSD), to aid in the management of the poisoned patient. The NPC was established in 1964 and the database was first formed at this time. Development of the CD ROM proper began in 1997 with the issuing of CD ROMs to seven select EDs for beta testing (user testing) and critique of the information, formatting etc. New software was designed and completed in 1998 to allow more efficient updating of the data and new formatting. This was again beta-tested and the final product released in 1999. The database is maintained and continually updated by Poisons Information Specialists and supervising Medical staff utilizing all available toxicology literature. Included in the database are drug, chemical, plant and animal toxicology datasheets as information sources and clinical decision aids. The database has been provided to hospital ED's on a CD ROM for use on local computer systems.
The evaluation of the impact and utility of information technology, such as the NZSD, in health care has proven somewhat difficult. This evaluation is part of a process aimed at improving our understanding of the role of information technology in health care and is necessary to enable the development of high quality systems offering a wide range of clinical and economic benefits [1]. Although computer based media has been available to healthcare services for some years now [2], the acceptability of delivering information via this media for immediate bedside clinical use has not been extensively studied. Despite the incorporation of information technologies into general practice [3], EDs [4] and inpatient areas, implementation and use of such systems is less than optimal [5]. Our aims in the present study were to describe the alternative information sources ED personnel use when faced with a clinical toxicology problem and to assess the quality of the current database.
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Materials and methods
The study was a self-administered questionnaire completed by ED personnel in New Zealand between September 2001 and February 2002. The questionnaire was developed using the following process. Firstly, small, informal group discussions were held with ED staff, both nursing and medical, as to sources used for poisons information, and general impressions regarding these information sources. Following these focus groups, a provisional open-question questionnaire was devised and circulated to the
Results
Of 117 questionnaires circulated to five large and 10 small hospitals, 82 were returned representing a response rate of 70%. ED medical staff completed 51 (62%) of these and 30 (37%) were completed by ED nursing staff (one questionnaire not specified). The number of poisonings cases seen varied between zero and 30 per week with a median of 3. Of the respondents, 37 were employed in large hospital ED's and 45 in small hospital ED's. The medians and ranges for the visual analogue scales are
Discussion
Toxicology presentations account for approximately 1% of total attendances to EDs [7], [8], and 12% of all acute injury hospital admissions [9]. The number of toxins and toxicants with potential to cause human illness is far beyond the number any individual clinician can to be familiar with. Although the treatment of many poisonings is largely supportive, information regarding particular substances should be available to aid physician clinical decision-making. The provision of this information
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This study has not been supported by any external funding.