Clinical trial NCT00226291: The Clinical Informationist: Does the Model Work
Official title: The Clinical Informationist: Does the Model Work
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Critical Illness
Keywords: EBM
evidence based medicine
informationist
clinical medical librarian
Lead sponsor: Vanderbilt University
Sponsor class: OTHER
First posted: 2005-09-26
Enrollment: 299
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL

Brief summary: This study is investigating the effects of an established clinical informationist program (evidence-based practice support service in which information professionals with significant clinical knowledge bases and advanced information seeking and appraisal skills) on clinical decision making at selected critical care units at Vanderbilt University Medical Center

Detailed description: Background To evaluate the role of the Clinical Informatics Consult Service(CICS), an informationist service at the Eskind Biomedical Library (EBL) at Vanderbilt University Medical Center (VUMC, in clinical decision-making, the EBL has been awarded a 3-year grant from the National Library of Medicine (5 R01 LM07849-02). The CICS is a well-established program that facilitates evidence-based practice by delivering targeted information in answer to complex, patient-specific questions. The CICS places librarians with specialized training in medical subject areas and in information retrieval ("clinical informationists") on clinical teams in intensive care settings. Acting as expert consultants, they analyze the biomedical literature to identify, filter, and present the best examples of each clinical viewpoint expressed about key problems.

Evaluation Project Working in cooperation with the Center for Evaluation and Program Improvement (CEPI) at Peabody College of Vanderbilt, the investigators will evaluate formally the role of CICS in clinical decision-making and evidence-seeking behavior. While past studies have evaluated clinical medical librarians' roles, few if any studies have examined the effectiveness and utility of the new clinical informationist approach in sites where informationists are well-established.

The project will also create reusable evaluation tools transferable across environments. Through a combination of observation and interviews, investigators will examine librarian involvement in three existing Vanderbilt CICS intensive care units. The project will collect detailed information about the ways in which clinicians incorporate CICS-provided information into their workflows. Next, investigators will conduct a randomized trial to evaluate the effect of CICS on decision-making. Investigators will compare clinicians' intended course of care vs. actual care when CICS results are provided and when clinicians seek information themselves.

Finally, "virtual cases" developed from actual patient CICS-related scenarios in each clinical unit will be incorporated into training tools that can be used to export elements of the CICS model to other locations. Demonstration of the utility of the clinical informationist approach can foster widespread adoption nationally, and increase the degree to which clinical practice becomes evidence-based.

Eligibility criteria: Inclusion Criteria:

Evidence-based questions requested by clinician on current service as an attending, resident, fellow, or nurse practitioner on one of the units included in the study

Exclusion Criteria:

All others

Primary outcomes:
measure: Immediate and potential future clinical decisions
timeFrame: 3 days post-consult
Secondary outcomes:
measure: Clinical action index
timeFrame: 3 days post-consult
measure: Number of research articles read
timeFrame: 3 days post-consult
measure: Satisfaction
timeFrame: 3 days post-consult
measure: Colleague consults
timeFrame: 3 days post-consult
measure: Time spent searching the literature
timeFrame: 3 days post-consult
Other outcomes:
Locations:
city: Nashville
country: United States
facility: Vanderbilt University Medical Center
state: Tennessee
Study officials:
affiliation: Vanderbilt University Medical Center
name: Nunzia B Giuse, MD, MLS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Giuse NB, Koonce TY, Jerome RN, Cahall M, Sathe NA, Williams A. Evolution of a mature clinical informationist model. J Am Med Inform Assoc. 2005 May-Jun;12(3):249-55. doi: 10.1197/jamia.M1726. Epub 2005 Jan 31.
citation: Rosenbloom ST, Giuse NB, Jerome RN, Blackford JU. Providing evidence-based answers to complex clinical questions: evaluating the consistency of article selection. Acad Med. 2005 Jan;80(1):109-14. doi: 10.1097/00001888-200501000-00025.
citation: Jerome RN, Giuse NB, Gish KW, Sathe NA, Dietrich MS. Information needs of clinical teams: analysis of questions received by the Clinical Informatics Consult Service. Bull Med Libr Assoc. 2001 Apr;89(2):177-84.
citation: Florance V, Giuse NB, Ketchell DS. Information in context: integrating information specialists into practice settings. J Med Libr Assoc. 2002 Jan;90(1):49-58.
citation: Giuse NB, Kafantaris SR, Miller MD, Wilder KS, Martin SL, Sathe NA, Campbell JD. Clinical medical librarianship: the Vanderbilt experience. Bull Med Libr Assoc. 1998 Jul;86(3):412-6. No abstract available.
citation: Giuse NB. Advancing the practice of clinical medical librarianship. Bull Med Libr Assoc. 1997 Oct;85(4):437-8. No abstract available.
citation: Sathe NA, Todd P, Gregg W, Clark J, Giuse NB. Virtual cases as a tool to promote the incorporation of EBM techniques into housestaff training . Medical Library Association Annual Meeting, Phoenix, AZ, May 2006. (Poster)
citation: Mulvaney SA, Bickman L, Giuse NB, Lambert EW, Sathe NA, Jerome RN. A randomized effectiveness trial of a clinical informatics consult service: impact on evidence-based decision-making and knowledge implementation. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11. doi: 10.1197/jamia.M2461. Epub 2007 Dec 20.
citation: Mulvaney S, Bickman L, Lambert W, Sathe N, Jerome R, Guise NB. Barriers to and facilitators of evidence based practices in physicians. Society for Behavioral Medicine 28th Annual Meeting. Washington, DC. March 2007. (Poster)