A rapid evidence-based service by librarians provided information to answer primary care clinical questions

Clinical informationist participation in grand round sessions of gastroenterology department: An action research study

BACKGROUND

Nowadays, providing access to the required information by clinical informationist (CI) is vital for clinical teams to make the best decision. This study was carried out to identifying how CIs should participate in grand round (GR).

MATERIALS AND METHODS

The current study is an action research study. It was conducted in the GR sessions of the Gastroenterology department of Al-Zahra Hospital affiliated with Isfahan University of Medical Sciences in 2017. Participants included attending physicians, fellowship students of the Gastroenterology departments, a CI, and two supervising medical librarians. Data were collected through observation and discussion. Qualitative content analysis and concept mapping were used for data analysis.

RESULTS

The findings indicated that existing problems were related to the CI, medical team, and infrastructural ones. The participation of the CI in medical team was arranged based on the following steps: planning, action, evaluation, and suggestions. It started from an initial diagnosis of patients and ended in GR meetings. During evaluation step, suggestions were made to remove the existing problems and in the fifth step, results were summarized and a framework for the participation of the CI in GR sessions was suggested.

CONCLUSIONS

Medical team members were satisfied with the participation of the CI, but it is necessary to remove the existing structural and personal barriers (related to the CI and medical team members), in order to improve the efficiency of this participation.

Essential Services of Clinical Librarians in Academic and Health Care Settings: A Cross-Sectional Study

This article provides a comprehensive summary of clinical librarian service models in the US, Canada, and the UK from a cross-sectional study. An online survey received 182 responses from clinical librarians in hospital (62%), academic (26%), and other (10%) libraries. These clinical librarians shared the services they provide, patrons they work with, and their perceptions of the value they add to clinical environments. Overall, this study quantifies the services offered most frequently by clinical librarians, the services felt to be most valuable, and the variety of health care clientele whom clinical librarians serve. These findings have implications for current clinical librarians, libraries and health care institutions, and for those who may become clinical librarians in the future.

A clinical librarian in a hospital critical care unit may generate a positive return on investment

BACKGROUND

Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit.

OBJECTIVE

The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital.

METHODS

Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention. Total costs included salary and equipment costs. Total monetised benefits included time saving for hospital staff, support for professional development and improved patient care.

RESULTS

When total monetised benefits were compared with total costs, the 15-month clinical librarian intervention generated a positive ROI of £1.18-£3.03 for every £1 invested.

DISCUSSION

Using outcome measures derived from previous research, this novel study generated promising results indicative for commissioners seeking to improve patient care and deliver value for money. To improve generalisability, multisite studies using standardised ROI tools are recommended.

CONCLUSION

Employing a clinical librarian in a critical care unit can generate a positive ROI.

Pre-requisites, barriers and advantages of clinical informationist participation in grand round: a qualitative study

BACKGROUND

Clinical specialists require access to the most recent and up to date professional information. However, barriers such as insufficient time and lack of necessary information retrieval skills necessitate the presence of clinical informationist (CI) in medical teams.

OBJECTIVES

This study sought to determine the pre-requisite for CI participation in the grand round.

METHODS

This was a qualitative study carried out using content analysis approach. Study involved all fellowship students and attending physicians in the department of gastroenterology at Al-Zahra hospital in Isfahan (Iran), who were selected using purposive sampling. Gathered reports were analysed using qualitative content analysis and concept mapping approaches.

DISCUSSION

To improve the process of CI collaboration with clinical specialists during the educational rounds, it is necessary for CI to have certain pre-requisite skills.

CONCLUSIONS

By identifying the pre-requisites for CI participation in the grand round and explaining advantages of this participation for clinical specialists, this study proposes a suitable process for implantation of CI participation in grand rounds.

The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors

Objective:

The research sought to identify the general use of medical librarians in pediatric residency training, to define the role of medical librarians in teaching evidence-based medicine (EBM) to pediatric residents, and to describe strategies and curricula for teaching EBM used in pediatric residency training programs.

Methods:

We sent a 13-question web-based survey through the Association of Pediatric Program Directors to 200 pediatric residency program directors between August and December 2015.

Results:

A total of 91 (46%) pediatric residency program directors responded. Most (76%) programs had formal EBM curricula, and more than 75% of curricula addressed question formation, searching, assessment of validity, generalizability, quantitative importance, statistical significance, and applicability. The venues for teaching EBM that program directors perceived to be most effective included journal clubs (84%), conferences (44%), and morning report (36%). While 80% of programs utilized medical librarians, most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic not necessarily EBM (58%). Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. The use of a librarian was not associated with having an EBM curriculum but was significantly associated with the size of the program. Smaller programs were more likely to utilize librarians (100%) than were medium (71%) or large programs (75%).

Conclusions:

While most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians’ expertise in teaching EBM is underutilized. Programs should work to better integrate librarians’ expertise, both in the didactic and clinical teaching of EBM.

How Do I Find the Evidence? Find Your Librarian-Stat!

Clinical nurses often struggle with a lack of time and proficiency when it comes to finding and reviewing research. Knowing where to start, and discerning which search terms will retrieve the best results, can be arduous. As expert searchers, medical librarians have the skills and knowledge to make significant contributions to the clinical team, helping nurses navigate information resources and research from start to finish. When there is not direct access to a librarian, the toolbox of resources outlined in the article can save nurses' time and effort when they require quality, evidence-based information.

Do Continuing Medical Education (CME) events cover the content physicians want to know? A content analysis of CME offerings

INTRODUCTION

The purpose of this study is to assess whether annual refresher session offerings match the needs of physicians by coding and comparing session syllabi to physician questions collected electronically at the point of care.

METHODS

Thirteen syllabi from annual refresher continuing medical education (CME) events offered to family physicians in Canada were collected and their session titles and descriptions entered into a database. Titles and descriptions were coded using the International Classification for Primary Care version 2 (ICPC-2). Titles and descriptions were further coded depending on whether the sessions involved a drug treatment/medication component. Syllabi content was compared to previously determined questions asked by physicians at the point of care.

RESULTS

Of the original 701 session titles, 625 (89.2%) were suitable for analysis. CME sessions focused on musculoskeletal, digestive, skin, urologic, and general categories were underrepresented in comparison to point-of-care questions. The reverse was true for the psychological/mental health category.

DISCUSSION

Differences between questions asked by physicians at the point of care and the content of contemporaneous CME refresher courses can be analyzed to identify gaps in CME offerings. This knowledge could be used to develop CME curricula and highlight areas of need for inclusion in refresher courses.

The status of health librarianship and libraries in the Republic of Ireland (SHELLI): a mixed methods review to inform future strategy and sustainability

BACKGROUND

This paper summarises the main points of a review of the Status of Health Librarianship & Libraries in Ireland (SHELLI). The review was commissioned to gain a broad understanding of what was happening in practice in Ireland; acquire knowledge about international best practice, and to inform strategic plans to develop and sustain health libraries and librarianship in Ireland.

METHODS

A Mixed Methods approach was used: a literature review; an online survey distributed to health librarians; Semi structured interviews with key stakeholders; a focus group drawing participants from the survey. All evidence was triangulated.

RESULTS

New roles for health librarians needed development and the changing educational needs of health librarians warranted attention. Increased collaboration across institutional boundaries needed more consideration, especially in relation to access to e-resources. Marketing of library services was crucial. Irish health library standards, needed to be updated and enforced and a proper evidence base established. The literature provided a number of examples of potentially useful initiatives.

CONCLUSIONS

A strategic plan of action was drawn up in three areas: (i) to identify champions and promote visibility of health service libraries, (ii) to establish a body of evidence and (iii) to support service development and staff mentoring.

Infection control professionals' information-seeking preferences

OBJECTIVES

The aims of this study were to: 1) establish whether infection control professionals (ICPs) who had access to and utilised medical librarian services for evidence-based medicine (EBM) research perceived this assistance to be useful and 2) to establish whether ICPs who used electronic or hard copy resources for EBM research perceived that those resources had a significant impact on their work.

METHODS

Convenience sampling was used to collect quantitative data via a questionnaire. Study participants were members of South-west and Western chapters of the Association for Professionals in Infection Control and Epidemiology. There were 264 questionnaires distributed in this study; 179 participants completed the questionnaire. The response rate for eligible respondents was 59.5% (157).

RESULTS

Results indicated 56.7% (51) of the ICPs with librarian access reported requesting assistance from their work facility librarian. In reference to locating infection control information, 77.9% (95), 87.3% (124) and 93.3% (138) of ICPs found textbooks, journals and the Internet 'very useful' or 'useful', respectively.

CONCLUSION

Study results indicated ICPs who used the assistance of medical librarians and/or hard copy or electronic resources for EBM research perceived such sources to be valuable for obtaining infection control information.

What do primary care practitioners want to know? A content analysis of questions asked at the point of care

INTRODUCTION

Assessing physician needs to develop continuing medical education (CME) activities is an integral part of CME curriculum development. The purpose of the present study was to demonstrate the feasibility of identifying areas of perceived greatest needs for continuing medical education (CME) by using questions collected electronically at the point of care.

METHODS

This study is a secondary analysis of the "Just-in-Time" (JIT) information librarian consultation service database of questions using quantitative content analysis methods. The original JIT project demonstrated the feasibility of a real-time librarian service for answering questions asked by primary care clinicians at the point of care using a Web-based platform or handheld device. Data were collected from 88 primary care practitioners in Ontario, Canada, from October 2005 to April 2006. Questions were answered in less than 15 minutes, enabling clinicians to use the answer during patient encounters.

RESULTS

Description of type and frequency of questions asked, including the organ system on which the questions focused, was produced using 2 classification systems, the "taxonomy of generic clinical questions" (TGCQ), and the International Classification for Primary Care version 2 (ICPC-2). Of the original 1889 questions, 1871 (99.0%) were suitable for analysis. A total of 970 (52%) of questions related to therapy; of these, 671 (69.2%) addressed questions about drug therapy, representing 36% of all questions. Questions related to diagnosis (24.8%) and epidemiology (13.5%) were also common. Organ systems questions concerning musculoskeletal, endocrine, skin, cardiac, and digestive systems were asked more than other categories.

DISCUSSION

Questions collected at the point of care provide a valuable and unique source of information on the true learning needs of practicing clinicians. The TGCQ classification allowed us to show that a majority of questions had to do with treatment, particularly drug treatment, whereas the use of the ICPC-2 classification illustrated the great variety of questions asked about the diverse conditions encountered in primary care. It is feasible to use electronically collected questions asked by primary care clinicians in clinical practice to categorize self-identified knowledge and practice needs. This could be used to inform the development of future learning activities.

Expert searching in health librarianship: a literature review to identify international issues and Australian concerns

BACKGROUND

The traditional role of health librarians as expert searchers is under challenge.

OBJECTIVES

The purpose of this review is to establish health librarians' views, practices and educational processes on expert searching.

METHODS

The search strategy was developed in LISTA and then customised for ten other databases: ALISA, PubMed, Embase, Scopus, Web of Science, CINAHL, ERIC, PsycINFO, Cochrane Library and Google Scholar. The search terms were (expert search* OR expert retriev* OR mediated search* OR information retriev*) AND librar*. The searches, completed in December 2010 and repeated in May 2011, were limited to English language publications from 2000 to 2011 (unless seminal works).

RESULTS

Expert searching remains a key role for health librarians, especially for those supporting systematic reviews or employed as clinical librarians answering clinical questions.

CONCLUSIONS

Although clients tend to be satisfied with searches carried out for them, improvements are required to effectively position the profession. Evidence-based guidelines, adherence to transparent standards, review of entry-level education requirements and a commitment to accredited, rigorous, ongoing professional development will ensure best practice.

A cost-consequences analysis of a primary care librarian question and answering service

Background

Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs).

Methods

We conducted a cost consequences analysis based on data from the JIT project [1]. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system.

Results

The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55.

Conclusions

The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

Evidence-based medicine: is the evidence out there for primary care clinicians?

BACKGROUND

Finding evidence to answer clinical questions is essential to the practice of evidence-based medicine (EBM). However, practising EBM in primary care is thought to be problematic because of concerns about whether evidence exists to answer specific questions.

OBJECTIVES

To determine the highest level of evidence per question; to ascertain the number of questions unanswered because of a lack of evidence; to establish the frequency with which guidelines answered questions; and to determine the domain of websites used to answer questions.

METHODS

Clinical questions were identified from two primary care answering services: ATTRACT and National Library for Health (NLH) Primary Care Answering Service. The types of evidence used to answer the question were noted, including whether this was from systematic reviews or meta-analyses (level one evidence) or from randomised controlled trials (level two). The data were collected from March to June 2008.

RESULTS

Level 1 or level 2 evidence answered 11% of questions. Sixteen per cent were unanswered because of a lack of evidence. Over 40% of questions were answered using guidelines. Forty-three per cent of questions were answered with one type of evidence and 24% with two.

CONCLUSION

Guidelines are useful resources for primary care clinicians, answering two-fifths of questions.

Meeting the challenges of clinical information provision

This virtual issue of the Health Information and Libraries Journal (HILJ) has been compiled to mark the 5th International Clinical Librarian Conference 2011. In considering the challenges of clinical information provision, the content selected for the virtual issue offers an international flavour of clinical information provision and covers a variety of different facets of clinical librarianship. The issue broadly covers the areas of information needs and preferences, clinical librarian roles and services, and education and training, and reflects the way in which a normal issue of the HILJ would be presented. This includes a review article, a collection of original articles, and the three regular features which comprise International Perspectives and Initiatives, Learning and Teaching in Action, and Using Evidence in Practice. All papers included in this virtual issue are available free online.

Celebrating the role of health information

This inaugural virtual issue of the Health Information and Libraries Journal (HILJ) celebrates the contribution of health information in informing health and social care library and information provision. It has been drawn together to reflect the 2010 biennial Health Libraries Group conference theme of Keeping Information Centre Stage Amid Changing Scenery and includes a series of eleven key papers published in the journal over the last two years. This virtual issue mirrors the usual format of a journal issue with a review article, original articles and regular features on Learning and Teaching in Action, Using Evidence in Practice and International Perspectives and Initiatives. All papers included in this virtual issue of Health Information and Libraries Journal are available free online.