Information Changes Lives
Two Point-of-Care Resources: FIRSTConsult vs. UpToDate
Information influences the clinical decision-making process, often resulting in changes to patient care. 1-3 With two questions arising for every three patients in office practice, and an average of five questions per patient encounter in academic settings, 4,5 access to information at the point of care is essential.
Two point-of-care (POC) products provided through HSL Online — FIRSTConsult and UpToDate — offer full-text results for immediate use, and have clinically relevant content that maps closely to the clinical task (e.g., differential diagnosis). Even so, they are very different products, and each offers unique advantages.
FIRSTConsult is formatted into four outlined sections that are accessible from the left navigational toolbar:
• Differential Diagnoses
• Medical Topics
• Patient Education
• Procedures
FIRSTConsult follows the conceptual process, beginning with the chief complaint through treatment options. Designed for rapid evaluation, the 350 chief complaints and 1,500 possible diagnoses can display by age and prevalence. For example, the FIRSTConsult chart above shows at a glance that in adults 45-65 years, acute dyspnea is more commonly caused by asthma than myocardial infarction. Another POC feature is provided through the Summary of Therapeutic Options under the Treatment section of Medical Topics. FIRSTConsult’s design conveys information quickly, and it uses a bulleted format for a simplified visual appearance. It’s updated weekly, offers over 30 procedural videos, and includes links to rated evidence such as systematic reviews, guidelines, and randomized controlled trials.
UpToDate is a collection of original topic reviews that provides a digest of information in paragraph format. The comprehensive, clinically applicable discussions are well referenced with diagrams and illustrations. Drug queries link to concise drug monographs through Lexi-Comp Online, and patient education materials can be accessed via the table of contents. While a new version of UpToDate is released every few months, literature reviews of over 330 journals and other updates are performed continually.
Both products have a single search box without limits or Boolean logic (“and,” “or,” “not”), retrieve information within a minute, and offer navigational aides. Only FIRSTConsult is available via remote access. Each product serves a purpose in the quest for readily applicable clinical databases. Consider these two POC products for instant access to information to support clinical decision-making.
--Michele Klein-Fedyshin
References:
1. Lindberg DA. Siegel ER. Rapp BA. Wallingford KT. Wilson SR. Use of MEDLINE by physicians for clinical problem solving. JAMA. 269(24):3124-9, 1993.
2. Klein MS. Ross FV. Adams DL. Gilbert CM. Effect of online literature searching on length of stay and patient care costs. Academic Medicine. 69(6):489-95, 1994.
3. Marshall JE. The impact of the hospital library on clinical decision-making: the Rochester Study. Bull Med Libr Assoc 80:169-178, 1992
4. Covell DG. Uman GC. Manning PR. Information needs in office practice: are they being met?. Annals of Internal Medicine. 103(4):596-9, 1985.
5. Osheroff JA. Forsythe DE. Buchanan BG. Bankowitz RA. Blumenfeld BH. Miller RA. Physicians’ information needs: analysis of questions posed during clinical teaching. Annals of Internal Medicine. 114(7):576-81, 1991.
