Clinical Librarianship

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Clinical Librarianship

• Kimberly Hancock, B.A., M.L.S.
• Regional Library Services
• Western Health

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Objectives

• Definition
• History
• Role of Clinical Librarian
• Evaluation of Clinical Librarian Services
• Library Services at Western Health

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Definition

• Clinical Medical Librarian (CML) services involve
  placing medical librarians at the point of
  decision-making within acute care institutions
  (Sladek 2004)
• Providing quality filtered information to
  clinician at the point of need to promote
  evidence-based health care(Winning Beverly,
  2003)

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Clinical Medical Librarian

• Takes the Library to the user
• Often provides information before they have asked
  for it

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Goals of CML Services

• To overcome the time, cost and expertise barriers
  that clinicians face when they attempt to
  incorporate the best current evidence from the
  literature into their patient care decisions.
• To enhance the educational experience of students
  and resident physicians in training.

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History

• Originated in the United states 1970s
• Funding from the National Library of Medicine
• University of Missouri - Kansas City School of
  Medicine 1971 Gertrude Lamb
• Hartford Hospital and the University of
  Connecticut Health Center 1974

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History

• Four programs by 1974
• 23 Programs in 1985
• 29 Programs in 1993
• (Bull Med Lib Assoc 2000)

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United Kingdom Trends

• Developing new Clinical Librarian programs
• Adapting or adding to existing library
  information services
• Response to Clinical Governance movement and
  evidence based health care

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Clinical Librarian Core Duties

• Attendance at ward rounds, case conferences,
  other clinical meetings
• Clinical guidelines development
• Information searching
• Information evaluation
• Teaching
• Service promotion (Sargeant, 2004)

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New Profile of the Clinical Librarian

• Expert knowledge
• Involved with professional team
• Attend bedside rounds / clinical meetings
• Contribute to continuing education
• Impact patient care
• Provide quality filtered case specific
  information
• Provide immediate responses at the point of
  care
• Define the clinical problem

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Role of Clinical Librarian

• Searching or helping to search for Evidence
• Evidence educators
• Dissemination of information
• Collaboration
• Infomediaries between patients and physicians

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Core Competencies / Education

• Familiarity with Medline, CINAHL and other
  relevant health databases
• Hand-held technology
• User education
• Project management
• Medical terminology courses (Sargeant, 2004)

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Who uses Clinical Librarian Services

• Medical Staff
• Nursing and midwifery
• Allied Health Professionals
• Clinical Governance and related staff
• Other groups i.e. bioengineers and social workers

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How is contact made?

• Email
• Clinical meetings
• Personal / informal contacts
• Ward rounds

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Clinical Librarians Activity

• Literature searching 12
• Teaching 11
• Meetings with health professionals 12
• Other information services average 9-28 (Ward,
  2004)

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What information is provided

• 100 send list of bibliographic citations
• 50 include search strategy
• 65 include a digest / summary of the results
  found

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Challenges

• Role definition for Librarians
• Budget
• Staff development for Clinical Librarians
• Workload stress
• Acceptance of Clinical Librarian services by
  other health professionals

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Evaluation of Clinical Librarian Services

• Wagner Review 2004
• 35 studies over 30 years using formal evaluation
  methods
• Mostly descriptive surveys of user opinions,
  inconsistent statistics
• Comparative quantitative research methods very
  rare only four studies

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Evaluation

• Cumulative evidence finds the CML program users
  find the information resources provided useful
  and good quality.
• However, no measurement of impact on direct
  patient care i.e. LOS, mortality, adverse drug
  effects etc.

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Areas for Research

• Settings for CML
• Impact of changing healthcare landscape
• Kind of work schedule
• Optimal ratio of CML to healthcare professionals
• Training or skill sets
• Optimal length of time to evaluate a CML program
• Effectiveness of anticipating information
  requests versus responding to direct requests
• Which evaluation data gathering and analysis
  strategies most effective

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New Research

• Banks 2007
• Study on decreased LOS associated with
  presentation of cases at morning report with
  librarian support
• Demonstrated a decreased length of stay for
  librarian supported cases (3 days versus 5 for
  controls)

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Library Services at Western Health

• Regional Library Services
• Three full time staff, part time student staffing
• Open 800 am to 1000 pm Monday Thursday,
  Friday 800 500 Saturday 900 500, Sunday
  100 1000

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Locations

• WMRH Level II
• STRH Close to Organizational Development
• Legrow Off main lobby
• Other sites resource room located in
  administration area and close to clinical areas

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Overview of Services

• All services and resources are available
  throughout the region
• Main collection in WMRH
• Smaller core collections in other sites /
  departments

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Library Services

• Literature Searches
• Interlibrary Loans
• Document Delivery
• Table of Contents
• Coin operated Photocopiers
• Internet Access
• Selected Dissemination of Information
• Teaching Sessions

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Physical Resources

• Books
• Medicine
• Nursing
• Management
• Allied Health
• Consumer Health

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Physical Resources

• Journals
• 200 Titles
• Medicine
• Nursing
• Allied Health
• Management

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Physical Resources

• Videos / DVDs
• Medicine
• Nursing
• Consumer Health

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Electronic Resources

• Newfoundland Labrador Health Knowledge
  Information Network (NLHKIN)
• Pubmed
• CINAHL
• Cochrane
• PsychInfo
• Social Work Abstracts
• Biomedicine Reference

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Electronic Resources

• NLHKIN
• 1600 full text electronic journals
• Links out to the full text from the databases
• http//www.med.mun.ca/nlhkin/

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Library Marketing

• Monthly general staff orientation
• Orientation of all new physicians
• Orientation of all new students
• Brochure
• Newsletter articles
• Internet and Intranet pages

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Library Outreach

• Meetings with clinical teams
• Child Protection Unit Stephenville
• Child Management Specialists
• Psychology Professional Practice Group
• Community Support Leadership Team
• Maternal Child Unit staff
• Psychiatry Unit
• Social Workers
• Medical Rounds

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Library Outreach

• Organizational Integration Evaluation Teams
• Population Health staff meetings
• Information Management Team
• Breastfeeding Action Group

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Library Usage Statistics
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Library Usage Statistics
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Library Services _at_ Western Health

• Combination of models
• Traditional hospital library services
• Academic Library Services
• Some Clinical Librarian services