Impact of facilitating physician access to relevant medical literature on outcomes of hospitalised internal medicine patients: a randomised controlled trial.

Introduction: There is limited high-quality evidence regarding the usefulness of bibliographic assistance in improving clinically important outcomes in hospitalised patients. This study was designed to evaluate the impact of providing attending physicians with bibliographic information to assist them in answering medical questions that arise during daily clinical practice.

Methods: All patients admitted to the Internal Medicine ward of Hospital Aleman in Buenos Aires between March and August 2010 were randomly assigned to one of two groups: intervention or control. Throughout this period, the medical questions that arose during morning rounds were identified. Bibliographic research was conducted to answer only those questions that emerged during the discussion of patients assigned to the intervention group. The compiled information was sent via e-mail to all members of the medical team.

Results: 809 patients were included in the study, 407 were randomly assigned to a search-supported group and 402 to a control group. There was no significant difference in death or transfer to an intensive care unit (ICU) (RR 1.09 (95% CI 0.7 to 1.6)), rehospitalisation (RR 1.0 (95% CI 0.7 to 1.3)) or length of hospitalisation (6.5 vs 6.0 days, p=0.25). The subgroup of search-supported physicians' patients (n=31), whose attending physicians received hand-delivered information, had a significantly lower risk of death or transfer to an ICU compared with the control group (0% vs 13.7%, p=0.03).

Conclusions: The impact of bibliographic assistance on clinically important outcomes could not be proven by this study. However, results suggest that some interventions, such as delivering information by hand, might be beneficial in a subgroup of inpatients.