Advocacy Quotes

> The following quotes, as compiled by Deb Weaver of the Children's
> Hospital in Denver and the Colorado Council of Medical Librarians
> advocacy team, relate to the importance of having a medical librarian
> on staff. In particular, how medical librarians:

A. Improve patient care and safety

B. Save money for the organization due to:

i\. Better decision-making

ii\. More efficient use of employees' time

*"Frequency of questions occurring in clinical practice (0.7-1.5 per
patient)" (Smith 1996)*

> Smith, R. (1996). \"What Clinical Information do Doctors Need?\"
> [British Medical Journal]{.underline} **313**(7064): 1062-1068.

*"Over 70% of questions remain unanswered due to lack of time,
forgetting the question and a perception that an answer would/could not
be found" (Green, Ciampi et al. 2000)*

> Green, M. L., M. A. Ciampi, et al. (2000). \"Residents\' Medical
> Information Needs in Clinic: Are They Being Met?\" [American Journal
> of Medicine]{.underline} **109**(3): 218-223.

*"Marshall reported that 80% of participating physicians changed their
care as a result of evidence...These changes reduced mortality risk in
19% of patients, avoided hospitalization in 12% of cases, changed
diagnostic tests in 51% and drug choice in 45%. Overall length of stay
in hospital was reduced in 19% of patients." (Marshall 1992)*

> Marshall, J. G. (1992). \"The Impact of the Hospital Library on
> Clinical Decision Making: The Rochester Study.\" [Bulletin of the
> Medical Library Association]{.underline} **80**(2): 169-178.

*"Efficient and timely access to evidence-based medical literature is an
important element in providing safe patient care."(Williams and Zipperer
2003 August)*

> Williams, L. and L. Zipperer (2003 August). \"Improving Access to
> Information: Librarians and Nurses Team Up for Patient Safety.\"
> [Nursing Economic\$]{.underline} **21**(4): 199-201.

*"Physicians' utilization of information identified through database
searching for inpatient care can contribute to reduced lengths of stay
and lower costs in several ways. Not only does information serve to
trigger new or different diagnostic tests or therapeutic maneuvers, but,
as studies have suggested, its usefulness also exists in halting
procedures or therapies that have been shown to be ineffective in
similar situations. As Garfield points out, beyond avoiding adverse
events, 'any time an unnecessary test is avoided or a more relevant one
is applied, the patient, the hospital, the physician, and even the
insurance companies benefit from lower costs.'" (Klein, Ross et al.
1994)*

> Klein, M. S., F. V. Ross, et al. (1994). \"Effect of Online Literature
> Searching on Length of Stay and Patient Care Costs.\" [Academic
> Medicine]{.underline} **69**(6): 489-495.

*"Our study is the first to demonstrate quantitatively, rather than
subjectively or through anecdotes that a statistically significant
relationship exists between the use of information from database
searching for severely ill patients and a reduction in LOS
\[length-of-stay\] and / or hospital costs. The causal nature of this
relationship, however, was not established." (Klein, Ross et al. 1994)*

> Klein, M. S., F. V. Ross, et al. (1994). \"Effect of Online Literature
> Searching on Length of Stay and Patient Care Costs.\" [Academic
> Medicine]{.underline} **69**(6): 489-495.

*"Tests cases with timely patient-care-related information retrieved
from librarian-mediated MEDLINE searches demonstrated reduced economic
hospital indicators, i.e. costs, charges, and lengths of stay.
Shortening LOSs or decreasing hospital costs can result in more
effective utilization of hospital resources. For those health care
organizations seeking to maximize the use of resources, the timely,
inexpensive intervention of a librarian-mediated MEDLINE search can
positively affect costs and LOS without eliminating health care access
or services." (Klein, Ross et al. 1994)*

> Klein, M. S., F. V. Ross, et al. (1994). \"Effect of Online Literature
> Searching on Length of Stay and Patient Care Costs.\" [Academic
> Medicine]{.underline} **69**(6): 489-495.

*"A key role for management, therefore, is to help improve access to
evidence-based literature for nurses to enable them to interact more
proactively for safety. Key to improving access to evidence from
biomedical literature is the medical reference librarian or clinical
librarian. Nurses and patients both benefit from a partnership between
nurses and librarians." (Williams and Zipperer 2003 August)*

> Williams, L. and L. Zipperer (2003 August). \"Improving Access to
> Information: Librarians and Nurses Team Up for Patient Safety.\"
> [Nursing Economic\$]{.underline} **21**(4): 199-201.

The following quotes pertain to the need for expert searchers to find
information that is:

a.  Authoritative

b.  Relevant

c.  Delivered in a timely, efficient manner

d.  Delivered to the right person at the right time

*"...with the advent of the World Wide Web, every professional worker
has become a searcher, but without either search training or a roadmap
of what he is searching. Without information training and skills, most
people don't know where to look, how to ask for what they are seeking,
or when it is okay to stop looking. One answer looks very much like
another unless the searcher understands what constitutes valid
information." (Feldman 2003)*

> Feldman, S. (2003). Enterprise Search Technology: Information
> Disasters and the High Cost of Not Finding Information,
> [www.portalsmag.com](http://www.portalsmag.com/). **2004:** 27-28.

*"Knowledge workers spend from 15% to 35% of their time searching for
information. Searchers are successful in finding what they seek 50% of
the time or less according to both Web search engines and our own
surveys. An IDC study in 2001 (Quantifying enterprise search, IDC#26826,
May 2002) found that only 21% of respondents said they found the
information they needed 85-100% of the time." (Feldman 2003)*

> Feldman, S. (2003). Enterprise Search Technology: Information
> Disasters and the High Cost of Not Finding Information,
> [www.portalsmag.com](http://www.portalsmag.com/). **2004:** 27-28.

*"Some studies suggest that 90% of the time that knowledge workers spend
in creating new reports or other products is spent in recreating
information that already exists. In 1999, a European study by IDC
examined this phenomenon, called the 'knowledge work deficit,' and
concluded that the cost of intellectual rework, substandard performance,
and inability to find knowledge resources was \$5,000 per worker per
year." (Feldman 2003)*

> Feldman, S. (2003). Enterprise Search Technology: Information
> Disasters and the High Cost of Not Finding Information,
> [www.portalsmag.com](http://www.portalsmag.com/). **2004:** 27-28.

*"The quest for information systems that deliver the right information
-- and only the right information -- at the right time to the right
people is by no means over. Organizations can not afford to ignore the
technologies that are available today. The cost of not finding
information is simply too high." (Feldman 2003)*

> Feldman, S. (2003). Enterprise Search Technology: Information
> Disasters and the High Cost of Not Finding Information,
> [www.portalsmag.com](http://www.portalsmag.com/). **2004:** 27-28.

*"Given the complexity and time constraints involved in care delivery,
seeking out the right information at the right time is an increasingly
difficult goal for many health practitioners to reach." (Williams and
Zipperer 2003 August)*

> Williams, L. and L. Zipperer (2003 August). \"Improving Access to
> Information: Librarians and Nurses Team Up for Patient Safety.\"
> [Nursing Economic\$]{.underline} **21**(4): 199-201.

*"...we note that strategies to improve the time efficiency of
evidence-based practice should receive high priority in future research.
Our results support a long-standing concern that lack of time is a major
impediment to practicing evidence-based medicine. We do not recommend
our search protocol for practical application because it was designed
for a specific research purpose. Time savers that seem promising include
instant resource books (compendia of previously performed searches) and
physician extenders such as electronic librarians." (Lucas, Evans et al.
2004)*

> Lucas, B. P., A. T. Evans, et al. (2004). \"The Impact of Evidence on
> Physicians\' Inpatient Treatment Decisions.\" [Journal of General
> Internal Medicine]{.underline} 19(5 pt. 1): 402-409.

*"Those who like looking for a needle in a haystack love searching the
World Wide Web. American companies spend \$107 billion a year paying
their employees to search for free information...Because going on the
Web, with its profusion of data, is like trying to drink water from a
fire hose, businesses increasingly are relying on data from specialized
resources...paying for high-quality, targeted information is more
cost-effective than relying on low-quality data." (Byrne 2003)*

> Byrne, T. (2003). \'Free\' Info on Web Might Cost More Than You Think,
> Cincinnati Business Courier. 2004.

*In truth, many healthcare professionals who think that Web search tools
have simplified the information-retrieval process may decide otherwise
when they've wasted an hour in fruitless pursuit and waded through
hundreds of pages of what turns out to be less than worthwhile---perhaps
even utterly useless---information. (Darves 2004)*

> Darves, B. (2004). \"Strategic Searching.\" [Medicine on the
> Net]{.underline} 10(5): 1-4.

*One of my mantras is urging people to understand that when they do a
search and find something, that doesn't mean they've done a
[good]{.underline} search," she \[Pamela Sieving, a biomedical librarian
and informationist at the National Institutes of Health\] says. (Darves
2004)*

> Darves, B. (2004). \"Strategic Searching.\" [Medicine on the
> Net]{.underline} **10**(5): 1-4.

*"End-user access to MEDLINE has allowed clinicians to research a given
topic and has increased their ability to provide evidence-based medical
practice. Subsequent efforts to simplify MEDLINE end-user searches may
have led to the misconception that searching the database effectively is
extremely easy and can be conducted in the same manner as an ordinary
Internet search. However, effective searching requires training and
practice, which many orthopaedic surgeons lack." (Smith, Herzka, Wenz
2004)*

> Smith, C. G., A. H. Herzka, et al. (2004). "Searching the Medical
> Literature." [Clinical Orthopaedics and Related Research]{.underline}
> April (421): 43-49.

The following quotes pertain to the notion that librarians are more
effective than other employees at getting the right information to the
right person at the right time.

a.  Librarians find information more quickly

b.  Librarians provide access to authoritative / reliable sources

c.  Librarians organize information for future retrieval and use

    i.  This eliminates the duplication of effort when multiple
        employees search for the same information or when employees lost
        the original information and must find it all over again.

*"Hersh et. Al. (2002) showed that even with fast connectivity and
access to online databases (Ovid, Pubmed, and CINAHL), nurse
practitioner students and medical residents who were given online
research training had difficulty efficiently and correctly performing a
search in a study emulating the effort to practice evidence-based
medicine. Expertise in refining the search question and then producing
and evaluating relevant results rests with the medical librarian."
(Williams and Zipperer 2003 August)*

> Williams, L. and L. Zipperer (2003 August). \"Improving Access to
> Information: Librarians and Nurses Team Up for Patient Safety.\"
> [Nursing Economic\$]{.underline} **21**(4): 199-201.

*"In the corporate information center model, the hospital library exists
to save the requesters time so that they can perform the duties they
were hired to do -- solve problems, develop new businesses, or treat
patients -- not spend their valuable time looking for the information to
do their jobs. Your hospital has employed expert, professional
librarians to retrieve information most efficiently, and they should be
utilized by administrators, too." (Ben-Shir 1989)*

> Ben-Shir, R. (1989). \"Untapped Library Resources are Yours for the
> Asking.\" [Hospitals]{.underline} **63**(20): 96.

*"In some institutions, libraries and librarians are seen as
nonessential, due to the misguided belief that anything worthwhile is
available free in full text on the Internet, and everyone has sufficient
skill and time to do quality searching. Providing print and electronic
resources for the professional and educational needs of hospital staff
continues to be most efficiently and cost effectively managed by
qualified librarians." (Gluck and Hassig 2001)*

> Gluck, J. C. and R. A. Hassig (2001). \"Raising the Bar: The
> Importance of Hospital Library Standards in the Continuing Medical
> Education Accreditation Process.\" [Bulletin of the Medical Library
> Association]{.underline} **89**(3): 272-276.

*"A key role for management, therefore, is to help improve access to
evidence-based literature for nurses to enable them to interact more
proactively for safety. Key to improving access to evidence from
biomedical literature is the medical reference librarian or clinical
librarian. Nurses and patients both benefit from a partnership between
nurses and librarians." (Williams and Zipperer 2003 August)*

> Williams, L. and L. Zipperer (2003 August). \"Improving Access to
> Information: Librarians and Nurses Team Up for Patient Safety.\"
> [Nursing Economic\$]{.underline} **21**(4): 199-201.

*"My guess is about 300 years until computers are as good as, say, your
local reference library in doing search. But we can make slow and steady
progress, and maybe one day we'll get there." -- Craig Silverstein,
Google's director of technology. (Author?? 2004)*

> Author?? (2004). Inside the World of Google, CBS News. 2004.

*"Difficult MEDLINE searches require the skills of librarians trained in
evidence-based methods...Cooperative searching of MEDLINE, using the
physician's knowledge of clinical practice and the librarian's knowledge
of the database and search engine, produces the best search results and
will serve to enhance your own \[the physician's\] skills." (Gallagher,
Allen et al. 2002)*

> Gallagher, P. E., T. Y. Allen, et al. (2002). \"How to Find Evidence
> When You Need It, Part 3: A Clinician\'s Guide to MEDLINE: Tricks and
> Special Skills.\" [Annals of Emergency Medicine]{.underline}
> **39**(5): 547-551.

*"Before attempting any literature searching, find out what help and
support is available. Hospital libraries may provide direct training on
searching databases, or more general guidance and support. Librarians
advise on the databases and other resources available and may provide
written instructions or have self-help tutorials." (Craig and Smyth
2002)*

> Craig, J. V. e. and R. L. e. Smyth (2002). [The Evidence-Based
> Practice Manual for Nurses]{.underline}. London, Churchill
> Livingstone.

*"If you \[the clinician\] suspect that you may have gaps in your
searching skills, strongly consider spending some time with an
experienced medical librarian or taking a course on MEDLINE searching."
(Group, Guyatt et al. 2002)*

> Group, T. E.-B. M. W., G. e. Guyatt, et al. (2002). [Users\' Guides to
> the Medical Literature: A Manual for Evidence-Based Clinical
> Practice]{.underline}. Chicago, American Medical Association Press.

*"Library services are important information access and management
resources for hospitals in patient care, research, administrative
decision support, education, and patient and consumer information. The
library professional is the key to the cost-effective access to and
utilization of these resources." (Association 1990)*

> Association, A. H. (1990). \"Management Advisory: Information
> Management.\" [Library and Information Services]{.underline}: 1-3.

*"Librarians, trained in medical literature searches, are aware of the
limitations of a search restricted solely to the MEDLINE database, but
many end-users or clinicians are not." (Smith, Herzka, Wenz 2004)*

> Smith, C. G., A. H. Herzka, et al. (2004). "Searching the Medical
> Literature." [Clinical Orthopaedics and Related Research]{.underline}
> April (421): 43-49.

*"Because of the numerous databases that may be searched for biomedical
information, and the multiple search interfaces in which they may be
searched, it is essential that investigators understand the importance
of collaboration with librarians. Effective searching involves an
iterative methodology that demands knowledge of database design, of
research methodology, and of the subject." (Smith, Herzka, Wenz 2004)*

> Smith, C. G., A. H. Herzka, et al. (2004). "Searching the Medical
> Literature." [Clinical Orthopaedics and Related Research]{.underline}
> April (421): 43-49.

**Miscellaneous:**

*"Members of the \[Connecticut State Medical Society\] CME Committee
have realized that a library is one of the most important components of
a well-rounded CME program, because it enables practitioners to educate
themselves on a given topic at the time that the need arises -- the
'teachable moment.'" (Gluck and Hassig 2001)*

> Gluck, J. C. and R. A. Hassig (2001). \"Raising the Bar: The
> Importance of Hospital Library Standards in the Continuing Medical
> Education Accreditation Process.\" [Bulletin of the Medical Library
> Association]{.underline} **89**(3): 272-276.

Bibliography

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