Brief
Communications
Clinical Medical Librarians in a Private Teaching-Hospital Setting By Lois ANN COLAIANNI, Director of Libraries Cedars-Sinai Medical Center Los Angeles, California THE library staff in the Cedars-Sinai Medical Center has been seeking more meaningful ways in which to make its services available to health professionals in the center. The clinical medical librarianship program at the University of' Missouri-Kansas City (UMKC) School of Medicine [1 ] seemed to offer one exciting possibility. After a visit to UMKC in 197.3 and a talk with Dr. Gertrude Lamb, Project Director at that time, and her staff', clinical medical librarianship was transplanted in a modif'ied form to the Cedars of Lebanon Hospital Division of' the Cedars-Sinai Medical Center. The medical center includes two separate general hospital facilities. The Cedars of Lebanon Hospital Division, in the Hollywood district of' Los Angeles, has more than 500 active beds. In addition to providing graduate medical training programs the center is a major teaching hospital for 2d, :3d, and 4th year medical students f'rom the Univ ersity of' Calitornia, Los Angeles. School of' Medicine. The medical librarv contains approximately 10,000 texts and subscribes to over 500 current journals. It is staffed by two f'ull-time medical librarians, a full-time library assistant, and 0.75 FTE librarv clerks. In April 1973 one librarian began attending weekly teaching rounds in surgery. At the request of the Chief Resident and the Department Head, a librarian began attending weekly teaching rounds in pediatrics in August 1973. Approximately six months later rounds in obstetrics were added. Bedside rounds are conducted in surgery and include the Department Head. the Chief Resident, residents, interns, and medical students. Pediatric and obstetrical rounds are at times not bedside and, in addition to the house staff', include attending physicians and members of' the nursing staftf'. In discussions ot' cases the librarian pays particular attention to such ques410
tions as "How common is this disease?" "What is the current management?" or "What are the complications of this therapy?" When a question is not answered or a difference of' opinion is voiced strongly, the question and the questioner are noted. As the librarian became a familiar figure, the staff directed questions to her for a search of' the literature. Rounds last 60-90 minutes and during this time the librarian usually notes three to eight questions that warrant a f'ollow-up. After rounds the librarian spends no more than two hours establishing a priority for the questions, selecting one to three succinct or comprehensive articles answering each question, and arranging for the material to be photocopied. The librarian is only "allowed" two hours, owing to the pressure of'other responsibilities. Literature searches are usually done manually because of the small number of references required. However, MEDLINE is available and in some cases extremely useful. Material to answer rush questions is prepared and the physician is notif'ied within two hours. Photocopies answering routine questions are ready within twenty-four hours. These copies are f'iled in a departmental resource f'ile for pediatrics, f'iled in a notebook in the library for surgery, and sent to each requester in obstetrics. The library staff' is able to provide this service without additional personnel by working harder and more efficiently on their other tasks. Rounds are found to be a most stimulating experience. Our experience indicates it requires 1 to 1I 2 hours to attend rounds and 2 hours to search the literature; that is 3 2 to 4 hours of a librarian's time per week for each rounds attended. Another half-hour of' clerical time is necessary for photocopying the material. For each rounds 50-100 photocopy exposures are made. PROBLEMS ENCOUNTERED 1. The librarian needs to learn to select "good" articles. The tendency is to overrespond in an attempt to avoid missing a critical article. 2. Daily contact with illness and death forces an adjustment to these realities; the librarian's closer involvement with the health care team usually increases sensitivities in these areas of' Bull. Med. Libr. Assoc. 63(4) Oct. 1975
BRIEF COMMUNICATIONS
the health professional's activities. 3. The program needs to be evaluated continually to determine whether it is a good use of the librarian's time. POSITINVE RESULTS 1. The librarian has an improved feel for what information the health prof'essional needs. 2. The health professionals understand what the librarian can contribute as a member of' the health care team. 3. Many questions raised at the bedside are never answered because the pressure of other activities discourages the requester from going to the library. 4. Evaluations made by the physicians indicate that the program has immense educational benefits which cannot help but be reflected in improved patient care. If the library is to be an active partner in the system of obtaining information in a medical center, ways of establishing this partnership are needed. The clinical medical librarianship program is one method; each librarian will have to decide whether it is an appropriate method in his or her institution.
disciplinary compartmentalization of knowledge, the unprecedented increase in the number of journals published, spiraling subscription rates, and the changing hospital have combined to present a perplexing problem to the health science librarian . ." [1]. Those words are still appropriate todav. In the intervening vears others [2, 3] have recommended journal titles to assist the hospital librarian in selection. These titles have been based on suggestions. not on journal titles hospital librarians actually acquire. In 1973 the Medical Library Group of Southern Calif'ornia compiled a union list of' medical and paramedical serials in thirty-four Southern Calif'ornia hospitals and six institutions serving individuals involved in the delivery of health care. Using data from the 197a4 edition of' the American Hospital Association Guide to the Health Care Field, the characteristics of the hospital group contributing to the union list are described in Table 1. The six other institutions include two pharmaceutical companies. one health insurance corporation, two research facilities, and one
consulting corporation. Holdings lists included in the union list were and any title subscribed to by twentv reviewed 1. ALGERMISSEN, V. Biomedical librarians in a patient care setting at the University of Missouri- or more of the forty participating institutions REFERENCE
Kansas City School of Medicine. Bull. Med. Libr. Assoc. 62: 354-8. Oct. 1974.
TABLE 1 CHARACTERISTICS OF THE HOSPITAILS
Journal Titles Held by Forty Health Care Institutions in Southern California
No. with
No. of hospitals internship
By Lois ANN COLAIANNI, Director of Libraries
Cedars-Sinai Medical Center Los Angeles. California
1
1
0 2 2 1 1
1 0 2 2 1
23
2000and
1 34
11
201-300 301-400
Bull. Med. Libr. Assoc. 63(4) Oct. 197.5
0 1 5 3
0 0 0 0 1
Medical Sciences Librarv University of California, Irvine Irvine. California
ninety recommended journals for the health science librarv: "Two decades ago the answer to the question, 'to which journals should the library in our hospital subscribe?' was fairly easy to determine. Today the disappearance of
0 1 5 5 5 0
701-800 801-900 901-999 1000-1999
101-200
IN 1967 Helen Yast, Librarian of the American Hospital Association, began an article listing
0 0 2 3 4 0
1 5 9 6 5 0 1 0 2 2 2
0-100
CYNTHIA BUTLER, Head of Public Services
401-500 501-600 601-700
No. with medical school resiaff ildencies iation No. with
:3 0
1
over
Total
19
411
Communications
Clinical Medical Librarians in a Private Teaching-Hospital Setting By Lois ANN COLAIANNI, Director of Libraries Cedars-Sinai Medical Center Los Angeles, California THE library staff in the Cedars-Sinai Medical Center has been seeking more meaningful ways in which to make its services available to health professionals in the center. The clinical medical librarianship program at the University of' Missouri-Kansas City (UMKC) School of Medicine [1 ] seemed to offer one exciting possibility. After a visit to UMKC in 197.3 and a talk with Dr. Gertrude Lamb, Project Director at that time, and her staff', clinical medical librarianship was transplanted in a modif'ied form to the Cedars of Lebanon Hospital Division of' the Cedars-Sinai Medical Center. The medical center includes two separate general hospital facilities. The Cedars of Lebanon Hospital Division, in the Hollywood district of' Los Angeles, has more than 500 active beds. In addition to providing graduate medical training programs the center is a major teaching hospital for 2d, :3d, and 4th year medical students f'rom the Univ ersity of' Calitornia, Los Angeles. School of' Medicine. The medical librarv contains approximately 10,000 texts and subscribes to over 500 current journals. It is staffed by two f'ull-time medical librarians, a full-time library assistant, and 0.75 FTE librarv clerks. In April 1973 one librarian began attending weekly teaching rounds in surgery. At the request of the Chief Resident and the Department Head, a librarian began attending weekly teaching rounds in pediatrics in August 1973. Approximately six months later rounds in obstetrics were added. Bedside rounds are conducted in surgery and include the Department Head. the Chief Resident, residents, interns, and medical students. Pediatric and obstetrical rounds are at times not bedside and, in addition to the house staff', include attending physicians and members of' the nursing staftf'. In discussions ot' cases the librarian pays particular attention to such ques410
tions as "How common is this disease?" "What is the current management?" or "What are the complications of this therapy?" When a question is not answered or a difference of' opinion is voiced strongly, the question and the questioner are noted. As the librarian became a familiar figure, the staff directed questions to her for a search of' the literature. Rounds last 60-90 minutes and during this time the librarian usually notes three to eight questions that warrant a f'ollow-up. After rounds the librarian spends no more than two hours establishing a priority for the questions, selecting one to three succinct or comprehensive articles answering each question, and arranging for the material to be photocopied. The librarian is only "allowed" two hours, owing to the pressure of'other responsibilities. Literature searches are usually done manually because of the small number of references required. However, MEDLINE is available and in some cases extremely useful. Material to answer rush questions is prepared and the physician is notif'ied within two hours. Photocopies answering routine questions are ready within twenty-four hours. These copies are f'iled in a departmental resource f'ile for pediatrics, f'iled in a notebook in the library for surgery, and sent to each requester in obstetrics. The library staff' is able to provide this service without additional personnel by working harder and more efficiently on their other tasks. Rounds are found to be a most stimulating experience. Our experience indicates it requires 1 to 1I 2 hours to attend rounds and 2 hours to search the literature; that is 3 2 to 4 hours of a librarian's time per week for each rounds attended. Another half-hour of' clerical time is necessary for photocopying the material. For each rounds 50-100 photocopy exposures are made. PROBLEMS ENCOUNTERED 1. The librarian needs to learn to select "good" articles. The tendency is to overrespond in an attempt to avoid missing a critical article. 2. Daily contact with illness and death forces an adjustment to these realities; the librarian's closer involvement with the health care team usually increases sensitivities in these areas of' Bull. Med. Libr. Assoc. 63(4) Oct. 1975
BRIEF COMMUNICATIONS
the health professional's activities. 3. The program needs to be evaluated continually to determine whether it is a good use of the librarian's time. POSITINVE RESULTS 1. The librarian has an improved feel for what information the health prof'essional needs. 2. The health professionals understand what the librarian can contribute as a member of' the health care team. 3. Many questions raised at the bedside are never answered because the pressure of other activities discourages the requester from going to the library. 4. Evaluations made by the physicians indicate that the program has immense educational benefits which cannot help but be reflected in improved patient care. If the library is to be an active partner in the system of obtaining information in a medical center, ways of establishing this partnership are needed. The clinical medical librarianship program is one method; each librarian will have to decide whether it is an appropriate method in his or her institution.
disciplinary compartmentalization of knowledge, the unprecedented increase in the number of journals published, spiraling subscription rates, and the changing hospital have combined to present a perplexing problem to the health science librarian . ." [1]. Those words are still appropriate todav. In the intervening vears others [2, 3] have recommended journal titles to assist the hospital librarian in selection. These titles have been based on suggestions. not on journal titles hospital librarians actually acquire. In 1973 the Medical Library Group of Southern Calif'ornia compiled a union list of' medical and paramedical serials in thirty-four Southern Calif'ornia hospitals and six institutions serving individuals involved in the delivery of health care. Using data from the 197a4 edition of' the American Hospital Association Guide to the Health Care Field, the characteristics of the hospital group contributing to the union list are described in Table 1. The six other institutions include two pharmaceutical companies. one health insurance corporation, two research facilities, and one
consulting corporation. Holdings lists included in the union list were and any title subscribed to by twentv reviewed 1. ALGERMISSEN, V. Biomedical librarians in a patient care setting at the University of Missouri- or more of the forty participating institutions REFERENCE
Kansas City School of Medicine. Bull. Med. Libr. Assoc. 62: 354-8. Oct. 1974.
TABLE 1 CHARACTERISTICS OF THE HOSPITAILS
Journal Titles Held by Forty Health Care Institutions in Southern California
No. with
No. of hospitals internship
By Lois ANN COLAIANNI, Director of Libraries
Cedars-Sinai Medical Center Los Angeles. California
1
1
0 2 2 1 1
1 0 2 2 1
23
2000and
1 34
11
201-300 301-400
Bull. Med. Libr. Assoc. 63(4) Oct. 197.5
0 1 5 3
0 0 0 0 1
Medical Sciences Librarv University of California, Irvine Irvine. California
ninety recommended journals for the health science librarv: "Two decades ago the answer to the question, 'to which journals should the library in our hospital subscribe?' was fairly easy to determine. Today the disappearance of
0 1 5 5 5 0
701-800 801-900 901-999 1000-1999
101-200
IN 1967 Helen Yast, Librarian of the American Hospital Association, began an article listing
0 0 2 3 4 0
1 5 9 6 5 0 1 0 2 2 2
0-100
CYNTHIA BUTLER, Head of Public Services
401-500 501-600 601-700
No. with medical school resiaff ildencies iation No. with
:3 0
1
over
Total
19
411
