title: Personal digital assistants change management more often than paper texts and foster patient confidence.
abstract: BACKGROUND
  Rapid retrieval of information, including drug treatment options, is critical to emergency department practice.
  
  
  OBJECTIVE
  To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes.
  
  
  METHODS
  Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency.
  
  
  RESULTS
  EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember.
  
  
  CONCLUSIONS
  Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA. srudkin@uci.edu
authors.forename: Scott E
authors.initials: SE
authors.lastname: Rudkin
authors.forename: Mark I
authors.initials: MI
authors.lastname: Langdorf
authors.forename: Demian
authors.initials: D
authors.lastname: Macias
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Oman
authors.forename: Amin A
authors.initials: AA
authors.lastname: Kazzi
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D034201:Computers, Handheld / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D003625:Data Collection; D003658:Decision Making, Computer-Assisted; D004526:Efficiency; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D017060:Patient Satisfaction; D010602:Pharmacopoeias as Topic; D011446:Prospective Studies; D013996:Time and Motion Studies