the evolving role and value of libraries and librarians in health care

The Evolving Role and Value of Librariesand Librarians in Health Care

Changes in medical information and technology arerevolutionizing health care. As clinicians try to incorpo-rate research into practice through comparative effec-tiveness research and decision support, they increas-ingly depend on technology to bring evidence to thebedside to improve quality and patient outcomes. Inte-grating current information into the processes of shareddecision making and continuous learning supports theapplication of evidence in clinical decision making. Healthsciences libraries and librarians have an increasingly im-portant role in providing that information to cliniciansas well as to patients and their families.

Health sciences libraries and librarians, like all par-ticipants in the health and health education system, mustdo more with less. Medical journal prices have in-creased by more than 30% in 5 years, yet the budgetsof academic health sciences libraries (specifically, librar-ies that are members of the Association of AcademicHealth Sciences Libraries) increased by only 5.7% dur-ing that same period, and their workforce decreased by11% between 2009 and 2012.1-3 As a result, these librar-

ies in the United States and Canada are able to pur-chase fewer information resources (although they haveminimized the declines through creative strategies suchas shared purchasing). In trying to reconcile cost withvalue like other participants in the health care system,health sciences libraries find it necessary to consider theevidence regarding the changing roles and value ofhealth sciences libraries and librarians.

Recent research has shown the value of informa-tion in patient care and highlights the role of the libraryand librarian in supporting this information revolution.4-6

The Value Study, conducted by Marshall et al4 at 56 li-brary sites serving 118 hospitals, surveyed physicians,residents, and nurses who were involved in patient careor clinical research and could recall an event in the last6 months when they had used an information re-source. Of the 16 122 survey respondents (including 5379physicians, 2123 residents, and 6788 nurses), three-fourths reported that they had definitely or probablyhandled some aspect of patient care differently as a re-sult of the information obtained from the library and in-

formation resources. Among the changes reported wereadvice given to the patient (48%), diagnosis (25%), andchoice of drugs (33%). Most respondents (95%) re-ported that the information resulted in more informedclinical decisions. Respondents also reported that the in-formation allowed them to avoid or reduce the possi-bility of the following adverse events: patient misunder-standing of the disease (23%); additional tests (19%);misdiagnosis (13%); adverse drug reactions (13%); medi-cal errors (12%); and patient mortality (6%).4

Other studies complement these findings. Sievertet al,5 describing the results of a survey completed by328 physicians and other health professionals at 4 hos-pitals, reported that 71% of the respondents said theychanged how they managed the care of a particular pa-tient as a result of information from the health scienceslibrary, its website, or any of its resources. Brettle et al6

conducted a systematic review of the evaluation of clini-cal librarian services. In the 18 studies included in the re-view, the majority (14 studies [78%]) reported a posi-tive effect on patient care, and more than one-fourth

(5 studies [28%]) identified a positive ef-fect on the choice of drug or therapy.

The study by Marshall et al4 alsoconducted 24 follow-up interviews withclinicians to provide insight into the per-ceived role of the library and the librar-ian in supporting information needs.The results suggest that librariansare valued for their search expertise andfor their contributions in education,research, and quality and performance

improvement.4 For example, librarians may teach stu-dents and clinicians to efficiently and effectively searchfor evidence. Those who use library resources reportthe information to be of value, which suggests themedical profession should give more attention toteaching students and clinicians skills that couldimprove their evidence searching.

At some centers, librarians are also becoming moreembedded into patient safety and quality improve-ment initiatives and into research and clinical teams. Re-search has demonstrated that when clinical librarians areinvolved in providing information in the patient care set-ting, answers to clinical questions can be obtained morequickly and efficiently. In one controlled study, a clinicallibrarian joined the intervention team for patient rounds,providing evidence searching and instruction to resi-dents and medical students.7 A significant positive ef-fect was reported by the trainees; 27 of 34 participants(79%) said they changed treatment plans based on thelibrarian’s searches, and 30 (88%) based on their ownsearches after learning new information skills from the

VIEWPOINT

Julia F. Sollenberger,MLSEdward G. MinerLibrary, University ofRochester, Rochester,New York.

Robert G. Holloway Jr,MD, MPHDepartment ofNeurology, School ofMedicine and Dentistry,University ofRochester.

Author Reading atjama.com

CorrespondingAuthor: Julia F.Sollenberger, MLS,Edward G. MinerLibrary, University ofRochester, 601Elmwood Ave,Rochester, NY 14642(julia_sollenberger@urmc.rochester.edu).

A librarian’s presence at morning reportcorrelated positively with shorterlength of stays and lower hospitalcharges in 55 cases with 136 matchedcomparisons

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librarian. Another randomized controlled trial showed that librarian-provided answers to clinical questions had a positive effect on de-cision making in a primary care setting.8 Eighty-eight physicians andnurse practitioners submitted 1417 clinical questions to a librarianduring a 7-month period; 80% of the answers provided by librar-ians were rated by the participants as having a positive cognitive in-fluence on decision making, compared with 20.8% for the controlquestion responses.

The librarian also has an increasing role in providing patient- andfamily-centered information. In many hospitals and ambulatory careclinics, librarians are working directly with patients to help them un-derstand their conditions and their care options.9 Information pre-scription programs are developed to provide personalized informa-tion to patients. For instance, a health care practitioner (eg, physician,nurse, social worker) can make a referral to an appropriate re-source, often a librarian who then provides information targeted di-rectly to the patient’s or family’s needs. Although more research mustbe done to evaluate such programs, 1 study (of 149 information pre-scriptions completed in the neonatal intensive care unit and for pa-tients with breast cancer) suggested that in an academic hospital set-ting, an information prescription service was a “useful adjunct toexisting services.”9

Librarians also can play a role in managing the electronic infor-mation resources of a health care institution. Librarians and theirtechnology support staff choose what publications and informa-tion sources to buy; negotiate prices; ensure that electronic re-source vendors have the information they need to provide access;ensure remote access through proxy servers; organize the informa-tion on digital portals; build interfaces to facilitate searching; and col-lect and analyze usage data to validate responsible use of institu-tional resources.

In a well-functioning health care system, value should be de-fined as patient outcomes relative to costs. In a report by Marshallet al,4 85% of 11 887 survey respondents instructed to recall a spe-cific single patient encounter reported that having access to infor-mation saved them time. A case-control study by Banks et al10 dem-onstrated that librarian support was associated with saved resourcesand reduced costs beyond a health practitioner’s time savings; a li-brarian’s presence at morning report correlated positively withshorter length of stays and lower hospital charges in 55 cases with136 matched comparisons.

The shift to include librarians in care teams will require care-ful attention to workflow design and to organizational and socialissues. The presence of an additional person on the team willaffect interpersonal dynamics, communication flow, and atten-tion to proper role functioning to optimize team performance.There is also a significant time commitment by clinical librarians,with scalability and sustainability in question. Librarian trainingmust also be addressed, with competencies defined, clinicaldomain education expanded, and ethical concerns related to con-fidentiality and the Health Insurance Portability and Accountabil-ity Act discussed.

With ongoing changes in health care as a result of informationtechnology, health sciences libraries and librarians can play an im-portant role in bringing high-quality, evidence-based medical infor-mation to the bedside, helping to make patient care both efficientand effective. Health care libraries and librarians are adapting to thechanging information needs of physicians, other health care pro-fessions, researchers, and patients. With rigorous evaluation, en-hanced librarian training, and continuous attention to advances intechnology and needs of the users, health care librarians can pro-vide value to patient care.

ARTICLE INFORMATION

Conflict of Interest Disclosures: The authors havecompleted and submitted the ICMJE Form forDisclosure of Potential Conflicts of Interest andnone were reported.

REFERENCES

1. Association of Academic Health SciencesLibraries (AAHSL). Annual Statistics of MedicalSchool Libraries in the United States and Canada.31st ed. Seattle, WA: AAHSL; 2013.

2. Association of Academic Health SciencesLibraries (AAHSL). Annual Statistics of MedicalSchool Libraries in the United States and Canada.32nd ed. Seattle, WA: AAHSL; 2010.

3. Association of Academic Health SciencesLibraries (AAHSL). Annual Statistics of MedicalSchool Libraries in the United States and Canada.35th ed. Seattle, WA: AAHSL; 2013.

4. Marshall JG, Sollenberger JS, Easterby-GannettS, et al. The value of library and information servicesin patient care: results of a multisite study. J MedLibr Assoc. 2013;101(1):38-46.

5. Sievert M, Burhans D, Ward D, et al. Value ofhealth sciences library resources and services tohealth care providers in medium and largecommunities across two mid-continental states.J Hosp Librariansh. 2011;11(2):140-157.

6. Brettle A, Maden-Jenkins M, Anderson L, et al.Evaluating clinical librarian services: a systematicreview. Health Info Libr J. 2011;28(1):3-22.

7. Aitken EM, Powelson SE, Reaume RD, Ghali WA.Involving clinical librarians at the point of care:results of a controlled intervention. Acad Med.2011;86(12):1508-1512.

8. McGowan J, Hogg W, Campbell C, Rowan M.Just-in-time information improved decision-makingin primary care: a randomized controlled trial. PLoSOne. 2008;3(11):e3785.

9. Oliver KB, Lehmann HP, Wolff AC, et al.Evaluating information prescriptions in two clinicalenvironments. J Med Libr Assoc. 2011;99(3):237-246.

10. Banks DE, Shi R, Timm DF, et al. Decreasedhospital length of stay associated with presentationof cases at morning report with librarian support.J Med Libr Assoc. 2007;95(4):381-387.

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