Transcript Advanced Care Bleeding weiss

The Clinical Librarian in an Emergency
Department
Professor Tim Coats
Professor of Emergency Medicine
Leicester University, UK
Objectives
 To identify information needs in emergency care
 To look at current models
 Speculate on the future
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
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
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?”
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
Current systems
 Books - ‘How to do it guides’
 ‘Google it’ - works well!
 Phone a friend
 Clinical Librarian
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
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
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
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