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Starting from Scratch: Establishing a Role for an Informationist on Rounds

Alison Aldrich, MSI MPH

Stephanie Schulte, MLISThe Ohio State University

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Background

• OSU HSL has a good history of collaboration with the College of Medicine and College of Nursing

• A Clinical Informationist position was created to improve HSL services to clinical faculty and staff

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Health Sciences Library

photo: medicalcenter.osu.edu

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OSU Internal Medicine Residents 2011-2012

photo: http://internalmedicine.osu.edu/education/welcome/our-residents/index.cfm

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10 patientsAttending

PGY-3

PGY-1

MS-3

MS-3Pharm

Pharm

CCM

Informationist

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Challenge: Who are you?

• Don’t expect to be introduced• Master the elevator speech• Repeat as necessary• Act like you belong

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Challenge: Encouraging Questions

attending59%

resident18%

intern9%

ccm6%

student6%

pharm2%

Percentage of Questions Asked by Team Role

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Challenge: Encouraging Questions

January

Febru

aryMarc

hApril

MayJune

July

August

Septem

ber

October

November

December

0

5

10

15

20

25

30

35

Questions by Month

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Challenge: Encouraging Questions

• Go back mid-afternoon• Take advantage of down time• Listen, listen, listen

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Challenge: Resident Burnout

Survey of US internal medicine residents, 2008-2009:• Overall burnout = 51.5%• Emotional exhaustion = 45.8%• Depersonalization = 28.9%

West, C. P., Shanafelt, T. D., & Kolars, J. C. (2011). Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA : The Journal of the American Medical Association, 306(9), 952-960.

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Challenge: Resident Burnout

• Empathize• Archive articles from rounds for residents

to access later• Send the best, include search strategy for

the rest

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May 2012 survey

• To all residents plus students and staff from rounds (n=22)

• 77.8% of respondents had interacted with the informationist on rounds

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May 2012 survey

• Did information/instruction provided by the clinical informationist allow you to handle a clinical situation differently than you would have otherwise?

77.8% yes

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May 2012 survey

• Did informationist services save you time?

78% yes

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May 2012 survey

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Challenge: Fishing vs. Teaching

McGinn, T., Seltz, M., & Korenstein, D. (2002). A method for real-time, evidence-based general medical attending rounds. Academic Medicine, 77(11), 1150-1152.

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Challenge: Fishing vs. Teaching

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Challenge: Fishing vs. Teaching

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Challenge: Fishing vs. Teaching

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Challenge: Fishing vs. Teaching

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The Main Challenge: Culture

“Culture trumps strategy every time.”

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The Main Challenge: Culture

“Culture trumps strategy every time.”

“Accreditation standards trump culture every time?”

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ACGME Milestone 15

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Year in Review

• Approximately 10 hours/week spent rounding

• 232 questions, 96.6 hours spent searching• Familiarity with culture, pace, and

frequently encountered clinical problems on rounds

• Preliminary evidence that it’s helping

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More to Try

• Develop evaluation strategies for milestones

• Round to multiple services• Promote it as a novelty - have attendings

sign up for informationist service• Electronic feedback options

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Connect with us

• Alison Aldrichalison.aldrich@osumc.edu @aldricham

• Stephanie Schultestephanie.schulte@osumc.edu @s_schulte