As part of the Kanta-Häme Hospital District, the Kanta-Häme Central Hospital (KHCH) is an acute care 338-bed hospital providing patient-centered, specialized medical care through its two facilities in Hämeenlinna and Riihimäki, in the south of Finland. The Hämeenlinna unit serves the entire hospital district of 173,800 inhabitants, while the Riihimäki unit primarily serves municipalities in the region, as well as the Janakkala area, for a total of 62,400 inhabitants. Combined, these two facilities employ 140 full-time clinicians and 850 full-time nurses.
Assessing the need for UpToDate
Interest in UpToDate was initially generated by two clinicians who had individual subscriptions funded by the hospital. Based on their feedback, and on the experience of other Finnish healthcare institutions already using the resource, the hospital decided to run a trial of UpToDate, asking all physicians to test it in their daily use.
While clinicians already had access to a local database of evidence-based guidelines in Finnish, the hospital clinical management was looking for a more comprehensive resource that would support clinicians when they needed to research conditions that were less common and about which they had less knowledge or experience. The results from the trial period confirmed UpToDate was a much needed resource to ensure patients were receiving high quality care, and the clinical decision support resource was officially adopted by Kanta-Häme Central Hospital in March of 2010. One of the deciding factors that led clinicians to adopt UpToDate during the trial was the depth and breadth of its content. With clinical topics spanning 16 specialties (which has grown to 25 specialties in 2017), UpToDate enabled clinicians to investigate unusual and often rare cases, something that set it apart from the local resource, which focused on a smaller group of more common diseases.
The main reason for purchasing UpToDate was the breadth of content. With UpToDate, physicians also get information and recommendations on rare cases where they don't have as much experience.
From UpToDate, I find clinical manifestation for different syndromes or genetic problems which are quite rare…It is impossible to know every rare disease, but with good information sources, it is possible to find answers to clinical questions and benefit from the evidence and experts' knowledge.
The survey targeted KHCH clinicians and compared UpToDate and the other resource. For a period of two weeks in December 2016, 6 questions were asked, covering the following areas:
…It is really a joy to read most of the time, compared to some bullet point guidelines… One of the most important things is that UpToDate also provides the opinion of the writers. In addition to the guideline/treatment recommendation itself, it is very useful to hear what the personal, experienced opinion of an expert is.
The next step in the adoption of UpToDate at Kanta-Häme Central Hospital will be the embedding of the clinical decision support resource into its patient information system, Effica.
We think that having UpToDate is a win-win-win situation. It's a win for the patients, who get better care thanks to the clinical staff having access to the latest relevant information. It's a win for clinicians and nurses, because they can rely on a trustworthy resource in their daily decision-making. And, ultimately, it's a win for hospital management, who can see an improvement in the quality of care we provide as well as in overall patient satisfaction.