Krafty Librarian

I have been a librarian for over 25 years (that means I am old). As someone who has been in a leadership position for a few of those years, one of the areas that concerns me are the challenges regarding educating and training the new generation of medical librarians to be ready for the current workforce and the future.

IMHO I believe ALA and many ALA accredited schools have failed us. They have been too slow to adapt to changes within the profession’s landscape. Students are graduating from programs with few skills or knowledge that would be considered applicable for even entry level positions. I have interviewed new graduates for medical librarian positions who have never heard of PubMed, UpToDate, Docline, CINAHL, etc. While these may be niche to the library world, they are some of the largest most heavily used resources in the medical library world. It is like interviewing for a public library position and saying you have never heard of Libby/OverDrive.

Even at entry level jobs you should have baseline knowledge for the professional position. While it is not impossible to get an entry level job without that baseline, it makes it much more difficult to do so. For example, it would be hard for me to get an entry level job as a computer programmer if I don’t have familiarity with any programming languages.

Many hospital libraries don’t have multiple librarians. First, you are lucky if the hospital has a library. If it has a library, and IF it has a medical librarian, there is usually only 1 person who is the medical librarian for that hospital. Hiring somebody and training them if they don’t even have the basics becomes challenging. The departing librarian must train the basics of medical librarianship PLUS the regular job training to the new hire in a matter of a few weeks before the departing librarian leaves. Of course that assumes the hospital allows for position overlap, meaning the new librarian is hired and trained by the departing librarian before they leave. Many places do not do position overlap. They hire after the person has left.

Academic medical libraries serving university and colleges with medical, nursing, and other health profession student typically have more than 1 librarian and the new employee can be trained and learn from other library staff. However, depending on the new hire’s pre-existing knowledge/skills and the job, it can take many months to train them.

The lack of knowledge and skills in health sciences librarianship in many graduates of library programs, makes it difficult to hire new library graduates.

However, as concerned as I am, I do have hope. Programs like WISE (Web-based Information Science Education) which allows students at ALA accredited WISE schools to take courses in special areas and from faculty at other WISE schools who are highly regarded in their area of expertise without the need or worry that credits will transfer. This sort of system makes sense. While there is a need to educate others in medical librarianship, the number of those interested in pursing that specialization is most likely not enough to support a program at SLIS if they only make it available enrolled students. But it still makes those specialized courses, necessary for those unique areas of librarianship available to students.

As a member of The Vision 2048 Task Force of MLA, I also have hope that the concerns and opportunities that we identified regarding educating future librarians will also be addressed by librarians, educators, library associations and accrediting bodies. The task force just published “Welcome to the Future: Challenges and Opportunities Discussed in The Vision 2048 Task Force Open Forums 2021-2023” (The main reason I decided to write this blog post) which identified education, pay, advocacy, as well as other things as important areas for the profession to address as we go forward.

While I still think I am a young 25 yr. old, I am actually closer to retirement than vanity likes me to admit. I care for this profession and hope that we can make adjustments so that when I retire (which is still awhile) the profession thrives and in the future there is a Vision 2063 addressing all new concerns and opportunities.

(Note: This is not a part of my AI writing experiments as some of my posts are. I will always note when I use AI on this blog.)

A post on Retraction Watch details an incident where Ina Vandebroek, the author of a book chapter “Ethical aspects of working with local communities and their biological resources,” in the 2017 edition of Pharmacognosy: Fundamentals, Applications and Strategies discovered the 2023 edition had the exact same chapter content from the 2017 edition (which she wrote) in the 2023 edition which she had declined to write or participate on. She stated the only differences are 2 additional sentences and the chapter listed different author.

Apparently, all you need to do be a chapter author in this Elsevier textbook is to add 2 sentences to what was written in the previous edition’s chapter for the new edition. Unfortunately, Elsevier’s contributor’s (author) agreement basically says that you if you publish a chapter in one of their books they may use all or any of the content for future editions.

While I understand Elsevier’s spirit of the contributor’s agreement, especially when you are talking about textbook chapters in book editions, this situation illustrates some concerns for authors, as it seems no meaningful new content was added and the original 2017 author’s words remained unchanged in any substantial way. So who is the real author, Vandebroek or the 2023 chapter author? Vandebroek sent a cease and desist letter claiming the book contains plagiarized material.

Readers also should have concerns as to what actually is written by the listed author and what was copy pasted from the previous edition? Vandebroek said that the entire chapter is exactly the same as what she wrote for the 2017 edition with the exception of 2 additional sentences. As I mentioned I don’t have either edition and I can’t find the references listed for that chapter in either the 2017 or 2023 edition online to compare to see if they are the same.

If references aren’t the same, and newer source material was referenced then how did the 2023 author do that while still using 2017 content? If the references are the same, then the 2023 author basically copy pasted the chapter and wrote 2 new sentences (as Vandebroek claims). Both of these situations are bad. You either have the “latest edition” of textbook that doesn’t have the latest information or a textbook that has fundamental flaws regarding writing research and references.

Unfortunately, it appears Vandebroek’s chapter is not the only chapter in this textbook where there are concerns with authorship. Retraction Watch details concerns regarding same 2023 author for Vandebroek’s chapter as being the sole author of 2 other chapters in that book, and other concerns regarding new authors for chapters attributed to different authors in the previous edition. Retraction Watch just mentions the author concerns. They did not go into any details as to whether those chapters had the same similarity problems as Vandebroek’s chapter.

It would be interesting if someone would look at the references for Vandebroek’s chapter in both the 2017 and 2023 editions to see whether they are the same. It would be also interesting to see if the other chapters of concern referenced by Retraction Watch suffered from the same cut and paste concerns as Vandebroek’ chapter has. IF you have both editions and have some spare time on your hands and want to report out on this, go for it, I would be interested in knowing.

‘Exhausting’: Author finds another’s name on an Elsevier book chapter she wrote

Bing Chat is public large-language model (LLM), that is integrated with ChatGPT 4, is hosted by Microsoft, and is best used on the Microsoft Edge browser. The OpenAI and Microsoft relationship is confusing to me, but I thought I would play with Bing Chat anyway. (Here is an article and diagram on their confusing partnership)

Before I started playing with Bing Chat for this blog I looked at the ZDNet article, “What is Bing Chat? Here’s Everything You Need to Know.”

The basics:

• Bing Chat supposedly can do citations
• There are no restrictions on date. If it was online today, it can be found
• Lots of plugins, including OpenTable and Wolfram Alpha, including Kayak, Klarna, Redfin, and Zillow. BTW I have no idea why/how Bing Chat would be in OpenTable etc. But the article did mention travel queries so I would assume that is where Kayak comes into play.
• Bing Chat is also in Windows 11 through a new Windows Copilot integration
• You can use it for images

According Microsoft “the new Bing is faster, more accurate, and “more capable” than ChatGPT or GPT-3.5, the LLM behind ChatGPT.” Bing Chat uses ChatGPT 4.0 which is the only way you can use ChatGPT 4.0 for free.

So I did a little playing around. Please note Bing Chat responses are screenshot images. I found this made it a little easier to show the output style and also more clearly define my output vs Bing Chat’s output.

I decided to test 3 things: Citations, dates (timeliness) and for fun I wanted to test images.

Citations, Timeliness, and Real World Examples:

Prompt: Write 2 paragraphs on the use of ChatGPT in medical libraries and provide exampes of ChatGPT use in medicine with URLs to those examples.

Bing Chat’s response:

Ok it is a little weird to see my blog as the first thing listed “for more insights.” But the links did work when I clicked on all of them.

Let’s try some medical stuff.
Prompt: Find 3 articles and provide citations on exercise induced asthma.

Bing Chat’s response:

Again the links worked when I clicked on them, including the one to UTD. But I was interested in getting some articles in PubMed so I refined my prompt.

Prompt: Search PubMed for 3 citations on exercised induced asthma, provide the PMID and a link to the article.

Bing Chat’s response:

The PMID’s were valid and the links to the articles went to the website where you could get the full text if you had a subscription.

PubMed Results vs Bing Chat:

I was interested in how Bing Chat’s results were different from a quick search on PubMed. Below are 2 screen shots from 2 searches. The first is exercise induced asthma searched as a keyword in PubMed. The second is exercise induced asthma searched as a MeSH term. Both searches were set to display Best Match. Since the articles Bing Chat retrieved clearly weren’t in most recent order, I was curious if Bing would retrieve things within PubMed more closely aligned with Best Match.

I have no idea why Bing Chat chose those 3 citations from PubMed, none of those citations were the most recent nor were they listed in the 50 citations displayed on PubMed’s Best Match results. – Weird

Images:

So what can Bing Chat do with images? I did some playing around with dog images. Note I uploaded an image of my dog, Bear. He is a Mountain Cur mix… so that is a little unfair that I did not upload a picture of a pure bred dog.

Bear with his favorite toy.

Prompt: What breed does this dog resemeble?

Bing Chat’s Response:

Wow that was not even close and the photo below Bing Chat’s response is certainly not a Golden Retriever.

Prompt: Show me a picture of a Mountain Cur mix dog

Bing Chat’s Response:

There we go… more like it. Especially the dog in the middle looks a lot like my pup.

Clearly Bing Chat had difficulty identifying the image I supplied but when I knew what type of image I wanted to retrieve, it did a good job.

Medical Images:

I don’t have any medical pictures that are copyright free AND aren’t already on the Internet where Bing Chat would be able to pull some sort of metadata on. So I didn’t test its capabilities of identifying medical images I supplied.

But I did ask it to retrieve pictures of asthmatic lungs. Yes that is very broad, that was intentional since I wanted to compare Bing Chat’s image retrieval to that of Google Images.

Prompt: Show me pictures of asthmatic lungs.

Bing Chat’s Response:

Google Images:

Obviously Google Images has a lot more images. I think Bing Chat is limited by its output style. However, it was interesting to see that the 3 images Bing Chat chose were not anywhere on the first page of results for Google Images. However, they were on the first page of Bing’s Images page (similar to Google Images). So clearly Bing Chat’s AI favor’s Bing search results over Google’s. (makes sense)

What was really weird and a little concerning was when I clicked on an image from Bing Chat, it was a little difficult to see where the image was from AND Bing Chat launched another tab on my browser to Bing Images and the top part of the page for that tab listed asthma medications that were for sale.

Screen shot: when I clicked on an image from Bing Chat.
Note the list of websites on the right…where is this image from? Not real obvious.
Note behind the giant black square the image is featured on, you can just see pill bottle sticking out on the left, that is the new tab that was opened on my browser.

Screen shot: Here is a screen shot after I closed the Bing Chat image. The newly opened tab is shows asthma medicine for sale above asthma lung images.

It is important to note if you search Bing for images (like you would Google Images) and don’t use Bing Chat to find images, you don’t get drugs listed for sale at the top (as seen in this screen shot below).

Bottom Line:

I think Bing Chat does a better job searching and finding text type of information. The links went to the correct places, I did not detect any hallucinations like I did with ChatGPT 3. I am still not sure why it chose the PubMed citations it did. Why were those better to show than a citation from one of PubMed’s 50 Best Match?

I am still sticking with PubMed for searching. But I am at least happy that it is actually retrieving the correct stuff.

I think there are a lot of concerns regarding it interpreting images, finding images, clearly showing the source of the images, and I am still irritated or unnerved that it opened a new tab on my browser featuring asthma drugs so prominently.

What interests you? What would like to see me try and test and play with next?
Let me know by commenting or emailing me your suggestions.

(Michelle’s words) I know I said I would write a post once a month, but I wanted to do an update since several comments generated some interesting questions and ideas. Specifically, someone asked if the ChatGPT response could provide links to the examples in its post. I was intrigued and I wanted to see if the links suffered from AI hallucination like ChatGPT’s reference.

Here are the results:

1. First time ever (screen shot below) ChatGPT3.5 gave me two side by side answers and asked which one I liked better. My guess is to help it to learn.
2. Second, the answer differs some from the answer given in my original post. This is not unusual. You can ask it the same thing with the exact same wording and it will provide a different result each time.
3. HOWEVER, my prompt to ChatGPT was different than the one I posed for my original post because I asked it to provide links to examples. So naturally it will be different. ChatGPT does not take its original answer and tweak it, like adding links. It often creates a new answer
4. The links (copy paste snippet from CHATGPT3.5 below image) go nowhere. I clicked on them within ChatGPT and I got a 404 error. So the AI provides links but the links do not go to any real sites.

So I asked the question to ChatGPT as second time to see what changes would happen.

1. I didn’t get the side by side 2 answers…weird.
2. Content was different (as expected)
3. Links changed and work…sort of. They go to actual websites and I don’t get a 404 error but as you read they really are sucky examples. I want the URLs for the 1st try Response 2 to work, not links to regular websites that are involved in AI.

So I tried for a final 3rd time to get the results I wanted. It is Halloween, I have candy to handout and beers to drink….no 4th try.

***PLEASE NOTE*** getting the results you want is as much a part of what you write in the prompt as it is ChatGPT interpreting what you wrote. ***I can’t stress this enought***

So here was my 3rd try prompt:

write a short blog post on the use of ChatGPT in medical libraries and provide examples of ChatGPT use in medicine with URLs to those examples

My Results:

1. It did better on the linking. All but MedGPT’s link worked and went to real pages.
2. Examples were meh and possibly not relevant. For example, it listed UpToDate and how it could benefit from ChatGPT. That was not what I wanted, I wanted specific examples of it use not what can benefit from its use. However…. ChatGPT interpreted my prompt differently.
3. Please note, it did not provide linked examples for medical libraries, because I messed up in my prompt and wrote, “and provide examples of ChatGPT use in medicine with URLs,” so it gave me exactly that.

(Screen shot of ChatGPT answer with 2 responses side by side)

(1st try Snippet of ChatGPT Response 2 words copy pasted: note links do not go anywhere)

Examples of ChatGPT in Action

To witness the transformative potential of ChatGPT in healthcare, here are some examples:

1. Clinical Decision Support: Link to Example
2. Patient Education: Link to Example
3. Medical Research: Link to Example
4. Language Accessibility: Link to Example
5. Telemedicine Integration: Link to Example

These examples illustrate the tangible benefits of combining ChatGPT with medical libraries, ultimately advancing patient care, research, and healthcare accessibility.

Conclusion

The partnership between ChatGPT and medical libraries is poised to reshape the healthcare landscape. By harnessing the power of AI-driven language models, healthcare professionals, researchers, and patients can access, interpret, and utilize medical knowledge more efficiently and effectively than ever before. As this collaboration continues to evolve, we can anticipate even more innovative applications that will elevate the quality and inclusivity of healthcare services globally.

(2nd try snippet of ChatGPT… links work but don’t add value IMHO)

Conclusion

The integration of ChatGPT with medical libraries holds immense promise in revolutionizing the healthcare information landscape. By simplifying information retrieval, offering contextual recommendations, and summarizing complex research, ChatGPT empowers healthcare professionals, researchers, and students to make informed decisions and advance medical knowledge. The combination of AI and medical libraries represents a significant step forward in the quest for better healthcare and medical breakthroughs.

Links to Examples:

1. Demo of ChatGPT: Explore the capabilities of ChatGPT in natural language understanding and generation.
2. PubMed Central: A well-known medical library where ChatGPT integration could enhance information access and retrieval.
3. ArXiv: A repository for academic papers, including medical research, which could benefit from AI-powered search and summarization features.
4. Google Scholar: A popular tool for academic research, which could potentially integrate ChatGPT for improved search and recommendations.

(Snippet from my 3rd and final try with ChatGPT and linking)

Examples of ChatGPT in Medicine

1. Medical Literature Summarization:
   • URL: MedGPT
   • ChatGPT can be employed to summarize lengthy research papers or clinical studies, helping healthcare professionals and researchers quickly extract the key findings and implications from complex texts.
2. Diagnostic Support and Medical Queries:
   • URL: AIDoc
   • AI-powered systems like AIDoc use ChatGPT to assist radiologists and doctors in interpreting medical images and answering specific questions related to patient cases, potentially leading to faster and more accurate diagnoses.
3. Clinical Decision Support:
   • URL: IBM Watson for Oncology
   • IBM Watson for Oncology employs ChatGPT-like models to provide personalized treatment recommendations by analyzing a patient’s medical history and comparing it with an extensive database of medical literature.
4. Medical Knowledge Retrieval:
   • URL: UpToDate
   • Platforms like UpToDate can benefit from ChatGPT’s natural language search capabilities, allowing healthcare professionals to find relevant clinical information quickly and efficiently.

Benefits of ChatGPT in Medical Libraries

The integration of ChatGPT into medical libraries offers several significant advantages:

• Simplified Search and Retrieval: ChatGPT enables users to search for medical information using natural language queries, reducing the need for complex search syntax.
• Contextual Insights: ChatGPT can provide context-specific recommendations and insights by understanding the user’s inquiries.
• Multilingual Support: ChatGPT can assist users in multiple languages, making medical literature more accessible to a global audience.
• Quick Summarization: ChatGPT can summarize extensive medical documents, making it easier for healthcare professionals to extract pertinent information rapidly.

(Michelle’s words)

Keep the comments coming. I promise due to work life balance I am really only going to try and publish once a month. I swear…I think…I will try really really hard.

I want to thank the many people who have shared some of their impact stories. I thought I would post these as little vignettes to serve as a sort of “Chicken Soup for the Librarian’s Soul.” While these stories may short, the impact of the medical librarian is not.

All stories are told in the first person. They are not my stories, they are the stories from the emails librarians have sent me.

_____________________

I bumped into a nurse who I was doing research for the other day. She thanked me for all of the work I did on INR (international normalize ratio) levels and Coumadin in patients with Covid-19. It turns out Covid-19 can lead to abnormal INR levels. The information I retrieved lead to a change in practice and treating patients at the hospital.

_____________________

I had done some research for a patron and later she told me that the help I had given her in researching her mother’s medical condition inspired her to change her career to cancer research.

_____________________

A former patient was suing the hospital for malpractice due to a surgical mishap that occurred. The surgeon and the hospital had indicated that the particular mishap was a known risk for the procedure, even though they had never had it happen before. The patient’s two expert witnesses had testified that the mishap, in their opinion, constituted malpractice. I was asked to do a comprehensive search to see if any other surgeon had reported this type of surgical mishap. (Previous searches by the legal department couldn’t find anything helpful.) I was able to find approximately 10 articles specifically on the surgical mishap, one of which was authored by a specialist in that area. This changed the outcome of the case and they were able to work to settle the claim.

_____________________

We had a gastroenterologist who was an occasional user of library services.  He had a patient in the ICU with a problem that was stumping him.  He came to the library and gave me some concepts and details to search on. I think he said she was bleeding internally and looked pretty grave. I went to work and had trouble finding very much, but I finally ended up with only one or two articles that looked fairly relevant. I believe I delivered them to him in the ICU.

He came into the library a day or two later and told me that the information in the articles had saved the patient’s life.  I was appreciative that he took time to come into the library to let me know.

_____________________

At the beginning of Covid-19, I helped sort supplies for each hospital unit. As you might remember there weren’t enough masks, face shields, or gowns. We would distribute just enough for each unit to get through a shift. Then I was a temperature screener at 4:00 am until 8:00 am at the hospital entrance. I came in on the weekend to help with N-95 fit testing. I begged, borrowed, and purchased (with my own funds) material for patients to read.

_____________________

Early in in the Covid-19 pandemic a former health sciences librarian mentioned that there was an international list of articles that people couldn’t fill because of library closures. She was in charge of ILL for a national library. She asked if I would look at the list and see if I could fulfill any of the requests. There were over 6000 requests. With my very old collection, I was able to provide some articles to libraries in the UK, Korea, and Qatar. The national library was recognized by IFLA for participating.

_____________________

Following a holiday luncheon for all hospital employees, I returned to the Medical Library in great spirits. After all, the CEO had personally recognized me, called me by name, and told me unequivocally that I was doing a great job, and that she appreciated my work.  Wow!  The CEO!  She remembered my name among all the thousands of employees! 

_____________________

These are just some of the stories that librarians shared with me. Medical librarians can impact patient care by helping doctors find the information needed to treat patients. They have an impact on the administrators and can influence people’s career choices in medicine. They can roll up their sleeves during a crisis and help outside of the library.

Please continue to email me your impact stories, big or small, I will find a way to profile them anonymously. Don’t be one of those librarians who suffers from imposter syndrome. What you do is important and I want to share it so others can learn and know it too.

I have been a medical librarian for over 25 years. (Funny, it I don’t feel that old.) In all those years I have been asked all sorts of questions about my job. The questions pretty much fall into 2 categories.

1. Why do we need a medical librarian?
2. What do you do as a medical librarian?

Since I find that most people form their idea of a librarian based off of their experiences from school or the public library, I understand that the area of medical librarianship is foreign to them.

One of the answers I provide to inquiring minds is: “We help doctors and nurses find information to better treat patients.” I find that answer often times helps people understand. Sometimes, I am asked for specifics on how our research helps clinicians treat patients. And in those instances I give personal examples of how the information I found helped treat a patient.

These stories are meaningful and illustrate our impact, but how often do we as a profession track how our research is used? I find it difficult. For every 100 searches or articles retrieved I maybe hear back from 1 person about how they used it. That is why this article caught my attention, “Analysis of a Hospital Librarian Mediated Literature Search Service at a Regional Health Service in Australia.” Siemensma, G. Clayworth C. Journal of Hospital Librarianship. 2021, 21(1) 11-19. doi.org/10.1080/15323269.2021.1860447.

The librarians in Australia, analyzed mediated literature search services to determine the impact of the service in their hospital. The authors noted there have been several larger studies (Marshall: JMLA. 2013 Jan;101(1):38–46. doi:10.3163/1536-5050.101.1.007) on the value of medical libraries, but their study was to look more granularly at a specific library service’s impact within their hospital.

Over the course of one year, librarians sent out 282 surveys (one for every search they conducted) and had a 40% response rate. The results from the survey indicated that the librarian’s research had an impact on patient care as well as in other areas of clinicians’ hospital work.

According Siemensma and Clayworth, clinicians reported the searches impacted patient care in the following ways:

• 83% reported obtaining new knowledge
• 46% reported it helped confirm current clinical practice
• 35% reported it led to improved policy/procedure
• 32% reported modification of the current clinical practice

Other ways patient care was impacted were in diagnosis, length of stay, choice of tests, choice of medications, advice given to patient, and increased productivity.

Regarding productivity, survey responders reported utilizing the library’s search services saved them a “minimum of 4 hours.” In fact 33 of the 112 people indicated that they saved greater than 7 hours of time saved.

As we continue to look at the impact of librarians in hospitals it is a good idea to do these types of smaller studies so that we have the hard data along with the personal stories. My hope is that some day someone outside of medical librarianship understand how we can make an impact and they no longer ask “What does a medical librarian do and why do we need them,” because they will know we help doctors and nurses find information to better treat patients.

Read the full article to learn more about their study and their survey. Here are more articles on the impact of librarian search services.

Effects of librarian-provided services in healthcare settings: a systematic review. Perrier L, Farrell A, Ayala AP, Lightfoot D, Kenny T, Aaronson E, Allee N, Brigham T, Connor E, Constantinescu T, Muellenbach J, Epstein HA, Weiss A.J Am Med Inform Assoc. 2014 Nov-Dec;21(6):1118-24. doi: 10.1136/amiajnl-2014-002825.

Evaluation of hospital staff’s perceived quality of librarian-mediated literature searching services. McKeown S, Konrad SL, McTavish J, Boyce E.J Med Libr Assoc. 2017 Apr;105(2):120-131. doi: 10.5195/jmla.2017.201.

A User Survey Finds that a Hospital Library Literature Search Service has a Direct Impact on Patient Care. Stovold E. Evidence Based Library and Information Practice. 2015 10(3):108-110. doi.org/10.18438/B8089X

The cost of health care is expensive. Hospitals want to treat patients in a cost efficient manner without sacrificing patient care. It is a balancing act. The hospital librarian can help with that balancing act.

An article published in Health Information & Libraries Journal, describes how clinical librarians providing information to hospital staff in the critical care unit can improve patient care, time savings, and may generate a positive return on investment.

The study was conducted in the United Kingdom, so there may be differences depending on the country your hospital library is in. Over the course of 15 months, they found that librarian intervention and activities generated a positive ROI of £1.18–£3.03 for every £1 invested. (For the American readers that is a ROI of $1.49-$3.83 for every $1.26 invested, depending on currency values.)

The clinical librarian spent 15 hours per week split across a 5 day work week (Monday-Friday) providing the following intervention services/activities.

• Pop-up library (rounding on the floor/wards)
• Academic study support
• Evidence searching support
• Noticeboard
• Journal club
• Facebook group.
• Online journal club
• Book box

In an email interview for this blog post, Victoria Treadway, the clinical librarian in the study, said the intervention activities were done in accordance to the needs of the week. So one day, time might be spent helping with Journal Club while the other day, time spent might consist of rounding.

So it appears that with a little bit of time, 15 hours out of a 40 hour work week, dedicated to providing services within the critical care unit, the hospital was able to see a positive return on investment. Additional benefits to having a clinical librarian were; time saved for clinical staff (1563 hours 85% of which was nursing), professional development support, and improved patient care. This not not only impacted the budget in terms of cost savings for the NHS but led to an increase in evidence based medicine culture, and improved clinical decision making. (figure 1 of Hartfiel N article)

Libraries and librarians are often thought of an expense rather than a benefit that actually reduces expenses and improves patient care. More of these types of studies are needed, “the development of a core set of validated outcomes would enable a direct comparison of results of future studies.”(Hartfiel N) The ability to compare the results with other institutions librarians would help librarians better illustrate their impact on the hospital, clinical staff, and patients.

Unfortunately, as with most things, due to changes in personnel and Covid-19 this clinical librarian program no longer exists within the hospital impacting the clinical staff. In email correspondence with Dr. Girenda Sadera, “Covid put a dampener on things. Once Victoria left the trust we were not able to replace her on the unit. At present I am aware that the nursing staff are having limited success with obtaining help from the library.”

But there is a silver lining, Treadway mentioned this research had a “wider impact on embedded librarianship at a national level, as it helped to inform the Health Education Gift of Time report which makes a case for expanding embedded librarian roles across England.”

Hopefully the role of the embedded librarian is expanded in England and we see more studies reporting on the impact medical librarians have on increased support of clinical staff, and improved patient care.

For more articles on the impact and value of medical librarian please read:

The value of library and information services in patient care: results of a multisite study. Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S.J Med Libr Assoc. 2013 Jan;101(1):38-46. doi: 10.3163/1536-5050.101.1.007.PMID: 23418404

Measuring Return on Investment in VA Libraries. Jemison K, Poletti E, Schneider J, Clark N, Stone RD. Journal of Hospital Librarianship. 2009 Nov;9(4):379-390. doi: 10.1080/15323260903253803.

Assessing return on investment in health libraries requires lateral thinking. Urquhart C. Health Information and Libraries Journal. 2020 Mar;37(1):1-4. doi: 10.1111/hir.12298

Tools:
Evidence you can use to communicate library value. Medical Library Association. https://www.mlanet.org/page/evidence-you-can-use. Last accessed 6/26/22.

References:
Hartfiel N, Sadera G, Treadway V, Lawrence C, Tudor Edwards R. A clinical librarian in a hospital critical care unit may generate a positive return on investment. Health Information & Libraries Journal. 2021;38(2):97-112. doi:10.1111/hir.12332

During the Spring of 2020 medical libraries were struggling to balance the need to provide information with the need to be safe from covid-19. The response was varied across the profession. Some hospital libraries remained open, some were open to a limited number of people, others were staffed but closed to patrons, while others were physically closed as staff worked remotely.

On June of 2020, the library received a call from the spouse of a thankful patient.

The caller wanted thank the library staff coming in to “man the library” which allowed her to get the books she needed during the pandemic. She wanted to send thanks to everyone contributing patient care, and shared a story about her husband, a current patient.

She revealed her husband had been “visiting” the library while he recovered from heart surgery. He would stop by the library, stand outside the closed glass doors, cry, and smile as he watched the library staff work during pandemic.

According to caller, her husband had triple bypass surgery right next to his main artery and was very close to dying but the doctors used Dr. Floyd D. Loop’s procedure to do her husband’s triple bypass. Because of Dr. Loop and the library having this info available for the doctors to study, her husband was recovering nicely. “He’s a feisty Italian man,” she said.

She credited the doctors and the information the library provided with helping to save her husband’s life. She couldn’t wait to come pick up her book to look through the doors like her husband to thank the library staff.

The call became a bright spot in the gray covid-19 world for the library staff and it illustrates why medical librarians are passionate about what we do.

-If you have a story about the impact of medical librarians, please contact me and I will share it.

Doctors, nurses, and other members of the patient care team are faced with problems on a daily basis. Some of these problems are easier to solve than others. Some of these require more research to better understand and solve the problem. Clinical guidelines require research to find the highest quality of evidence with the most current, relevant data to determine the appropriate standard of care. Medical librarians are experts at providing that type of research.

In today’s post on a librarian’s impact in hospitals and patients, I would like to present the research done by a librarian at the Oncology Nursing Society who researched and co-authored a clinical practice guideline and a systematic review and meta-analysis.

ONS Guidelines™ for Opioid-Induced and Non-Opioid-Related Cancer Constipation.Rogers B, Ginex PK, Anbari A, Hanson BJ, LeFebvre KB, Lopez R, Thorpe DM, Wolles B, Moriarty KA, Maloney C, Vrabel M, Morgan RL.Oncol Nurs Forum. 2020 Nov 1;47(6):671-691. doi: 10.1188/20.ONF.671-691.PMID: 33063786

Management of Opioid-Induced and Non-Opioid-Related Constipation in Patients With Cancer: Systematic Review and Meta-Analysis.Ginex PK, Hanson BJ, LeFebvre KB, Lin Y, Moriarty KA, Maloney C, Vrabel M, Morgan RL.Oncol Nurs Forum. 2020 Nov 1;47(6):E211-E224. doi: 10.1188/20.ONF.E211-E224.PMID: 33063777

The guidelines included 13 recommendations for the management of opioid-induced and non-opioid-related constipation in patients with cancer. The guidelines were then implemented and their impact was evaluated and published. Translating Evidence to Practice: A Multisite Collaboration to Implement Guidelines and Improve Constipation Management in Patients With Cancer.Ginex PK, Arnal C, Ellis D, Guinigundo A, Liming K, Wade B.Clin J Oncol Nurs. 2021 Dec 1;25(6):721-724. doi: 10.1188/21.CJON.721-724.PMID: 34800103

According to Ginex et al. “Despite the prevalence of OIC (opioid-induced constipation), there is a paucity of research on management strategies.” The clinical practice guideline (PMID: 33063777) was implemented with nurse champions who identified practice gaps and improved the management of constipation among patients with cancer patients who were prescribed opiates. The authors noted that making local practice changes across multiple sites to reflect the national guidelines was not only “feasible but cost-effective.”

As noted in these articles, there were many people who helped research the problem, create the guidelines, and implement them across multiple locations. The librarian was part of the health care team that lead to improving patient care in a cost-effective way. As I mentioned the authors said there was a “paucity of research,” which is academic speak for there was not a lot of information on this topic and what was found, was hard to find. Thankfully they had a medical librarian on their team to find that hard to find research to help them.

Just as hospitals have experts who directly care for patients, it is also important for them to have librarians as experts to do the research and support the patient care teams. I can sew on a button, but you wouldn’t want me to close. You want a doctor who does that all the time. A doctor can find a good article, but if you want to find the evidence to impact patient care, you get a expert who spends everyday searching for evidence…a librarian.

Who knows it might just lead to improved patient care in a cost effective way.