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

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

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)

Clinical Medical Librarian Takes the Library to the user Often provides information before they have asked for it

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.

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

History Four programs by Programs in Programs in 1993 (Bull Med Lib Assoc 2000)

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

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 )

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

Role of Clinical Librarian Searching or helping to search for Evidence Evidence educators Dissemination of information Collaboration “ Infomediaries ” between patients and physicians

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

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

How is contact made? Clinical meetings Personal / informal contacts Ward rounds

Clinical Librarians ’ Activity Literature searching 12% Teaching 11% Meetings with health professionals 12% Other information services average 9- 28% (Ward, 2004)

What information is provided 100% send list of bibliographic citations 50% include search strategy 65% include a digest / summary of the results found

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

Evaluation of Clinical Librarian Services Wagner Review 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

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.

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

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)

Library Services at Western Health Regional Library Services Three full time staff, part time student staffing Open 8:00 am to 10:00 pm Monday – Thursday, Friday 8:00 – 5:00; Saturday 9:00 – 5:00, Sunday 1:00 – 10:00

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

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

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

Physical Resources Books  Medicine  Nursing  Management  Allied Health  Consumer Health

Physical Resources Journals 200 Titles Medicine Nursing Allied Health Management

Physical Resources Videos / DVD ’ s Medicine Nursing Consumer Health

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

Electronic Resources NLHKIN 1600 full text electronic journals Links out to the full text from the databases

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

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

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

Library Usage Statistics

Library Western Health Combination of models: Traditional hospital library services Academic Library Services Some Clinical Librarian services