The Eskind Library recently implemented a Clinical Librarian program in the VUMC MICU. Clinical Librarian programs allow librarians to be present in actual clinical settings, bringing their information retrieval and filtering skills to bear directly at the "point-of-need" in the cycle of patient care. Clinical Librarian programs have been successful in other institutions and settings, notably Yale (Medicine, surgery), UCLA (Ob/gyn residency program) and Baylor (Medicine). Eskind's Clinical Librarian model includes the provision of a subject-specific, searchable electronic Knowledge Base, which will be composed of questions fielded from the clinical teams and answers provided by the Clinical Librarian.
Since last November, a Clinical Librarian has attended morning rounds in the MICU two days per week. If a physician has a specific question during the course of rounds -- for instance, "What are the advantages or disadvantages of using Troponin or CK levels for determining myocardial infarction?" -- the librarian runs a literature search, finds and copies the retrieved articles, filters them for relevancy, and delivers one or two of the best articles to the MICU. The articles are specific to the physicians' questions, with highlighted text guiding the reader to the most pertinent sections. If the existing literature doesnıt provide adequate answers, the Clinical Librarian works with other Vanderbilt departments to find more complete information.
Data from the information requests gathered at morning rounds is kept in an electronic file. The data, complete with questions, answers, search strategies and source lists, will soon become available to the MICU physicians and staff as a searchable Knowledge Base. The literature will be kept current by programming an automatic SDI (Selected Disseminated Information) of the initial search strategy, to be run upon updates of the MEDLINE database. This type of Knowledge Base is expected to be particularly useful for the MICU, where many of the questions arising from patient cases are likely to be repeated. As the Knowledge Base unfolds, various informatics and medical teams will evaluate, refine, and verify the reusability of its content.
Dawn Miller, MLS, Information and Education Services Librarian, manages Eskindıs Clinical Librarian program and regularly attends rounds in MICU. Dawn is backed up by Kimbra Wilder, MS, Information and Education Services Librarian Trainee. The program is guided by Nunzia Giuse, MD, MLS, Director of the Active Digital Library -- one of the few librarians in the United States who also holds a medical degree. The designers of Eskindıs Clinical Librarian model hope the resulting Knowledge Base will benefit MICU physicians and staff, and provide a useful resource for other library-specific projects, such as Consultation and Outreach.
Sandra Martin, MLS, a member of EBL's Clinical Librarian team, rounds with residents on the NICU once a week, trying to gain an in-depth knowledge of the resources used and the questions asked repeatedly. Sandra will work with Bob Janco, MD, to incorporate those resources into a proposed redesigned third-year Pediatrics clerkship. The redesigned clerkship will promote an innovative, evidence-based environment for training Pediatrics residents. Sandra's work will also provide a searchable electronic Knowledge Base of questions and answers. The project is now in the planning stages.
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