Medical Libraries: An Essential Resource in Outcomes Improvement
By systematically researching and accessing best practice and evidence, medical libraries connect organizations with knowledge to drive outcomes improvement. Medical libraries are particularly valuable in today’s information-rich digital world; Google quickly answers any query, but accessing accurate, focused information requires diligence, skill, and the highest quality resources.
Medical librarians, who hold master’s degrees in their specialty, are uniquely qualified to connect outcomes improvement teams with reliable, current, and relevant evidence. Many medical librarians receive credentialing through the Medical Library Association Academy of Health Information Professionals in recognition of their exemplary qualifications, health information knowledge, and commitment to the profession.
In recent years, tightening health system finances have put medical libraries under pressure. Some organizations have closed their libraries, and others have reduced staff—often in conjunction with hospital mergers. Some hospital administrators aren’t fully aware of the value of medical libraries, or don’t understand that paid subscriptions deliver high-quality, evidence-based information they can’t access online for free. This article describes how getting the most out of published knowledge requires the resources of medical libraries and expertise of medical librarians.
Medical Libraries Are Growing and Diversifying
As technology advances, the medical librarian’s role is diversifying. Medical librarians support research through advanced search skills, instruction on effective use of information resources, and support of institution-level performance improvement or quality initiatives. Some participate in hospital rounds as clinical medical librarians, providing direct support as caregiver team members. Others fill the role of informationists, contributing both information science and clinical/biomedical science.
To keep up with the increasing availability of online resources, today’s librarians are adept at gaining access to electronic resources through contract and licensing negotiations. They make information resources accessible from multiple locations; whether through enhanced retrieval from search engines or automated linking, medical librarians provide seamless access to full-text articles from PubMed citations. They can also establish proxy-server systems, which allow access to information from outside the institution.
Librarians may also lead their institutions on maintaining compliance with copyright guidelines. Through their management of print and online journals, books, and information resources, medical libraries provide a deep knowledge base for the institution. This includes access to national guidelines, systematic reviews (e.g., the Cochrane Collaboration), or point-of-care tools (e.g., UpToDate), whether resources are focused by subject (e.g., drug information) or provider type (e.g., nursing-related collections).
Medical Libraries Connect Organizations with Knowledge to Drive Outcomes Improvement
Research demonstrates that medical libraries improve healthcare quality, and save time and money for clinicians and healthcare organizations. Hospital and health system libraries support outcomes improvement by providing evidence-based research. Medical librarians often sit on committees to help guide quality initiatives or develop evidence-based clinical guidelines. Librarians find best practice and evidence through literature searches, and deliver focused results in the form of full-text articles from the library’s own collection or by arrangements with other libraries—growing the breadth and depth of knowledge beyond the walls of the institution.
Medical Libraries on the Front Line of Outcomes Improvement
Allina Health sought to improve spine surgery performance at some of its facilities, which prompted a major improvement initiative in the form of a multidisciplinary spine program. With support from the medical library, including a series of literature searches focused on spine surgery outcomes as well as the delivery of pertinent journal articles, the organization developed an evidence-based care model. The model aims to deliver care to every spine patient right care at the optimal time for the best possible outcome. The program includes evidence-based care guidelines, along with continuous monitoring of the data. As a result, Allina has improved quality of care and lowered pain levels for spine patients.
When Allina develops clinical guidelines and protocols, Library Services searches and appraises the evidence. This process has produced 25 systemwide guidelines and contributed to clinical outcomes improvement in several areas:
- A five percent reduction in Stage 1 lung cancer treatment variation, with a focus on optimal treatment.
- A 20 percent decrease in the number of heparin protocols, which has resulted in reduced incidence in bleeding, along with other safety benefits.
- Implementation of a system-wide guideline for acute pain management with opioids.
Library Services also works closely with Allina’s Clinical Service Line councils and participates in the Clinical Practice Council, providing the knowledge base for Allina to make peer-reviewed, evidence-based recommendations for several issues:
- Appropriate conditions to prescribe medical cannabis.
- Appropriate age for mammography screening.
- Evidence in support of preoperative screening protocols.
- Appropriate use of postoperative pulse oximetry.
- Procedures in robotic surgery achieves the best cost and clinical outcomes.
- The effectiveness of decision-making in colorectal screening.
On a monthly basis, Library Services helps Allina identify possible improvement opportunities by searching the literature for current articles on clinical variation and cost reduction. Recent articles considered cover several important improvement areas:
- Variation in the cost of common surgical procedures.
- Cost analysis of a national surgical consensus guideline in breast cancer surgery.
- Analysis of safety and potential cost savings with early discharge after percutaneous coronary intervention.
High-Quality, Value-Based Care Requires Data and Evidence
High-quality, value-based care must be both data driven and evidence based to support the right kinds of improvement. Data from an enterprise data warehouse (EDW) can show areas of clinical variation and are strengthened when presented with the medical library to show the value and effectiveness of potential solutions to address that variation. Also, hot topics in the literature around variation can be funneled to an analytics team to dig in and understand how the topic may be affecting an organization. The library-furnished evidence complements data from the EDW or similar sources, making both knowledge bases essential for effective improvement.
Recently, a large-scale, multisite study focused on the value and impact of medical libraries. The survey found that information provided by the library facilitated outcomes improvement:
- Contributed to a higher quality of care (93 percent of respondents).
- Saved time (85 percent).
- Provided new knowledge or substantiated prior knowledge or belief (91 percent).
The study confirmed that information provided by the library can drive better informed clinical decisions by substantiating prior knowledge or providing new knowledge. In one key improvement area—avoidance of adverse effects—the study highlighted a number of key outcomes related to patient safety, which the organization avoided as a result of information furnished by the medical library. These patient safety events included: misdiagnoses (13 percent), adverse drug reactions or interaction (13 percent), and medication error (12 percent).
Given the rate of medical knowledge growth, it is almost impossible for clinicians to keep up with current findings, even in highly specialized fields. In 2016, nearly 870,000 citations were added to the MEDLINE database. Because clinicians make difficult decisions on a regular basis, the medical library provides expert direction on this huge volume of literature with focused, targeted information and answers.
Medical Libraries—Key to Better Care, Reduced Cost
Medical libraries help health systems improve outcomes by providing focused, reliable access to knowledge and information that defines best practice and evidence. They play key roles in achieving a higher quality of care that improves patient experience and population health, and reduces cost. With the expertise to efficiently search the literature, medical librarians save valuable clinician time and provide evidence to support data-driven improvement and identify improvement opportunities. For many health systems with an outcomes improvement strategy, the medical library is a critical asset.
Would you like to learn more about this topic? Here are some articles we suggest:
- Improving Outcomes That Matter Most to Patients
- The Top Six Early Detection and Action Must-Haves for Improving Outcomes
- 7 Features of Highly Effective Outcomes Improvement Projects
- A Guide to Successful Outcomes Using Population Health Analytics
- How Allina Health Deployed Evidence-Based Decision Making and Reduced Variation