examining clinical questions: a research collaboration · examining clinical questions: a research...
TRANSCRIPT
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.
• Esparza et al., (2013) J Med Lib Assoc., 101(3):185-91.
• Klein et al., (1994) Acad Med., 69(6):489-95.
• Banks et al., (2007) J Med Lib Assoc., 95(4):381-7.
• Covell et al., (1985) Ann Intern Med., 103(4):596–9.
• Ely et al., (2005) J Am Med Inform Assoc., 12(2):217-24.
• Ely et al., (2007) J Am Med Inform Assoc., 14(4):407-14.
• Osheroff et al., (1991) Ann Intern Med., 114(7):576-81.
• Bennett et al., (2006) J Contin Educ Health Prof 26(2):120-7.
• Horwitz et al., (2008) Arch Intern Med., 168(16):1755-60.
• Bembea, Melania M., et al. "Neuromonitoring During Extracorporeal Membrane Oxygenation: A Systematic
Review of the Literature." Pediatric Critical Care Medicine (2015).
• Chavez, Miguel A., et al. "Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and
meta-analysis." Respir Res 15.1 (2014): 50.
• Colbert-Getz, Jorie M., et al. "Assessing Medical Students’ and Residents’ Perceptions of the Learning
Environment: Exploring Validity Evidence for the Interpretation of Scores From Existing Tools." Academic
Medicine 89.12 (2014): 1687-1693.
• Custer, Jason W., et al. "Diagnostic Errors in the Pediatric and Neonatal ICU: A Systematic Review." Pediatric
Critical Care Medicine 16.1 (2015): 29-36.
• Grover, Surbhi, et al. "A systematic review of radiotherapy capacity in low and middle income
countries." Frontiers in Oncology 4 (2014): 380.
• Lee, Angela C., et al. "Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving
massive transfusion." Transfusion 54.1 (2014): 244-254.
• Oh, Esther S., et al. "Preoperative risk factors for postoperative delirium following hip fracture repair: a
systematic review." International journal of geriatric psychiatry (2014).
• Pereda, Maria A., et al. "Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-
analysis." Pediatrics (2015): peds-2014.
• Rinke, Michael L., et al. "Interventions to reduce pediatric medication errors: a systematic
review." Pediatrics (2014): peds-2013.
• Tuffaha, Sami H., et al. "Pyoderma Gangrenosum After Breast Surgery." (2014).
• Walsh, Kathleen E., et al. "Medication Adherence Among Pediatric Patients With Sickle Cell Disease: A
Systematic Review." Pediatrics 134.6 (2014): 1175-1183.
• Wieland, L. Susan, et al. "Who has used internal company documents for biomedical and public health
research and where did they find them?" PloS one 9.5 (2014): e94709.
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
