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