Improving Access to Information during Rounds through

Librarian Support

Lisa Olsen KilburnInformation Resources Specialist

Southern Regional AHEC

October 2010

Accreditation Council for Graduate Medical Education

General Competencies• Practice-based Learning and Improvement

– locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems (aka evidence based medicine)

– use information technology to manage information, access on-line medical information; and support their own education

The Problem

• Searching the literature takes time • Residents are very busy

Duke/Southern Regional AHEC Family Medicine Residency Program

• MD and DO Family Medicine Residency• Fayetteville, North Carolina• 21 residents• 8 four week rotations on Inpatient Medicine

seeing patients at Cape Fear Medical Center• Average 10 – 15 patients on service

Medical Rounds

• Schedule– Residents start rounding on patients at 7 am– Meeting at 10 am to discuss assessment and plan

• In attendance– Attending physician– 2 to 5 residents– Attending pharmacist– Pharmacy resident– Medical and pharmacy students

Intervention by the Information Resources Specialist

• Attend rounds once a week• Prompt the residents to develop questions• Research the questions• Post links to relevant articles to a blog on the

AHEC Digital Library• Post the search strategy used• Email the articles to the faculty and residents• Finish everything before the end of the day

Resident Requirements

• Complete a search request form with the question in PICO format

• Ask 2 questions per year• Review the posted articles• Post 2 comments• Present articles to medicine team• Deadline: Third quarter evaluation

Technical Challenges

• Residents access to the internet and thus the blog was somewhat variable

• Some links required tech support to create– Online textbooks were difficult to work with

• Due to licensing agreements with publishers, rotating medical and pharmacy students usually did not have access to the blog

Participant Satisfaction Surveys

• November 2009 (4 month)– 66% response rate– 68% of residents

• June 2010 (1 year)– 59% response rate– 50% of residents

• Handed out at noon conference• Missing participants were sent the survey via

email and inter-office mail• Collected by the Residency Coordinator and

the library

Survey Results in Aggregate

• 97% were “satisfied” or “very satisfied” with the librarian presence

• 94% rated the articles as “moderately” or “extremely” useful

• 25% admitted they would not have done the research on their own

• 85% voted to continue the program

Responses by Position

Residents• Resistance due to

the perceived increased workload– 2 votes to cancel the

program (1 maybe)– 90% spent less than

30 minutes reviewing the articles

– 100% spent less than 15 minutes commenting on the articles

Faculty• Strong support from

the Residency Director

• Variable support from faculty– Presentation at

rounds– Rotating faculty– Faculty turnover

Use of Posted Articles

Frequently Sometimes Rarely Never

Formal discussion during rounds

4 9 3 0

Informal discussion with peers

1 9 2 2

Informal discussion with attending physician

1 8 6 0

Discussion with patients

2 5 6 2

Not used/discussed 2 5 1 4

Began emailing articles

Most Frequently Cited Journals

• New England Journal of Medicine (9)• Annals of Internal Medicine (6)• Chest (5)• Cochrane Database of Systematic Reviews (4)• Journal of Thrombosis and Thrombolysis (4)• Lancet (4)• Annals of Emergency Medicine (3)• CDC website (3)• Critical Care Medicine (3)• Expert Opinion on Pharmacotherapy (3)• Neurology (3)

Outcomes

Benefits• Questions regarding

clinic patients as well as hospitalized patients

• Questions outside of the weekly visit

• Increased visibility for the library

Challenges• Faculty and resident

preference for review articles

• Medically difficult questions

• Articles not received in time to affect patient care

• Medicine team personality

Conclusion

• The program is ongoing• Benefits to both the residency and the library• Could easily to adapted to other institutions