Guest post by Basia Delawska-Elliott and Donna Belcinski, medical librarians serving hospitals in Oregon and Connecticut.
Recently there have been a number of messages going out to medical library discussion lists announcing the unfortunate closing of yet another hospital library. It seems that, in this era of for-profit medicine, libraries are looked upon as luxuries. Yet those of us who work in them know our services are not only needed but valued by the physicians, nurses, and other health professionals who regularly call on us to answer their questions.
Anyone who doubts the need for information professionals in a hospital probably doesn’t understand what we do.
Many people think everything is on Google, and it might be, but it’s not easy to find. Medical literature is found in databases that often require time, patience, and skill to search, and a subscription to access.
Furthermore, someone has to assess the information needs of the hospital community, negotiate pricing for and purchase the resources that best fit those needs, work with vendors and the institution’s IT department to set up access to the resources, and then navigate the resources to retrieve what is in them.
Searching databases takes time, patience, and skill. While it is certainly possible for medical professionals to have the patience and skill, do they really have the time? How many nurses and physicians, in the course of a busy 12-hour shift, can find the time to search the medical literature?
A point-of-care tool can give a quick answer, but if something in-depth or out of the ordinary is required, those tools aren’t usually helpful. More specialized skills and knowledge of how information is organized are needed to answer complex clinical questions. Hospital librarians have not only the educational background, but also the experience to navigate databases and retrieve hard-to-find information.
Many people don’t seem to understand what a librarian does, why it’s different from a Google search, and that the “information bubble” is as real in medicine as it is in other disciplines. They may also be unaware that googling can lead to selective retrieval of information and confirmation of bias. The groundbreaking 1992 Rochester study (Marshall) and the 2013 follow up (Marshall) showed the vast majority of physicians changed the course of patient treatment based on library-provided information—80% in 1992, 75% in 2013. This telling statistic confirms that librarian-mediated searches and resources curated by hospital librarians do make a difference.
Every time a hospital library closes, we send out a call to arms and vow to stem the tide of attrition in our ranks. Yet the task of saving hospital libraries has become increasingly difficult. Once mandated by law, requirements for hospital libraries have been dropped by regulatory agencies—first by the Health Care Financing Administration in 1986, then The Joint Commission in 1993. In the climate of expense cuts, this shift has made hospital libraries an easy target. Point-of-care products, which synthesize current evidence in support of decision-making regarding tests, interventions, or diagnosis, have also made it more difficult to convince administrators that other information resources are still needed—and oftentimes more reliable. And with health systems increasingly consolidating, health system administrators—now removed from everyday hospital concerns—may see the library only as an expense and not as an asset their hospital staff value and rely upon.
Although hospital librarians have primarily concentrated on providing patient-care information, we also support a number of different important hospital functions and initiatives including research, information literacy training, graduate medical education, undergraduate and graduate nursing and allied health education, continuing education, Magnet preparation, evidence-based nursing practice, and hospital administrative and competitive intelligence research. Cuddy (2005) described a similar assessment of the breadth of library contributions in the Fuld Campus study.
The value of a hospital librarian has been proven. And with doctors and nurses asked to practice evidence-based medicine, is it really wise to close hospital libraries and dismiss the professionals best equipped to find that evidence?
What steps can we take to ensure the latest announcement of a hospital library closing is the last?
Cuddy, T.M. (2005). Value of hospital libraries: The Fuld Campus study. Journal of the Medical Library Association, 93, 446-449.
Marshall, J.G. (1992). The impact of the hospital library on clinical decision making: The Rochester study. Bulletin of the Medical Library Association, 80, 169-17.
Marshall, J.G., Sollenberger, J., Easterby-Gannett, S., Morgan, L. K., Klem, M. L., Cavanaugh, S. K., . . . Hunter, S. (2013). The value of library and information services in patient care: Results of a multisite study. Journal of the Medical Library Association, 101(1), 38-46.