Emergency physicians often need point-of-care access to current, valid information to guide patient management. Most emergency physicians do not work in a hospital with a computerized decision support system that prompts and provides them with information to answer their clinical questions. Searching for answers to clinical questions online, especially those related to diagnosis and treatment, can be challenging, in part because determining the validity and clinical applicability of the results of individual studies is beyond the time constraints of most emergency physicians. This article describes currently available point-of-care sources of evidence-based information to answer clinical questions and provides the access information for each.

Aims and Methods: A retrospective cohort was identified to examine the impact of information availability on outcome of emergency psychiatric assessment.

Results: Of 144 assessments undertaken during a 2-month period, 110 (76%) involved patients already known to regional psychiatric services, with records held on-site and remote from acute services at the District General Hospital site. 18 (16%) on-site clinical records were accessed during emergency assessments, only 3 (3%) of which were accessed during out-of-hours. No off-site records were accessed. Admission rates were low, with only 22 (15%) of assessments leading to admission and 63 (44%) resulting in onward referral to other services. Outcome for in- and out-of-hours assessments did not differ.

Conclusion: Our data failed to show a significant effect of accessing clinical records on admission rate.

There is increasing interest in collecting morbidity data from general practice. We describe our experience from Northumberland MEDICS, one of the first morbidity data collection projects in the UK. All Northumberland practices were invited to participate. Data were initially collected every 3–6 months and included the prevalence of chronic diseases, disability in the over 75s, and recording of health markers, such as smoking status. Thirty-three out of 52 practices participated. There was marked variation in prevalences and recording of health markers between practices. Recorded prevalence of hypertension and diabetes increased steadily from 1994 to 1998. Outcomes, judged by the original objectives, were mixed. However, as the project evolved, evidence emerged that MEDICS was contributing to a culture in which the use of data from practice clinical systems to improve patient care has become a core objective. Key lessons from our experience include appreciating: the importance of data quality and minimising workload for practices; the difficulties practices face in recording morbidity data consistently and systematically; the limitations of GP morbidity data for health needs assessment and commissioning at district level; and the need to focus on providing useful and relevant data for individual practices. MEDICS now covers all 53 Northumberland practices. The project focuses on recording and analysing data to help practices improve structured patient care. Increasingly data collection in general practice in Northumberland is seen as a core activity with the current dataset linking closely with local priorities and reflecting national initiatives such as Clinical Governance and National Service Frameworks.

The National Service Framework (NSF) for coronary heart disease (CHD) requires that all people with established CHD are identified and managed systematically; accurate and complete electronic patient records (EPRs) are thus essential. This project aimed to first establish the completeness and consistency of recording electronic information about CHD (diagnosis, risk factor monitoring and aspirin usage) across a group of general practices and secondly, to provide feedback on their performance. The third part of the project planned to evaluate the effect of this feedback on the general practices’ electronic data recording but this is not reported in this article. Twenty-two of 26 general practices in one Primary Care Trust (PCT) participated. A random sample of 75 people with a Read code for CHD and/or who were taking one or more of five drugs used in CHD were selected from each of the 15 practices using Egton Medical Information Systems (EMIS) to manage their EPRs. The remaining seven practices used Torex electronic clinical system and from each of these practices, a random sample of 25 patients with a Read code for CHD was selected. Sample sizes were pragmatic rather than being chosen for possible statistical significance. At each practice the patients’ paper patient records and EPRs were searched for information about CHD diagnosis, risk factor monitoring and aspirin usage. Results were fedback and discussed with each individual practice and presented to the PCT. Electronic recording of CHD diagnosis was fairly complete but recording of risk factor monitoring and aspirin usage was more inconsistently recorded. Providing feedback to the general practices raised practitioners’ awareness of strengths and weaknesses in their electronic record keeping. Work to improve EPRs needs to be ongoing, to ensure that there is complete and easily accessible information about people with CHD so that their care management can be planned and implemented effectively.