The%20Clinical%20Librarian%20in%20an%20Emergency%20Department

1
The Clinical Librarian in an Emergency Department

• Professor Tim Coats
• Professor of Emergency Medicine
• Leicester University, UK

2
Objectives

• To identify information needs in emergency care
• To look at current models
• Speculate on the future

3
Knowledge needs

• UK emergency model - based on junior doctors
• FY2, ST level - often not aware of their own
  ignorance!
• Types of condition different from previous
  experience
• Common conditions and rare conditions
• Often isolated working
• Time pressure
• acuity of patients needs
• volume of patients

4
Knowledge needs

• In summary, the challenge is
• Very rapidly getting the right bit of information
  to a clinician who may not be aware that they
  need it

5
Levels of information needed

• Patient based - past medical notes What was
  found last time this patient had a TIA?
• Local procedures - How do I refer this patient
  to the TIA clinic?
• National guidelines - How do I treat my patient
  who has a TIA?
• Specialised question - How do I treat this
  patient with haemophilia who also has a TIA?
• Educational overview - I dont know much about
  TIA, where can I find out about it?

6
Time available

• Total of 20 to 30 minutes per patient
• (history,examination, explanation, treatment,
  recording)
• Finding information - ?10 of this?
• Certainly no more than 5 mintues

7
Current systems

• Books - How to do it guides
• Google it - works well!
• Phone a friend
• Clinical Librarian

8
Clinical Librarian in Emergency Care

• Cardiac arrest - get me a librarian stat
• Role
• Understanding the language and clinical and
  practical issues of emergency care
• Saving clinicians time by assisting in literature
  searches
• Enabling painless access to evidence / published
  material
• Supporting evidence based patient care at the
  bedside
• Providing tailored training in searching (aimed
  at junior staff)
• Maintaining close links with clinical teams to
  understand their information needs
• Developing future information systems

9
Practical examples

• Safer treatment for cyanide poisoning -
  preparation of evidence based case to Hospital
  Therapeutics Committee.
• Learning how to search the literature for the
  FCEM exam Clinical Topic Review
• Preparing a Cochrane review looking at the
  administration of heliox to children with croup
• Looking at the evidence base for a local
  guideline on management of the acute red eye

10
Future Systems

• Electronic patient record
• Series of Knowledge buttons
• Local procedures
• National guidelines
• Systematic reviews
• Textbook material
• Relevant literature search
• Context based red flags
• Information presented without active seeking
• ? Connection to user level of knowledge

11
Summary

• Emergency Physicians have particular information
  needs
• Current systems do not fit the bill
• A clinical librarian can enhance the system
• The EPR presents an opportunity for the future