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Examining Clinical Questions:
A Research Collaboration
July 9, 2015
EAHIL + ICAHIS + ICLC Workshop
Edinburgh, Scotland
10-12 June 2015 1
Presented by: Blair Anton, MLIS, MS, AHIP
Question
• How do clinical questions emerge and move
toward resolution in an intensive care unit
setting over the course of 24 hours?
The Collaboration
• Relationships are critical. Time spent building
them is time well spent.
• Phased approach to partnership: Research
requires partners from multiple disciplines
• Library champions = Partners
• Share the question and gauge interest and
perspective from partners.
7/9/2015 3
Setting
• Weinberg Intensive Care Unit (WICU)
– 20 beds
– Teaching hospital
– Tertiary care facility
– Comprehensive critical care: surgical oncology,
medical specialty and general surgery
Population and Recruitment
• IRB-approved protocol
• 19 Clinicians: Attending Physicians, Fellows,
Residents, Nurses, Pharmacists
• No electronic health records or other sources
of PHI were accessed or used.
Observations
• Round-the-clock observation of participants
for two (2) consecutive 48-hour periods
• Recorded questions, the process to pursue
answers and the outcome (usefulness)
• Questions related to treatment, medications,
diagnosis, prognosis, etiology and harm.
Measurements
• Data about each question:
– Was it answered immediately?
– Was it pursued later?
– Did it remain unanswered?
– If answered, what source was used?
– Was the answer useful?
Results
• 112 questions were collected from the 2 48-hour study periods
• 70 of those were answered immediately or pursued later
• 42 remained unanswered
• Of the total, 15% of questions persisted across shifts until they were answered, sometimes up to 4 shifts later.
Results
• Activities during which questions were
captured:
– Rounds (54), case review (19), teaching (15), and
curbside consultations (24)
• Participants were satisfied two-thirds of the
time when answers were found (23/37
observed instances)
Results
• Clinicians asked most questions related to
treatment and medication, followed by
etiology, diagnosis and prognosis questions
Literature in Context and Impact
• Clinicians ask more questions than they
answer
• Persistence of questions across shifts
• Illness complexity = increase in questions
• Timeliness and methods of answering queries
impacting health care outcomes
• Barriers to pursuing answers
Limitations
• Shadowing multiple participants individually
• Study period constraints and questions lost to
follow-up; unknown resolution
Conclusions
• Questions persist until resolved in some
manner
• Questions are found in dialogue over time, in
a life cycle of inquiry
• Information service delivery can be improved
and positively impact health care outcomes
References
• Anton et al. (2014) J Med Lib Assoc, 102 (3):201-5.
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Closing Thoughts
• Skills and expertise are commodities, intellectual property
• Conversations are two-way streets
• Ask to get a “seat at the table” on committees that are information-resource relevant
• Showing up and being part of the conversations increases value of the profession and academic research efforts