Value of Library and Information Services in Patient Care Study Executive Summary Talbot Research Library Fox Chase Cancer Center Philadelphia, Pennsylvania National Network of Libraries of Medicine, Middle Atlantic Region School of Information & Library Science, University of North Carolina at Chapel Hill 1

Value of Library and Information Services in Patient Care Study Last Fall, the Talbot Research Library was accepted to participate in the launch phase of the Value Study. A web-based survey was administered to clinicians, on a voluntary basis, in March-April The purpose of the study was to understand the value and impact of information resources and services provided by the library and librarians on patient care. The Value Study was a partnership of the National Network of Libraries of Medicine, Middle Atlantic Region (NNLM/MAR) and the University of North Carolina at Chapel Hill (UNC). 56 libraries serving 118 institutions in the US and Canada participated in the survey. 2

3 Survey methods Web-based survey (open to clinicians performing patient care or clinical research) Invitation to participate in the survey was sent via lists –Dr. Bob Beck, Dorothy Riehs, and Joanne Hambleton served as “champions” for the study Four survey reminders were sent to boost participation.

Critical incident technique In the survey, respondents were asked to think about an occasion in the last six months when they looked for information resources for patient care (beyond what is available in the patient record, EMR system or lab results) and to answer questions regarding that occasion. 4

Response and Demographics Fox Chase had a favorable response rate – 110 responses (30%) as compared to an overall response rate of 10%. The majority of Fox Chase participants were women (73%). The majority of FCCC participants were in the age group (61%).

Education and Experience of Participants Fox Chase physician participants had a higher percentage of MD and PhD degrees as compared to overall respondents. Fox Chase nurse participants had a higher percentage of Bachelor, Masters, and PhD degrees. Fox Chase had more participants who were Certified Nurse Practitioners than overall participants. The majority of Fox Chase participants (61%) had 16 years or more experience as a health care professional, compared to the overall respondents (52%).

Results: Value of library and information sources 7

Changes in handling the clinical situation and patient care as a result of the information 67% of FCCC participants responded that they probably or definitely handled the clinical situation differently as a result of having the information (75% overall). 55% of FCCC participants indicated that the information influenced them in advising their patient or their patient’s family (48% overall). 60% of FCCC physician participants indicated that the information influenced their choice of treatment (42% overall) 43% of FCCC physicians’ choice of drugs was influenced by the information (46% overall).

Value of the information Almost 100% of all participants (FCCC and overall) agreed that the information was: Relevant Accurate Will be useful in the future Was of clinical value Helped refresh memory of details and facts Contributed to higher quality of care Current

Value of Information (cont) 96% of FCCC participants agreed that the information resulted in a better informed clinical decision (95% overall). 93% indicated that it provided new knowledge (92% overall). 91% responded that it substantiated prior knowledge (95% overall). 86% agreed that having the information saved them time (88% of FCCC physicians and 100% FCCC nurses) Overall results were85%.

How many hours of time was saved as a result of this information? It saved FCCC physicians a mean of 2.8 hours (Overall 2.6) It saved FCCC nurses a mean of 1.3 hours (Overall 2.0) It saved FCCC clinician respondents an average of 2 hours (overall 2.5)

Adverse Effects Avoided 25% of FCCC clinician participants avoided patient misunderstanding of disease as a result of the info (23% overall) 18% of FCCC participants (26% FCCC physicians) avoided additional tests or procedures (19% overall) 14% of FCCC participants (23% of FCCC physicians) avoided an adverse drug reaction of interaction (13% overall)

Importance of Library and non-library resources in answering the question Library/Information Resources was ranked no.1 by 98% of FCCC clinicians (97% overall). Discussion with colleagues was considered important by 92% of FCCC clinicians (also 92% overall). Lab Tests were important to 89% of FCCC clinicians (87% overall). Diagnostic imaging was important to 79% of FCCC clinicians (80% overall).

Results: Library resources used 14

Number of Resources Used FCCC physicians used an average of 4.7 resources in answering the clinical question (overall physicians consulted 3.8). FCCC nurses used an average of 3.5 resources (overall nurses consulted 2.8).

Top five library resources used 16 Overall (n=100) Attending physicians (n=38) Nurses (n=51) PubMed/ MEDLINE60%82%45% UpToDate55%79%39% Micromedex53%42%65% Journals (online)49%66%41% Books (online)26%32%18% Overall (n=14,591) Attending physicians (n=5,233) Nurses (n=6,280) Journals (online)46%59%30% PubMed/MEDLINE42%54%25% UpToDate40%53%18% Books (online)30%32%22% Micromedex24%14%35% FCCC Overall

Did you find the information you needed? 80% of FCCC attending physicians answered “completely” (64% overall). 53% of FCCC nurses answered “completely” (52% overall). 17% of FCCC clinicians answered “partially due to time constraints” (21% overall). 14% of FCCC clinicians answered “partially due to information incomplete” (16% overall). 2% of FCCC nurses (0% of FCCC physicians) answered “not at all” (2% and 0% overall).

Access Points used 74% of FCCC physicians accessed the info via the library’s website (60% of physicians overall). 65% of FCCC nurses accessed the info via the institutional intranet. 24% of FCCC physicians found the info in the institution’s library (21% of physicians overall). 18% of FCCC physicians found the information by asking a librarian or member of the library staff (15% of physicians overall).

Summary Information provided by the Talbot Research Library influences FCCC clinicians in managing clinical situations, advising patients, and in choice of treatment and drugs. Information provided was relevant, accurate, current, and believed to contribute to higher quality of care. Participants responded that the information saved time, decreased additional tests and procedures, and avoided adverse drug reactions and patient misunderstandings. Library resources outranked other resources and most clinicians’ questions were completely answered or partially answered. Most information is accessed from the library’s website or the institutional intranet, although 24% of FCCC physicians still find it in the physical library. 18% of FCCC physicians found the information with the assistance of a librarian or library staff member.