The Clinical Librarian in an Emergency Department

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 patient’s 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 don’t 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