National Study Illustrates HSL’s Value for Clinical Decision Making and Patient Study
An independent North American study conducted in 2011 found that library users based at UNC Hospitals placed a very high value on Health Sciences Library (HSL) resources and services. Moreover, the HSL’s results were, by and large, higher than the average for all respondents and significant. The overall purpose of this study was to ascertain the value of library services to patient care. 56 total sites participated in the United States and Canada, including seven in the Southeastern US. Responding clinicians at UNC Hospitals told interviewers that our resources and services played a role in avoiding misdiagnosis, adverse drug reactions, medication errors, mortality and unnecessary surgery.
When UNC respondents were asked to recall a specific patient care situation, 92% said they ‘definitely’ or ‘probably’ handled the situation differently as a result of having information from the library. The same number (92%) said using the information from the library saved them an average of 2.1 hours with the situation they were dealing with.
Meanwhile, some examples of beneficial changes UNC respondents identified were:
- 59% said it changed the advice they gave to the patient or family;
- 54% said it changed their choice of drug;
- 49% said it changed their choice of treatment;
- 43% said it changed their diagnosis
Some examples of adverse events avoided were:
- 38% said it helped them avoid additional tests or procedures;
- 34% avoided patient misunderstanding;
- 26% avoided misdiagnosis;
- 21% adverse drug reaction;
- 18% medication errors;
- 11% patient mortality;
- 8% unnecessary surgery.
Use of Library Resources
Also in the study, the national results report the top five library resources used as being: online journals (46%), Pubmed (42%), UptoDate (40%), online books (30%) and Micromedex (24%). UNC results were Pubmed (78%), online journals (75%), UptoDate (67%), online books (38%), and Micromedex (26%). Nearly all respondents evaluated information obtained as being relevant, accurate, of clinical value, contributing to higher quality care, and resulting in better clinical decisions. At UNC, the ability to access UptoDate (and its links to full text journals) contextually from within the medical record also saves clinicians’ time.
How did respondents access library resources? 82% of UNC respondents said they accessed information resources through our library’s web site (compared to only 50% of respondents nationally). One of the most popular features of our site is the Clinical Resources pages which also can be accessed via WebCIS (an online clinical information system used by UNC Hospitals) or via the main HSL home page (79,688 page views in FY 12 of just the Resources home page). HSL monitors use of these and other resources and adjusts our licenses as needed. In addition to the resources listed above, other heavily used clinical resources include Visual Dx, MD Consult, and Lexi-Comp Online. Each has experienced increased use over the past three years.
Heavily used clinical journals include JAMA, New England Journal of Medicine, The Lancet, Pediatrics, and Annals of Internal Medicine [data obtained from 2011 report from Serials Solutions].
Use of Library Services
7% of respondents in the study cited above mentioned asking a librarian for assistance in that specific patient situation. 68% of our respondents reported that the information they used was complete. In addition to responding to individual requests, librarians assigned to UNC Hospitals also reach out to selected clinical services (surgical oncology, GI surgery, infectious diseases), patient care quality and safety groups, and patient education teams to offer information support. In FY 11, librarians provided 444 direct information consults with clinicians, an increase of 29% over the prior fiscal year.