Special Feature

Online Resources in Critical Care Medicine

By James E. McFeely, MD, Medical Director Critical Care Units, Alta Bates Summit Medical Center, Berkeley, CA, is Associate Editor for Critical Care Alert.

Dr. McFeely reports no financial relationship to this field of study.

A wide variety of resources have been developed over the last several years, primarily Internet-based, to assist the critical care provider in managing patients in the ICU. These resources span a wide spectrum of topics and quality, but when used selectively can enhance both the quality and efficiency of care provided to critically ill patients.

Professional society websites

All the major professional societies have websites, many of which offer resources for both provider education and specific disease management (see Table 1). In particular, the Society of Critical Care Medicine website has E-learning modules of pediatric and adult ICU topics which, while primarily developed for house staff, also provide an excellent overview for the critical care practitioner. The American Association of Critical Care Nurses (AACN) provides an E-learning program, practice resource links, collections of websites, and more than 300 continuing education offerings for their members.

Table 1. Professional Society Websites

Society of Critical Care Medicine

American Association of Critical Care Nurses

American Thoracic Society

European Society of Intensive Care Medicine

Intensive Care Society

American Association for Thoracic Surgery

http://www.sccm.org

http://www.aacn.org/

http://www.thoracic.org/

http://www.esicm.org/

http://www.ics.ac.uk/

http://www.aats.org

Comprehensive Resources

There are several Internet sites that act as comprehensive medical resources, encompassing information on all fields of medicine. These are essentially continuously updated online textbooks (see Table 2). The MD Consult website not only encompasses disease-specific reviews but also provides direct access to online versions of many of the classic textbooks that, in the pre-Internet era, were the primary resource for clinicians. UpToDate has an excellent collection of patient information pamphlets that either can be directly e-mailed or printed and handed to patients. ICUroom.net has daily pearls and video presentations of most of the major invasive procedures performed in critical care medicine. Continuing medical education (CME) credits can be earned directly through most of these websites, and some of that CME is free (e.g., Epocrates.com). A recent article identified more than 135 web-based educational resources for critical care education.1

Table 2. Comprehensive Resources

UpToDate ($495/yr)

MDconsult ($395/yr)

Medscape

SCCM eLearning portal

PubMed

Epocrates (free and paid)

http://www.uptodate.com

http://www.mdconsult.com

http://www.medscape.com/

http://learnicu.org/Pages/default.aspx

http://www.ncbi.nlm.nih.gov/pubmed/

http://www.epocrates.com/products/

Medical Calculators

Some of the Internet resources most frequently used by clinicians are various calculators for determining patient-specific information to guide disease management. Many of the general sites listed above (see Table 2) have calculators built into them. In addition, simply typing the relevant calculation into a Google search (e.g., "A-a gradient," "free water deficit") will bring up the appropriate calculator at the top of the results page. Clinicians will need to confirm for themselves that the calculator is applying the appropriate formula and that the units of measure in the web-based calculator are the same as in the data entered by the clinician.

Pharmacy Database

Clinicians also frequently use Internet-based resources to review pharmacy information. A number of excellent resources are available. The general sites listed above all include current drug information. Epocrates.com provides a free pharmacy app that is very popular. In addition, the Physician's Desk Reference (PDR) can be accessed directly online (PDR.net). There also is a mobile version of the PDR available for smart phones.

Practice Guidelines

We often have a need for specific practice guidelines. They are available in the general sites listed in Table 2. They also can be found at disease-specific websites (see Table 3). In addition, practice guidelines can be specifically searched for using the PubMed website. For those unfamiliar with how to search specifically for guidelines, there is a YouTube video available describing how to perform such a search (http://www.youtube.com/watch?v=O4z2RrobKLc). Many procedural videos also are available on YouTube.

Table 3. Disease-Specific Websites

Surviving Sepsis Campaign

ARDS Foundation

American Heart Association

American Stroke Association

Mayo Clinic Patient Information Site

http://www.survivingsepsis.org

http://www.ardsil.com/

http://www.heart.org

http://www.strokeassociation.org

http://www.mayoclinic.com/health-information/

Discussion Groups

A number of the medical society websites have links to discussion groups for their membership. For example, the Society of Critical Care Medicine (SCCM) website in particular has sites devoted to discussions of specific disease entities, ICU management issues, and integration of care.

Patient Education and Information

Many of the general sites mentioned above have information written at a level appropriate to distribute to patients and families. The disease-specific websites also often have good patient information (see Table 3). In addition, the Mayo Clinic website has excellent materials on most major medical topics written for patients and families.

Smart Phones

Smart phone technology has evolved rapidly over the last few years and now provides access to point-of-care information on most major medical topics. In particular, there are many software packages available for the iPhone and Android operating systems (see Table 4). These include medical calculators; pharmacy databases; mobile access to the SCCM website; and applications to track and assist with billing using ICD-9, CPT codes, and tracking of RVUs.

Table 4. Smart Phone Application Websites

iPhone Store

Android Store

Blackberry

http://www.apple.com/iphone/apps-for-iphone/

https://market.android.com/apps/MEDICAL

http://appworld.blackberry.com

There are a wide variety of online resources available to the critical care clinician. This article is only able to skim the surface of what is available. Relying on major society websites, general medical information sites, and increasingly the use of smart phones, the ICU clinician will be able to efficiently provide the most up-to-date care for his or her patients.

Reference

  1. Kleinpell R, et al. Web-based resources for critical care education. Crit Care Med 2011;39:541-553.