Effect of using protocols on medical care: randomised trial of three methods of taking an antenatal history.

Abstract

Objective-To compare the effectiveness of three methods of taking an antenatal history on the quality ofobstetric care.Design-Randomised controlled trial. Setting-Antenatal clinic of St James's University Hospital, Leeds.Subjects-2424 women attending the hospital for the first (booking) visit.Interventions-Histories were taken by midwives using an unstructured paper questionnaire, a structured paper questionnaire (incorporating a checklist), or an interactive computerised questionnaire (incorporating 101 clinical reminders).Main outcome measures-The number of clinical responses to factors arising from the antenatal booking history according to method of taking the history. Actions were categorised as medical and surgical, obstetric, personal, current symptoms and treatment, related to maternal age, and related to two common actions (cervical smear testing and dental hygiene) and were weighted for clinical importance by 10 obstetricians.

Benefits and risks of structuring and/or coding the presenting patient history in the electronic health record: systematic review

“…Structured forms can act as a prompt not only to document more completely, but also to actually remind a clinician or patient to address a certain topic (ie, it can improve contemporaneous care, not just its documentation). This effect has been well established for reviews of chronic diseases,46 but we were unable to identify similar investigations for patient history. None of the studies examined included a longitudinal dimension, for example using a previously structured history to compare the patient's current status with a past occasion.…”

Fortnightly Review: How to ensure that guidelines are effective

“…They range from patient specific reminders at the time of consultation to general non-specific reminders. Patient specific reminders at the time of consultation could include, for example, attachment of guidelines to the medical record,31 inclusion of guidelines on a desk top computer,32 33 or specially designed clinical records 34. The key factor is that the guidelines are brought to the clinician's attention at the time of the consultation and are thus able to influence the clinical decision prospectively.…”

An epistemology of patient safety research: a framework for study design and interpretation. Part 2. Study design

“…Most evaluations of computer-based interventions to improve safety have been based on individual randomisation but have nevertheless shown positive results, implying either that contamination was not widespread or that the underestimated effect size was still significant 14 15. However, when contamination exceeds about 30% a cluster study is generally more efficient 16.…”