Keywords and key information
Source, date and links
The revolution in medical care and all aspects of life is the access to information on the internet. A google search can now answer many of the questions and help you navigate the worldwide mass of information that is now accessible.
However this still takes time, and the source is not always reliable. Once information is found it also needs to be retrieved quickly. At present there is no system that holds key verified information and allows its retrieval quickly for immediate use. Most consultations give a doctor less than seven minutes in which to make a diagnosis and pass on key information so fact management and retrieval is crucial.
The following features are those of a wiki type index, which has been piloted in Hampshire. It is a wiki as it is collaborative and updated by all users. It is an index as it directs users to the site of information, with key facts provided. It is also known as a KnowHow index as it is a Focused and Collaborative index.
An index page needs to be user friendly with the capacity to add the keywords relevant to the user group
Keywords and key information
A short summary of the key information is needed. Often this is only a few words that are needed to make the decision or diagnosis. This may be normal ranges for a blood result, contact phone numbers, diagnostic criteria or local facilities
Source, date and links
The source of any information should be clear so that the reader can assess its reliablity. Was it from someone with expertise? Is it in date? Does it link to the original source on the internet to get more information?
This does need at least one person in the team who is allocated or keen to enter information as it comes to the group. Usually several people enter information as required. This then becomes a collaborative resource like a wiki. Rather than every person setting information aside, a shared fact management database can reduce duplication, save time and make consultations more effective. This is a wiki type index.
The original working example is the LLAMA fact management database and index . This was assessed as part of a research project and the report is in the downloads section of docrick under 1 LLAMA final publication. It is a GP practice based version for use at one surgery.
Two Case scenarios – the problem and solution
The problem – in primary medical care
Appointments in general practice are usually set at ten minute intervals.This usually works out as seven minutes face to face consultation with 90 seconds preparation and 90 seconds for records and actions such as referrals
A 45year old man who is overweight has booked an appointment. The GP is running 15 minutes behind because an earlier patient brought several problems to his consultation. The appointment booking shows he is attending for his blood sugar result
Before the appointment the GP checks the blood results. Is this diabetes is the question? One result is 7.4 and one is 8mmol/l What is the national criteria for diabetes diagnosis he thinks to himself? It is in the memory but it is important – is the GP sure? There is a definition saved in the paper files from a letter last year but it is hard to find. The GP flicks through the paper files and cannot find it. He clicks on google and after a minute finds the diabetes Uk website but is not confident of the answer. This takes two minutes in all.
The patient enters. Possible diabetes is discussed and further blood tests are arranged. He is advised on weight reduction as this is likely to be effective in any case. Weight advise on the internet is poor and the GP advises to reduce portion size, reduce fatty foods and offered a review to discuss weight management
The patient becomes tearful and the GP realises more time is needed. He describes his low mood, his partner has alcohol problems. He asks about restarting citalopram as this helped before. There are limited leaflets with respect to mood so the GP looks for the paper leaflet for counselling which he cannot find. The GP phones reception who bring up a leaflet
The GP recalls a problem with citalopram, which was reported recently. This information does not exist in the paper and computer copies of the BNF yet. The GP reecalls that low dose was safer so starts a low dose with a plan to review after discussing with the other GPs
The patient leaves the room with a follow up appointment for a blood test, for weight review and to discuss mood. The GP writes a note to phone the mental health team tomorrow and make the referral. The consultation has taken 15 mins and the GP is now 20 minutes behind. The GP is frustrated that he is more behind and is aware he needs time to check the citalopram side effects, diabetes diagnosis and to make the referral.
A solution – in primary medical care – same scenario, different outcome
A 45year old man who is overweight has booked an appointment. The GP is running 15 minutes behind because an earlier patient brought several problems to his consultation.The appointment booking shows he is attending for his blood sugar result.
Before the appointment the GP checks the blood results. Is this diabetes is the question? One result is 7.4 and one is 8mmol/l. What is the national criteria for diabetes diagnosis the GP thinks? It is in the memory but it is important – is the GP sure? There is a definition saved in the paper files from a letter last year but it is hard to find. An internet search on google or doctors net will take too much time. The GP clicks on the fact management database icon and enters the word “diabetes diag” which takes him to the Diabetes UK definition entered when the letter was seen last year and has a hyperlink to the current website information. This takes under 10 seconds
The patient enters: The GP discusses the diagnosis of diabetes. The patient is advised on weight reduction as this is likely to be effective. Weight advise on the internet is poor. The GP searches on “weight” on fact management database and the patient is given a printed sheet
Patient becomes tearful and the GP realises more time is needed. The patient describes his low mood, his partner has alcohol problems. He asks about restarting citalopram as this helped before. There are limited leaflets with respect to mood. The GP enters the keyword counselling and prints existing information on local counsellors, books on prescription, RELATE info and alcohol support info. Advice is given about medication, exercise, time to self, time of work and counselling
The GP recalls a problem with citalopram, which was reported recently. The information on this does not yet exist in the paper and computer copies of the natonal formulary. The GP enters the keyword drug latest and reads about abnormal heart rhythms risk with QT prolongation and citalopram. Citalopram is started with advice on correct dose and an ECG check arranged
Ther patient leaves the room with a follow up appointment. The GP looks for the mental health team contact number and enters the keyword mental health, retrieves the contact number and telephones to make the referral
The consultation has taken 12 mins and the GP is now 17 minutes behind. The GP is confident about the management and can move onto the next patient having completed the tasks needed
Cases are aggregated so that they do not relate to one identifiable individual.
The database used is the LLAMA fact management database and index. This was assessed as part of a research project. has been reported at conferences and is in the downloads section of docrick under 1 LLAMA Final publication