Evaluation of a Clinical Medical Librarianship Program at a University Health Sciences Library* BY JANET G. SCHNALL, Reference Librarian
JOAN W. WILSON, Reference Coordinatort
Health Sciences Library University of Washington Seattle, Washington ABSTRACT An evaluation of the clinical medical librarianship program at the University of Washington Health Sciences Library was undertaken to determine the benefits of the program to patient care and to the education of the recipients of the service. Results of a questionnaire reflected overwhelming acceptance of the clinical medical librarianship program. Guidelines for the establishment of a limited clinical medical librarianship program are described. A statistical cost analysis of the program is included.
Care Unit (NICU) three times a week, and the other CML attended morning work rounds in the Department of Orthopedics twice a week. Each retrieved information on subjects or questions arising during rounds which called for additional information from the literature. A MEDLINE search was performed for most subjects, as this was the quickest method for retrieving current bibliographic information. If the CML determined MEDLINE to be inappropriate for the question, other sources were used, for example, Excerpta Medica, Science Citation Index, and textbooks. The requester then received either the bibliographic citations or the pertinent facts with the source noted, or two or three photocopied definitive articles on the subject selected from the MEDLINE printout by either the librarian or the requester. This procedure of searching and forwarding pertinent information was usually done within the same day on the NICU and within twenty-four hours for the Department of Orthopedics. The recipients of the service were encouraged to telephone their CML in the Health Sciences Library at any time during the week with questions that arose when the librarian was not present on rounds. During the experimental period 33% of the searches for the NICU and 5% of the searches for the Department of Orthopedics were done as a result of telephone requests.
STIMULATED by the clinical medical librarianship program of the University of Missouri-Kansas City as presented at the 1973 Annual Meeting of the Medical Library Association by Dr. Gertrude Lamb, the University of Washington Health Sciences Library planned a program on a more limited scale. In the fall of 1973 two reference librarians added the responsibility of attending hospital rounds to their activities so that they could provide a specialized literature service based on patient-related information needs. A questionnaire was planned as an evaluation tool to try to determine how much benefit there might be to the quality of care to individual patients and also to the education or continuing education of the interns, residents, medical students, nurses, physical therapists, and physicians who were the direct recipients of this service. DATA COLLECTION During an experimental period of eight months, one clinical medical librarian (CML) participated In May 1974, approximately eight months after in attending rounds on the Neonatal Intensive this service began, the CMLs distributed a threepage questionnaire (see Appendix 1) to all those *Based on a paper presented June 5, 1975, at the who had been present on rounds in the NICU and Seventy-fourth Annual Meeting of the Medical Library the Department of Orthopedics, regardless of Association, Cleveland, Ohio. tJoan W. Wilson is presently Head of Public Services, whether or not they had taken advantage of the Health Sciences Library, University of Virginia, service. A cover letter was attached to each quesCharlottesville, Virginia. tionnaire stating: first, the purpose of the experi-
Bull. Med. Libr. Assoc. 64(3)July 1976
CLINICAL MEDICAL LIBRARIANSHIP PROGRAM DISCUSSION The major difference in the results of the questionnaire between the NICU and the Department of Orthopedics was on the actual operation of the CML literature service. Seventy-three percent of the NICU as compared to 47% of the Department of Orthopedics preferred to have the CML present during rounds as opposed to having the CML services readily available full-time within the library. The other difference between the two departments (as stated previously) was the question of the clinical value of the literature service, where 97% of the NICU as compared to 67% of the Department of Orthopedics felt the literature service clinically valuable. It was observed by the CML in the Department of Orthopedics that the attitude and leadership of the departmental team leaders were important factors in the effectiveness of the service, because they appear to influence RESULTS positively or negatively the use made of the service The overall response to the program was en- by the others. In the orthopedics department a thusiastic, with 100% of the NICU and 93% (one literature-oriented chief resident receptive to the blank) of orthopedics wishing to see the literature experimental program was succeeded two and service continued. one-half months later by one who acknowledged All questionnaires returned indicated that the that his reading of the journal literature was literature service was valuable from the stand- extremely limited and who made no attempt to point of education or continuing education. More- stimulate problem-solving discussions during over, both the NICU and orthopedics department rounds. The questionnaire responses reflect the felt the experimental program was of clinical differences in receptivity to the service of these importance in determining the diagnosis and two orthopedic groups. treatment of patients hospitalized at the time (NICU: 97%; orthopedics: 67%). Evaluations of CONCLUSIONS the CML service at Cedars-Sinai Medical Center From the composite evaluation of the results of also indicate that the program has "immense educational benefits which cannot help but be the questionnaire and the observations of the two CMLs, the following guidelines were developed to reflected in improved patient care" . When queried if the literature service saved any be used by a librarian who has other library time for the recipients, both departments were in responsibilities yet wishes to provide a limited strong agreement (NICU: 100% yes; orthopedics: clinical medical librarianship service. 1. A determination should be made as to which 93% yes). Sixty percent of orthopedics and 53% of the NICU would have looked up the subjects on departments appear to be most interested in havtheir own if the CML had not done so, although ing such a service. The importance of receptivity many on both services commented that they by the department and close cooperation between would not have been as thorough, as quick, or as the CML and head of the department receiving the service cannot be overemphasized, as comprehensive. An overwhelming majority felt their awareness demonstrated by the University of Washington of the Health Sciences Library and its services CML experience as well as by Roach and Adand resources increased as a result of the experi- dington at Cook County Hospital, Chicago . mental program (NICU: 97%; orthopedics: 87% The University of Missouri-Kansas City School yes). Fifty percent of the NICU and 33% of or- of Medicine also believes that a hospitable envithopedics were interested in more exposure to ronment is essential to the success of a CML MEDLINE, and 63% of the NICU and 47% of or- program . Negative reactions expressed by some departthopedics desired more information on specialized ments were that the patients' rooms were already bibliographic resources and services.
mental program; second, the purpose of the questionnaire which was to evaluate the service; and third, the use of the results of the questionnaire to determine if the program might become a permanent part of the University of Washington Health Sciences Library operation, if it might be expanded to other departments, or if it would be discontinued entirely. Because the house staff and students had since rotated through many services, the cover letter also listed a sampling of the literature topics they had requested to remind them of their exact subject requests which were searched by the CML. After one month a duplicate questionnaire was sent to those individuals who had not yet responded. In all, 83% (30/36) of the NICU questionnaires and 58% (15/26) of the orthopedics department questionnaires were returned.
Bull. Med. Libr. Assoc. 64(3)July 1976
SCHNALL AND WILSON TABLE 1 STATISTICS AND COSTS OF CML SERVICE
Orthopedics CML service
NICU CML service
Oct. 1973Feb.Sept. 1973Oct. 1974* April 1975 Oct. 1974 Experimental Post-ques- Experimental period tionnaire period Number of weeks Number of rounds Number of rounds per week Number of hours on rounds Number of hours per round Number of searches Number of searches per round Number of hours on searches Number of hours per search Total number of hours Personnel cost Personnel cost per round MEDLINE cost Cost per week
31 56 1.81 54.75 0.98 111 1.98 79.40 0.72 134.15 $700.26
11 11 1.00
19.08 1.73 24 2.18 34.24 1.43 46.95 $285.93t $245.55 $
Oct. 1974May 1975 Experimental Post-quesperiod tionnaire Post-questionnaire
56 125 2.23 213.95 1.71 308 2.46 263.80 0.86 477.75 $2,498.58
27 27 1.00 36.71 1.36 98 3.63 77.87 0.79 120.92 $736.40t $632.41 t
87 181 2.08 268.70 1.48 419 2.31 343.20 0.82 611.90 $3,198.84
38 38 1.00 55.79 1.47 122 3.21 112.11 0.92 167.87
$24.00 $28.18t $24.504
$23.42: $98.00 $30.90t $27.05 t
$877.96t $26.90t $23.10t
$122.00 $30.1lt $26.31 :
*Librarian did not attend rounds between June 1974 and January 1975.
t Reflects increased personnel salary.
4Based on personnel salary during experimental period.
overcrowded by the rounds retinue and that the added presence of a CML was not considered constructive. This attitude would probably hinder a CML service from the start. It would be far preferable to initially prove the benefits of the service in an enthusiastic department and to refine procedures, and then let the service stand as an example to the more skeptical physicians who are still potential participants in a CML program. It should be remembered, however, that many of the reasons for hesitation are valid, and it is not the purpose or role of the librarian to become personally involved with the patient, to complicate the physician-patient relationship, or to intrude upon the privacy of any individual. Indeed, it may not be necessary to the effectiveness of the service for the CML to be present in the patients' rooms at all, if the CML is included in routine departmental discussions regularly held for the purpose of reviewing the diagnosis and treatment of patients with interesting or unusual problems. This point is borne out by the success of the CML service to the NICU which obviously involves no interaction with patients, and by the later success of the orthopedics CML service when the CML
attended meetings instead of ward rounds during a period later than that covered by the questionnaire. 2. The CML does not have to be present on all rounds each week. The purpose of the CML attending rounds is to become familiar with the subjects, procedures, and personnel, and for all those attending to become familiar with the services of the CML. In the results of the questionnaire both departments recommended having the CML present on rounds one time less per week than the number actually attended during the eight-month experimental period. Presently, the CMLs attend rounds once a week. After the decrease in attendance, the personnel cost of the CML attending rounds on the NICU was reduced approximately 50% (see Table 1). The initial personnel cost for the first year of the program on the NICU was approximately $2,500. Based on the same salary, the subsequent sixmonth cost of the service after the attendance decrease was only $632. Significantly, the number of searches did not decrease proportionately. Presently, for one-half the personnel cost, the NICU CML answers 67% of the original number Bull. Med. Libr. Assoc. 64(3)July 1976
CLINICAL MEDICAL LIBRARIANSHIP PROGRAM
of questions, or approximately 200 questions per year. Thus, if one is interested in establishing a limited CML service, one can keep personnel costs to a minimum and not significantly compromise value or service. 3. The CML should be available by telephone full-time in the library when not attending rounds (NICU: 97%; orthopedics: 80%). It would be desirable for a back-up librarian to take phone requests when the CML normally assigned to the department is not present in the library. 4. A form letter should be distributed to the recipients of the service describing the operation of the CML program and including the telephone number of the CML in the library when not on rounds. This letter is especially valuable if the department served has rotating house staff and students. 5. Copies of relevant articles should be promptly delivered to the physicians, staff, and students for the service to be optimally useful. This is especially valid for the NICU, which is an intensive care unit where information is needed as quickly as possible. Experience with the Department of Orthopedics also demonstrates this point. During most of the experimental period, very few articles were photocopied and delivered to the orthopedics department, thus requiring the members of that department to come to the library to read or check out the articles which were put aside in a special area provided for them by the CML. In this setting, requiring a time-consuming walk to the library, the Department of Orthopedics did not take full advantage of the CML program until the operation of the service was changed to provide selected photocopied articles directly to the recipients in their department. Support for photocopying had to come from the departments benefitting from the service, since the Health Sciences Library budget does not have provisions to cover such costs. Furthermore, the departments might be expected to have a greater interest in a service for which they pay at least a fraction. Many respondents to the questionnaire also suggested that the departments should support the necessary photocopy service. It is interesting to note that not one respondent to the
Bull. Med. Libr. Assoc. 64(3) July 1976
questionnaire felt that the library alone should assume the cost of the entire service. 6. During the experimental period similar clinical topics arose repeatedly. Therefore, a formal file should be maintained to avoid unnecessary duplication of work. Subjects already searched with appropriate references or MEDLINE printouts as well as one or two photocopied articles should be kept. 7. An assistant to the CML is needed to deliver printouts and articles to the departments, to pull volumes, photocopy, maintain the file, keep statistics, and do other necessary paperwork. This additional help was in fact only used during the postquestionnaire period, and then only sparingly. The minor personnel costs involved have been included in the statistical compilation as CML time. 8. In accordance with the interest expressed in the questionnaire, periodic lectures on literature sources, demonstrations of MEDLINE and other computerized data bases, and tours of the Health Sciences Library facilities should be instituted for the departments served. The questionnaire proved the clinical medical librarianship program established by the University of Washington Health Sciences Library to be a success in both the education or continuing education of the house staff and students and in improved patient care. As a result of the questionnaire, the two CMLs have continued their regular library responsibilities and have provided to the NICU and the Department of Orthopedics the clinical librarianship service closely adapted to the eight guidelines enumerated above. REFERENCES 1. COLAIANNI, Lois A. Clinical medical librarians in a private teaching-hospital setting. Bull. Med. Libr. Assoc. 63: 410-411, Oct. 1975. 2. ROACH, AGNES A., AND ADDINGTON, WHITNEY W. The effects of an information specialist on patient care and medical education. J. Med. Educ. 50: 176-180, Feb. 1975. 3. ALGERMISSEN, VIRGINIA. Biomedical librarians in a patient care setting at the University of
Missouri-Kansas City School of Medicine. Bull. Med. Libr. Assoc. 62: 354-358, Oct. 1974.
SCHNALL AND WILSON APPENDIX 1 ROUNDS EVALUATION QUESTIONNAIRE N = Neonatal Intensive Care Unit
OR = Department of Orthopedics 1. Was the literature service of any value to you from the standpoint of education or continuing education? Yes No
N 100% 0%
OR 100% 0%
2. Was the literature service of any value to you clinically in determining the diagnosis or treatment of any patients under your care during this experimental time period? N OR N OR Yes 97% One patient only? 67% 7% 13% No 3% 33% 1-5 patients? 60% 40% 30% More than 5? 13% 3. (a) Approximately what % of material retrieved did you read?* OR N 100% 20% 43% 90% 10% 7% 75% 20% 27% 50% 17% 33% 25% 20% 13% 0% 0% 0%
(b) If you did not read any, why not? 4. (a) Did this service save you any time? N OR Yes 100% 93% 0% 7% No (b) Would you have looked up your subjects on your own if there had not been the librarian on rounds to do it for you? N OR Yes 53% 60% No 23% 40% 5. Is it of value to have a librarian present during rounds as opposed to having her services readily available in the library? N OR Yes 73% 47% No 17% 40% 6. Which type of rounds would be more appropriately served by having a librarian present?* N OR Morning work rounds 20% 47% Attending rounds 83% 40% Grand rounds 0% 27% Other 0% 0% 7. Would you prefer having a librarian present at rounds?* N OR Once a week? 20% 40% Once every other week? 3% 7% Twice a week? 43% 27% Three times a week? 27% 7%
*Some respondents checked multiple answers.
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CLINICAL MEDICAL LIBRARIANSHIP PROGRAM 8. (a) During the librarian's vacation, do you want to have a back-up librarian present in her place? N OR 60% Yes 83% No 7% 7% (b) If there was no back-up person present on your rounds, did you make use of the fact that there was a librarian in the library on call for back-up service? N OR 47% 20% 43% 47% If not, why not? 9. Would you wish to have included in the service the full-time availability of the librarian so that if any questions or need for information should arise when she is not right there, you could telephone her in the library? OR N 80% Yes 97% 13% 0% No 10. Has your awareness of the Health Sciences Library, its services and resources, increased as a result of this particular service? OR N 87% Yes 97% 13% 3% No 11. Would you be interested in having more exposure to the bibliographic resources and services of the library, i.e., a demonstration of how MEDLINE searches are performed: OR N N OR 37% 60% Yes No 33% 50% Or a lecture on literature sources, indexes, etc. in your field of interest? Yes No
OR N OR 20% 40% 47% No How would you rate the librarian's performance? OR N 93% Excellent 90% 7% 10% Very good 0% 0% Satisfactory 0% 0% Unsatisfactory Comments: How could the librarian's performance be improved, i.e., would a stronger subject background, or more enthusiasm, etc., be recommended? Do you want to see the service continued? N OR OR N 0% 0% No 93% Yes 100% If you made little use of this service, why? What suggestions do you have for improving the service? Who do you feel should pay for this service? Please feel free to make any additional comments. Yes
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