Esparza, Julia M., et al. “The effect of a clinical medical librarian on in-patient care outcomes.” Journal of the Medical Library Association, 101.3 (2013): 185-191.
Doctors often have to research in order to provide superior patient care. The importance of this part of the healthcare process (together with the rise of the Internet) led to the creation of clinical medical librarians (CMLs) in the 1970s. CMLs are generally considered to be quite helpful in research, but their actual impact has proved difficult to measure. Although one study performed found that the CML involvement led to a shorter patient stay times and quicker treatment, the field of patients which matched the criteria was very limited. To begin filling this void, the authors decided to study whether having an embedded CML at LSU Health Shreveport would make a difference in patients’ length of stay/cost of care/readmission rate for patients. An experienced CML was hired, and began going on the morning rounds with the care providers. Additionally, the CML was given access to the electronic patient records. Two groups (one control, one test) were selected, 253 patients in each. Patients were added to the test group when a care provider asked the CML a question about care specifically for that patient. Three analyses were performed in total: a comparison between test and control groups for outcome variables, between the time in care, etc. between each of the test group and up to 4 patients with similar situations in the last 5 years, and between the in-hospital mortality rates of test subjects with the closest matched control. During the study, the CML was most often asked questions concerning treatment and diagnosis, but also called upon for general overviews of the subject. The sites most often consulted were PubMed, AccessMed, and MD Consult. Overall, results for the intervention group were much worse than the control group. This turned out to be because patients in the test group were overall in worse condition (though also younger) than those in the control group. When the findings were adjusted for this, they found no particular difference between the presence and absence of a CML, except that (bizarrely) the intervention group were readmitted within 30 days something around 5 times more frequently. Although the discussion did reveal certain limitations of the study (only one CML was studied, study wasn’t randomized, and the groups studied could have been larger) it also noted a remarkable number of variables beyond the control of the researchers, some of which probably influenced the outcome of the study.
This paper was an interesting look at a study that was conducted scientifically but still yielded disappointing results.