ICLC 1: Quality Assurance for Clinical Librarians, Informationists, and Embedded Librarians

As a clinical librarian, I always wondered if getting started in rounds could be made easier, that there were some kind of rules in establishing the clinical librarian in a service that I didn’t know about. Now I feel relieved – Alison Aldrich in her presentation “Starting from scratch: establishing a role for an informationist on rounds” demonstrated that there are no rules but there are some strategies you can use. These strategies include: having an elevator speech to quickly define who you are and the value you bring; exuding a confident “belongingness”; using time between the rounds to cultivate relationships with the team. Over and above the service component, Aldrich confirmed that the presence of an informationist engenders a culture of inquiry that may not be there when the informationist is absent. This presents intriguing questions around an informationist’s presence as an influential agent for promoting patient safety. There also seems to be an inherent demand on the clinical librarian/informationist to synthesize the literature found on a question: employing critical appraisal, her and her colleague provide only the best 3-4 articles and summarize the overarching direction of evidence for a inquiry. Unfortunately Aldrich ran out of time to present their data but I look forward to talking to her further about their findings.
The “big data” from the Value study offers exciting data mining opportunities and follow up studies. Joan Bartlett in “The impact of library and information services on patient-care outcomes: a Canadian perspective” explained that she has obtained permission from the authors to conduct such a study on the Canadian libraries who participated in the study. Canadian qualities such as bilingual delivery of information services and resources, a publicly funded acute healthcare system, the absence of a national medical library, and national health research funding in knowledge translation activities contribute to a unique contribution to other national perspectives of the data.
Perhaps the most controversial paper presentation was Jane Surtees’ “Converting care to currency: the impact of UpToDate on test avoided, length of stay, time saved and referrals prevented in a large UK acute hospital trust”. The survey study was based on an UpToDate trial her library hosted over a 3-4 month period. Using a critical incident design, respondents were asked how they felt their usage impacted and/or influenced several patient-care indicators such as length of stay, and reduction of test requests. Of all the presenters in the session, Surtees received the most questions from the audience arising from the methodology presented and the conclusions drawn.
How much are the informationists at John Hopkins valued? This was the question Victoria Goode and her colleagues addressed in their study “Measuring value: a survey for assessing our impact”. The 22 question survey study, using the critical incident design, asked respondents to stream themselves into 1 of 4 categories of need; the category of research was the most selected, followed by patient care. The top reported benefits for informationist support for the research category, was publication output; for patient care, it was resolving/preventing miscommunication with patients. Many of the respondents commented on not knowing about informationist services. Since the survey, the informationists have begun internal medicine rounds supporting residents information needs arising from questions from patients and this interaction seems to be improving the marketing issue via word of mouth.
Vanderbuilt hospital had an evidence-based need: to reduce the number of test requests. An interdisciplinary committee was struck and several informationists were asked to participate in this committee. Rachel Walden on behalf of her co-authors presented “Providing expert collaboration for the development and implementation of evidence-based practices”, walking the audience through the process they took to manage the multiple variables and overlapping health topics such a question presents. They decided to triage their searching in the following way for each topic: Level 1 was focused on finding guidelines from organizations such as AHRQ, NICE – recognized for producing rigorous, well-done guidelines; if none were available, the searching moved to Level 2 which were guidelines (of lesser quality) and other evidence that provided decision recommendations; finally, if the topic search did not result in any guideline found (for whatever reason) primary evidence was provided. Walden gave the example of chest x-rays (pre-operative): with the exception of lung cancer, for all other clinical situations, Level 1 & 2 evidence was sufficient; in the case of lung cancer due to the changing evidence of this topic, Level 3 was used. One resource the committee used to focus their topic list was Choosing Wisely (www.choosingwisely.org). The template that Walden et al. created to synthesize and document this process was very nice and I encourage anyone interested in this process to look up their powerpoint when it is available to consult it. One key take home message that resonated with me was her message of “talk truth to power” diplomatically but confidently if you are being asked to support “garbage” just because a high-powered committee person has a vested interest in particular research. So true!

3 thoughts on “ICLC 1: Quality Assurance for Clinical Librarians, Informationists, and Embedded Librarians

  1. Thanks for writing on different sessions. I missed this session, however get a gist of it by reading this post. Very informative.
    Keep it up.

  2. Thanks for blogging this, Andrea. I didn’t actually have much more to say about our data, which is limited and preliminary at this point. I was hoping to talk briefly about the new ACGME accreditation standards, particularly milestone 15 about learning and improving at the point of care.
    http://www.acgme-nas.org/assets/pdf/Milestones/InternalMedicineMilestones.pdf
    I think clinical librarians in the US should have a role in helping their programs figure out how to fairly and realistically assess residents on these particular EBM competencies.

  3. I attended the International session on Monday. Jane Surtees presented her data on the use of UpToDate in Medicine. During the Q&A session that followed, a member of the audience stood and attacked Ms. Surtees not for the content of her work, which was excellent, but because she had chosen to study what is an unpopular resource in the library world. While it’s impossible to control the behavior of attendees, it was glaringly apparent that the moderator of the session lacked the training and experience to mitigate the uncomfortable turn of events. MLA should act immediately to ensure that such vitriolic attacks are appropriately handled. Ms. Surtees had considerable difficulty attending the MLA conference; her participation was in question right up until she flew. I hosted Ms. Surtees in my home during her stay in Greater Boston to help defray some of her travel costs in attending. I was, therefore, witness to her considerable distress after the session. I believe she felt unwelcome at MLA as a result of the interaction. Also, adding insult to injury, after the fact, the official MLA blog reported inaccurately on Ms. Surtees’ study design. Ms. Surtees should at very least receive an apology from MLA for a poorly handled situation. I was deeply embarrassed that a colleague, especially one from another country, had such a negative experience, and in all my years of professional librarianship, I have never seen such unprofessional behavior all the way around. Please act to prevent such occurrences in the future, and please act quickly to offer Ms. Surtees appropriate condolences for a conference that has left a very bad impression on a top-notch colleague.

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