Integrating Embedded Clinical Informationists into the Users' Workflows: Real-time Interactive Asking and Answering Clinical Questions
10:35 AM - 10:51 AM
Objective: The main objective was to build a service model that will provide a platform for formal, workflow-related transactions among clinical informationists, physicians, and residents. The overall goal was to develop pathways, enabling clinical informationists to directly contribute to the department of medicine’s mission for graduate medical education within the existing activities, and create observable, traceable, and evident outcomes.
Methods: A traditional librarian position was repurposed in order to embed a clinical informationist in a clinical department at a teaching hospital. The service then expanded to include informationists at two more teaching hospitals. The clinical informationists partnered with the chief residents and attending physicians in the resident reports. While the chief residents and the attending physicians engaged residents in generating clinical questions, clinical informationists were finding answers and presenting results in real time. The questions and answers were documented in the blog format for reuse at future resident reports and in sessions with the clinical teams. As the service progressed, informationists identified new opportunities to provide services in the existing educational and clinical workflow of the department of medicine.
Results and Conclusions: Using resources created by clinical informationists, chief residents developed learning activities to extend the educational benefit of the questions generated during resident report. In addition, faculty incorporated the clinical informationists into another educational activity, journal club presentations. This model provided residency program directors with evidence that clinical informationists added value and made a direct contribution to the educational mission of department of medicine. For clinical informationists, this model increased visibility and provided channels for meaningful dialogue with residents and clinicians.
Authors: Amy E. Allison, AHIP, Clinical Informationist; Kevin D. Bradford, Clinical Informationist; Anna Getselman, Associate Director; John Nemeth, Clinical Informationist; Woodruff Health Sciences Center Library; Emory University, Atlanta, GA
Collaborating in a Personalized Medicine Initiative: Provision of a Pharmacogenetics Consult Service
10:51 AM - 11:07 AM
Objective: Strategically aligning the biomedical library's provision of best evidence efforts to the institutional vision for personalized medicine by applying expert driven answers to pharmacogenetics clinical questions.
Methods: One of Vanderbilt University Medical Center's initiatives in personalized medicine engages, under the diagnostic management team (DMT) umbrella, a group of clinical experts to interpret complex laboratory evaluations. This effort is designed to consider both a patient's phenotype and available genotype information. The Knowledge Management and Eskind Biomedical Library (KM/EBL) team embedded an information scientist and a clinical librarian to aid the DMT in the access to best evidence. Employing a well-tested workable model, the KM/EBL information specialists participate in discussions and respond with critically appraised, synthesized summaries of biomedical and pharmacogenetics literature at the time and place of clinical decision making. The library maintains an updated knowledge management database to capture the summaries and enable dynamic search execution for current literature results to facilitate reuse and currency of information across all participating members.
Results/Conclusions: With pharmacogenetics becoming one of the central elements to patient care, it is critical for librarians and information scientists to acquire the content knowledge necessary for providing the evidence-based support clinical teams need. The project described above represents an instance in which a clinical librarian and an information scientist successfully embedded with a diagnostic team to provide evidence-based support for coagulopathy test interpretations. To date, the KM/EBL information specialists have addressed ten complex clinical questions for three attending physicians, and have developed dynamic searches for twenty-five topics for the overall education and knowledge of the DMT. Although not formally evaluated, the program has received positive anecdotal feedback. Perhaps the best outcome of this project is the willingness of the attending physician coordinating the clinical effort to work with the KM/EBL team to devise a framework that can be transferred to DMTs that may be established in the future.
Authors: Tracy C. Shields, Librarian, Knowledge Management and Eskind Biomedical Library; Mary Beth Bauer, Pharmacogenetics Information Scientist, Knowledge Management; Annette M. Williams, Associate Director, Knowledge Management and Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN; Michael Laposata, Professor, Medicine and Pathology, Department of Pathology, School of Medicine, Vanderbilt University, Nashville, TN; Nunzia B. Giuse, AHIP, FMLA, Assistant Vice Chancellor, Knowledge Management, Director, Eskind Biomedical Library, and Professor, Department of Biomedical Informatics and Department of Medicine; Knowledge Management, and Eskind Biomedical Library; Vanderbilt University Medical Center, Nashville, TN
Embedded Clinical Medical Librarian: Assisting Patient Care on the Front Lines
11:07 AM - 11:23 AM
Objective: In 2003, the US military embedded journalists into battalions during the invasion of Afghanistan. While the military’s goal was to fight their enemy with weapons, they also knew they needed journalists involved to win the information war. Embedded librarians may join forces with researchers, clinicians, or others to fight a war to provide excellent health care. This report will discuss the cultural and social aspects of rounding with a clinical team five days a week for more than three hours a day as an embedded clinical medical librarian (CML).
Methods: A CML, embedded in an internal medicine care team at Louisiana State University Health Sciences Center-Shreveport (LSUHSC-S) for more than eighteen months, will report on the cultural and social issues in working on the front line. This will include how the CML aids clinicians in providing excellent patient care, while being aware of the social and cultural boundaries. In addition, a discussion of interactions outside the internal medicine care team will frame how the CML becomes a visible symbol for the library.
Results: Using participant observation methods, analysis was done of questions, comments, and interactions between the CML and the members of the internal medicine clinical team. The CML encountered a delayed reception among some team members. Through a positive, unobtrusive interaction, the CML gained acceptance and increased use during rounds. After attending rounds with a CML, some participants often contacted the CML to assist while on other clinical teams.
Conclusions: Acceptance may come slowly when a CML joins a clinical team. Every interaction builds confidence in the role of the CML in assisting in patient care. Libraries or librarians instituting CML programs should plan for slow acceptance. For the CML at LSUHSC-S, the personal interaction increased overall clinical requests outside clinical rounds and found clinicians outside the clinical team seeking assistance from the library for searches and training. Interaction inside and outside the internal medicine care team while rounding can stimulate team members and others to “rethink” their view of the library.
Authors: Julia Esparza, AHIP, Clinical Medical Librarian; Marianne Comegys, Director and Chair; Department of Medical Library Science; Louisiana State University Health Sciences Center, Shreveport, LA
Embedded Librarian in Two Nurse-managed Clinics: Providing Health Information and Education to Vulnerable and Underserved Patients
11:23 AM - 11:39 AM
Objective: Nurse-managed health clinics serve as crucial health care access points for vulnerable and underserved patients and provide primary care, health promotion, and disease prevention services to patients of all ages, primarily those who are uninsured, underinsured, or living in poverty or members of racial and ethnic minorities. Over eighty-five of the nation’s leading nursing schools operate nurse-managed health clinics, enhancing learning and practice opportunities for nursing school faculty, nursing students, and other health professions students. To support evidence-based practice and promote health literacy, a medical librarian was embedded in two nurse-managed clinics.
Methods: A librarian was embedded in two nurse-managed wellness clinics for four hours per site each week. One clinic is housed in an urban community center, and a program providing daily activities for primarily minority seniors was selected as the patient group. The second clinic is housed in an urban multiservice center for the homeless. Health screenings and assessments (bl
