Point of Care
Point-of-Care in EBP
Point-of-care resources offer synthesized information evaluated by experts that often includes rating scales or graded recommendations. Most of this information is secondary, and has been pre-appraised to allow for quick, on-the-spot decision making.
Benefits of point-of-care tools include:
- more efficient search structure than in large, "academic" databases
- results in the form of systematic reviews, meta-analyses, guidelines, and critically appraised topics
- immediate access to full text (in most cases)
Resource Types: Systems, Synopses, Syntheses, Studies
From a point-of-care perspective, we can place evidence into four categories:
Systems |
DescriptionTextbook-like resources that summarize evidence, often intended to aid clinical decision making. Resource examplesDatabases: Cochrane Answers | DSM V TR | UpToDate |
Synopses |
DescriptionSummaries of expertly assessed studies and systematic reviews with advice for application. Resource examplesDatabases: ACP Journal Club | TRIP (Open Access) | ECRI Guidelines (Open Access) |
Syntheses |
DescriptionSystematic reviews and clinical practice guidelines that critically assess the state of the research. Resource examplesDatabases: Cochrane Library of Systematic Reviews | PubMed Clinical Queries (Open Access) |
Studies |
DescriptionIndividual clinical studies (ie. randomized controlled trials) in peer-reviewed publications. Resource examplesDatabases: PubMed (MEDLINE, PMC) | CINAHL | PsycINFO | SocINDEX |
When searching for best evidence in clinical decision making, start at the the top of the hierarchy with systems and work your way down to synopses, syntheses, and studies. Opt for databases like PEPID or UpToDate, which present information quickly, clearly, and efficiently.
Remember that point-of-care tools are meant to save time in a fast-paced clinical environment. Even so, it is important to maintain proficiency in larger databases such as MEDLINE, in order to locate new research studies as they are published.
Mobile Applications can also be very helpful at the point-of-care, however, use caution since nearly anyone can develop an app! You must carefully evaluate the information & source. STAT!Ref is a library resource with a mobile app that is recommended to NAU students, as it provides access to ACP Smart Medicine, 5 Minute Clinical Consult, Red Book, and more.
Clinical Practice Guidelines - Websites
The following websites and portals provide quick access to summative evidence corresponding with different clinical domains.
- 2 Minute MedicineA medical review organization originating from Harvard Medical School, 2MM provides quick, precise summaries of studies and guidelines, and breaks it down into manageable chunks.
- AAP Pediatric Collectionsaddress important issues in pediatric medicine, child health, public health, trending news/events, and the latest best practices in pediatric medicine. Key policy statements and research are complemented with news articles and blog posts to concisely explain the key findings and recommendations for improvement in practice, policy, and education.
- ACC Expert Consensus Decision PathwaysECDPs are intended to provide guidance for clinicians in areas where evidence may be limited, new and evolving, or lack sufficient data to fully inform clinical decision making. They include algorithms that are more actionable and can be translated into tools or apps to further accelerate the use of ACC's clinical policy at the point of care.
- ACP Clinical RecommendationsACP develops three different types of clinical recommendations: Clinical Practice Guidelines, Clinical Guidance Statements, and Best Practice Advice. ACP's goal is to provide clinicians with recommendations based on the best available evidence; to inform clinicians of when there is no evidence; and finally, to help clinicians deliver the best health care possible.
- AFP Healthcare TopicsAFP editors have identified our best collection of information on the most commonly sought topics and assembled it here for your convenience. The editors will periodically add to these to ensure that they remain as useful as possible.
- CMA Infobase: Clinical Practice Guidelinesa database of evidence-based Canadian clinical practice guidelines (CPGs). It includes approximately 1,200 clinical practice guidelines developed or endorsed by authoritative medical or health organizations in Canada.
- ECRI Guidelines Trust"Publicly available web-based repository of objective, evidence-based clinical practice guideline content. Its purpose is to provide physicians, nurses, other clinical specialties, and members of the healthcare community with up-to-date clinical practices to advance safe and effective patient care. This centralized repository includes evidence-based guidance developed by nationally and internationally recognized medical organizations and medical specialty societies."
- NCCIP Clinical Practice Guidelines for Complementary and Integrative Health"Issued by third-party organizations, and not NCCIH, these guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature. These guidelines are not fixed protocols that must be followed, but are intended for health care professionals and providers to consider. While they identify and describe generally recommended courses of intervention, they are not presented as a substitute for the advice of a physician or other knowledgeable health care professional or provider."
- NICE Guidance - Guidelines and PathwaysThe National Institute for Health & Care Excellence (NICE) provides guidance, advice, quality standards and information services for health, public health and social care. Also contains resources to help maximize use of evidence and guidance.
Click here to go to UpToDate
UpToDate is used across healthcare as a go-to resource for point of care information. It is a complex platform with a host of resources. These include:
- Practice Changing Updates | updates to the biomedical literature which might necessitate a change in practice.
- Drug Information | Pharmaceutical information for providers and patients, with further breakdown by pediatrics and international care
- Patient Education | Consumer health information presented in basic overviews and more advanced, detailed reviews
- Calculators | a wide range of measurements divided up by discipline / specialty (ie: anesthesiology)
- Drug Interactions | an experimental calculator that identifies potential interactions when combining different medications
Accessing UpToDate
UpToDate can be easily accessed from the web or mobile after following a few simple steps!
- Click on the UpToDate link on the NAU A-Z Databases page: https://libraryguides.nau.edu/az.php;
- You will most likely be prompted to login with your NAU credentials;
- You will be redirected to the UpToDate homepage (which looks a lot like Google!);
- Go ahead and click "Register" in the top right corner of the screen, and enter your information;
- Now that you've registered, you can bypass the NAU website, and go to UpToDate at www.uptodate.com;
- Keep in mind, you will sometimes be prompted to authenticate from the NAU website, but not often;
- You can now download the UpToDate Mobile App by following the instructions on the this page: https://www.uptodate.com/home/how-access-uptodate
- You are all set! If you have any questions, you can always reach out to NAU Library for answers!
Searching UpToDate
Search functions in UpToDate are similar to those in Google Search. Boolean operators are not necessary. Additionally, UpToDate will associate search terms with controlled vocabulary (ie: a search for "heart attack" delivers results for "myocardial infarction").
Reviewing results in UpToDate
Information in UpToDate is subject to consistent peer review and editing daily. Review is conducted by authors and editors based on their specialty. Following evidence-based practice, decisions are made following a hierarchy of evidence, beginning with meta-analysis of randomized clinical trials.
Based on the amount of research available, and the quality of that research, UpToDate reviewers provide recommendations for practice, with focus on the following: 1) quality of evidence; 2) relative importance of the outcomes; 3) magnitude of effect; 4) absolute magnitude of the effect; 5) precision of the estimates of the effects; 6) cost.
Graded recommendations in UpToDate
Many results in UpToDate will carry a graded weight that falls anywhere between strong recommendations with high quality evidence and weak recommendations with low quality evidence. See this page for more in-depth information.
| Grade of recommendation | Clarity of risk / benefit | Quality of supporting evidence | Implications |
|---|---|---|---|
|
1A Strong recommendation, high quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa. | Consistent evidence from well performed randomized, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk. | Strong recommendations, can apply to most patients in most circumstances without reservation. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
|
1B. Strong recommendation, moderate quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa. | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate. | Strong recommendation and applies to most patients. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
|
1C. Strong recommendation, low quality evidence |
Benefits appear to outweigh risk and burdens, or vice versa. | Evidence from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain. | Strong recommendation, and applies to most patients. Some of the evidence base supporting the recommendation is, however, of low quality. |
|
2A. Weak recommendation, high quality evidence |
Benefits closely balanced with risks and burdens. | Consistent evidence from well performed randomized, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk. | Weak recommendation, best action may differ depending on circumstances or patients or societal values. |
|
2B. Weak recommendation, moderate quality evidence |
Benefits closely balanced with risks and burdens, some uncertainly in the estimates of benefits, risks and burdens. | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate. | Weak recommendation, alternative approaches likely to be better for some patients under some circumstances. |
|
2C. Weak recommendation, low quality evidence |
Uncertainty in the estimates of benefits, risks, and burdens; benefits may be closely balanced with risks and burdens. | Evidence from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain. | Very weak recommendation; other alternatives may be equally reasonable. |
Point-of-care tools
The following list of tools are available for online access through a web browser. They are designed to provide immediate reference for questions relating to measurement, definitions, ICD codes, and clinical inquiries.
- AccessMedicine English-Spanish Medical Dictionary (NAU Only)An up-to-date medical dictionary with English terms and Spanish equivalents, as well as explanations how to use a medical dictionary for translation, tips for Medical Spanish, and pronunciation.
- AHRQ Electronic Preventive Services SelectorThe ePSS is an application commissioned by the AHRQ and updated by the U.S. Preventive Services Task Force. It is designed to help primary care providers identify preventive services appropriate to their patients. NOTE: the EPSS Calculator does not provide preventive service information for gender non-conforming patients. Neither does it take into account the prevalence of health disparities in determining necessary services.
- BCM Age-based Pediatric Blood Pressure Reference ChartsThis calculator can help to determine whether a child has a healthy blood pressure for his/her height, age and gender. The normal range of blood pressure varies based on sex characteristics, height percentile, and age. This calculator automatically adjusts for differences in height, age and gender, calculating a child's height percentile along with blood pressure percentile. The normal blood pressure range, while steadily increasing with age, will shift based on the child's height.
- Diagnosaurus by AccessMedicine (NAU only)"Diagnosaurus provides differential diagnoses (DDx) of symptoms, signs, and diseases. By using the various indexes, you can choose to view entries by organ system, or select to view the list of symptoms only, the list of diseases only, or all of the entries. For example, if you wish to review the causes of a patient's chief complaint, simply select the symptom or sign from the alphabetical listing. If you have made a diagnosis and wonder what other disorders to consider, select your diagnosis from the list to see its DDx."
- STAT!Ref Toolkit (NAU Only)The STAT!Ref database comes with a number of helpful tools, including: ICD Procedure and Diagnosis Codes, BoardVitals, Stedman's Medical Dictionary, and EBMcalc
- UpToDate Calculators (NAU Only)UpToDate provides access to an enormous range of calculators for everything from temperature and weight to discipline-specific callculators for point of care.
Mobile apps
Unless otherwise noted, the following list mobile apps are available on both Android and iOS devices.
Mobile apps are useful tools for having immediate access to information in the moment. They are also particularly useful for medical translation (see MediBabble and Canopy Speak). Additionally, you'll find apps for calculation, definitions, and shared-decision making. Of course, patients might also find value in these and other mobile apps.
- BMJ Best Practice MobilePools information from the BMJ Best Practice web app for mobile use. It is one of the most respected resources available for summaries.
NOTE: "This companion app is available to those who have access to BMJ Best Practice. To download this app, all users will need to set up a personal account on the BMJ Best Practice website." - Calculate by QxMD"Essential tools in General Practice, Internal Medicine, Cardiology, Surgery, Obstetrics, Nephrology, Hematology, Orthopedics, Pediatrics, Gastroenterology, Neurology, Neurosurgery, Respirology, and more."
- Canopy Speak"Communicate quickly with patients using translated medical phrases in Spanish, Chinese, Arabic, Hindi, Korean, Malay, Portuguese, Russian, Tagalog, Vietnamese, and more. Show phrases with text, and play with audio."
- CDC Medical Eligibility Criteria for Contraceptive Use (CDC US MEC)"The U.S. Medical Eligibility Criteria for Contraceptive Use comprises recommendations for the use of specific contraceptive methods by patients who have certain characteristics or medical conditions. The U.S. Selected Practice Recommendations for Contraceptive Use addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods."
- CDC STD Treatment Guide (2015)The STD Tx Guide app is a quick reference guide for healthcare professionals and related parties on the identification of and treatment for sexually transmitted diseases.
- CDC Vaccine Schedules"Quick access from CDC to ACIP-recommended immunization schedules, complete with footnotes. Intended for healthcare professionals recommending and administering vaccines to infants, children, adolescents, and adults."
- EpocratesEpocrates provides access to a number of different point of care resources, including calculators, tables,guidelines, and prescription information.
- MediBabble Translator (iOS only)MediBabble is "a free, professional-grade medical interpretation app for healthcare providers. MediBabble is a history-taking and physical exam application designed to improve the safety, efficiency, and quality of care for non-English speaking patients."
- Medscape"Medscape provides fast and accurate clinical answers at the point-of-care and is the leading medical resource for physicians, medical students, nurses, and other healthcare professionals. Using Medscape Consult, physicians can access a community of more than 250K physicians worldwide to share cases, ask questions, and benefit from their knowledge and diverse experiences. Discuss clinical challenges and crowdsource the answers in a 24/7 moderated environment."
- STAT!Ref Mobile"STAT!Ref is a reputable healthcare e-resource enabling users to intuitively cross-search full-text, evidence-based and authoritative resources. With 300+ resources currently offered in over 50 healthcare disciplines, STAT!Ref provides the latest healthcare information in a customizable and convenient format. STAT!Ref is used by millions of professionals and over 90% of medical universities. This free app ensures that Android users will get the most from STAT!Ref database content, provided courtesy of your library. NOTE: Access to an existing STAT!Ref Online subscription is required in order to use this app."
Patient education
Many of the following resources are freely available to patients as consumer health information resources. However, in some cases, providers might also want to access these resources so as to provide them to patients during / after any patient-provider interview.
- AZDHS Newborn ScreeningThe Arizona Office of Newborn Screening, a division of Arizona's Public Health Preparedness within the Department of Health Services is charged with the responsibility of ensuring that the testing for congenital disorders, critical congenital heart defects, and hearing loss are conducted in an effective and efficient manner. The program provides education to the general public, the medical community, parents and professional groups.
- Catch-up Vaccination SchedulerA patient education tool based on the 2018 Childhood and Adolescent Immunization Schedule recommended by the ACIP, AAP, AAFP, and ACOG. This parent-friendly tool provides generally recommended dates for immunizations based on your child's birth date and vaccination history. Some diseases or treatments for disease affect the immune system.
- CDC Milestone TrackerDeveloped by the CDC, this app allows parents / guardians to track a child's healthcare from 2 months to 5 years.
- CDCPA Immunizations and Developmental MilestonesThis chart can help parents track immunization for their infant child from birth through 6 years old.
- End the Epidemic - AMA Task Force to End Opioid AbuseProvides access to patient and physician educational materials in the areas of education, treatment, stigma, Naloxone, and safe storage of opiates.
- Familydoctor.orgA product of the AAFP (American Academy of Family Physicians), Familydoctor.org provides patient-based information regarding disease prevention and control, wellness, family health, and links to external health resources, as well as an interactive symptom checker.
- Healthfinder.govHealthfinder.gov has resources on a wide range of health topics selected from approximately 1,400 government and non-profit organizations.
- Health Literacy Online: A Guide for Simplifying the User ExperienceThis guide, from Health.gov, provides step-by-step instructions to ensure that online and mobile health information meets health literacy standards for patient education.
- HHS Office of Minority Health Knowledge CenterThe OMHRC Knowledge Center contains a collection of 50,000 documents, books, journal articles, and media related to the health status of racial and ethnic minority populations. The library collection also includes sources of consumer health material in more than 35 languages.
- MedlinePlusBEST BET MedlinePlus is one of the most widely recognized consumer health resources on the Internet. It is provided through the U.S. National Library of Medicine.
- OSHA NIOSH Heat Safety Tool"Take precautions against outdoor heat while at work with the OSHA-NIOSH Heat Safety Tool. Featuring real-time heat index and hourly forecasts, specific to your location, as well as occupational safety and health recommendations from OSHA and NIOSH. The OSHA-NIOSH Heat Safety Tool is a useful resource for planning outdoor work activities based on how hot it feels throughout the day."
- UpToDate - Patient Education Portal (NAU Only)UpToDate provides more than 1,500 patient education topics, plus more than 1,000 translated into universal Spanish, that facilitate clinician-patient communication. These materials educate and promote shared decision-making based on medical evidence, clinical recommendations, and patient preference. Engaging patients in their medical care and treatment decisions often reduces costs and leads to better outcomes. UpToDate patient articles include full-color pictures, graphics, and charts to help the reader understand his or her condition and to reinforce key messages regarding care.