Clinical questions raised by clinicians at the point of care: a systematic review.

Del Fiol G, Workman TE, Gorman PN. Systematic review: the relationship between clinical experience and quality of health care. JAMA Intern Med. 2014 May;174(5):710-8. doi: 10.1001/jamainternmed.2014.368.

Clinicians frequently raise questions about patient care in their practice. Although they are effective at finding answers to questions they pursue, roughly half of the questions are never pursued. This picture has been fairly stable over time despite the broad availability of online evidence resources that can answer these questions. Technology-based solutions should enable clinicians to track their questions and provide just-in-time access to high-quality evidence in the context of patient care decision making. Opportunities for improvement include the recent adoption of electronic health record systems and maintenance of certification requirements.

  • In 11 studies, 7012 questions were elicited through short interviews with clinicians after each patient visit.
  • The mean frequency of questions raised was 0.57 (95% CI, 0.38-0.77) per patient seen, and clinicians pursued 51% (36%-66%) of questions and found answers to 78% (67%-88%) of those they pursued.
  • Overall, 34% of questions concerned drug treatment, and 24% concerned potential causes of a symptom, physical finding, or diagnostic test finding.
  • Clinicians' lack of time and doubt that a useful answer exists were the main barriers to information seeking.