Author Affiliations: Departments of Pediatrics and Anesthesia, Children's Hospital and Harvard Medical School, Boston, Mass (Dr Randolph); Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario (Drs Haynes, Cook, and Guyatt); and School of Public Policy, University College London, London, England (Dr Wyatt).
Users' Guides to the Medical Literature
Section Editor: Drummond Rennie, MD, Deputy Editor (West), JAMA.
It is 7 AM, and medical rounds are starting on university hospital ward
3B. In the past 24 hours of your residency, you have transferred 2 critically
ill patients to the intensive care unit; accepted 11 patients to your medical
service; examined and revised medication orders for 22 patients; placed 9
intravascular catheters; written 35 notes; and reviewed, categorized, and
acted on more than 300 new pieces of laboratory and radiology data. You were
planning to ask the infectious disease specialist about a patient, but he
seems very busy, and the broad-spectrum antibiotic regimen you prescribed
should suffice. You were just told that you ordered total parenteral nutrition
for the wrong patient. While deciding which patient should receive parenteral
nutrition, you realize that the calculations for the amino acid concentration
are erroneous. After the first 5 minutes of your first patient presentation,
the senior physician asks you details from the patient's past medical history.
You wish you could refer to your admission note, but you couldn't access it
before your rounds because a utilization review clerk had the chart.
Randolph AG, Haynes RB, Wyatt JC, Cook DJ, Guyatt GH. Users' Guides to the Medical LiteratureXVIII. How to Use an Article Evaluating the Clinical Impact of a Computer-Based Clinical Decision Support System. JAMA. 1999;282(1):67-74. doi:10.1001/jama.282.1.67