Clinical Librarianship

Kimberly Hancock, B.A., M.L.S.Regional Library ServicesWestern 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 1974• 23 Programs in 1985• 29 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?• Email• 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 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

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• http://www.med.mun.ca/nlhkin/

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

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DocumentDelivery

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Library Services @ Western Health• Combination of models:

• Traditional hospital library services

• Academic Library Services

• Some Clinical Librarian services