Wednesday, 28 November 2007

NLH Document of the week

Taken from the National Library for Health "Document of the week"

Librarian support decreased the length of hospital stay.

Case control study looking at the effect of librarian support on patient care.
This case-control study found that during residents' morning report, where case discussion was taking place, supported by a librarian-guided, computerized literature search, the length of hospital stay for patients was reduced. The researchers concluded that "Morning report, in association with a computerized literature search guided by the librarians, was an effective means for introducing evidence-based medicine into patient care practices."
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Citation:Decreased hospital length of stay associated with presentation of cases at morning report with librarian supportDE Banks, R Shi, DF Timm, KA Christopher, DC Duggar, M Comegys, J McLartyJournal of the Medical Library Association, 2007, 95(4), pp371-373

I've just printed off & read this article through, using the CASP Critical Appraisal Checklist for Case-Control studies.

The study asked the question of whether a combination of Morning Report + librarian-provided literature search results altered length of stay, hospital charges (it's a US-based study) or readmission rates. Over 8 months, 105 patients were presented at Morning Report, and these were apparently random, as the doctors involved were given no directions over which patients to select. The comparisons were drawn from the hospital register of almost 20,000 patients admitted over the past 5yrs and 7months, and were matched by ICD9 diagnoses, age & secondary diagnoses. The results of the study show that the median length of stay was 2days in those patients presented at Morning Report (p=0.0238). The authors appear to have taken into account issues of selection bias, and the problems with matching all patients.

I've been thinking a bit more about this, and it is hard to tell which aspect of the intervention made the real difference - was it the extra interest from Morning Report, the literature search, or both? And were the cases presented naturally more interesting/complicated cases? If they were more complex conditions that stimulated interest, you'd expect more time to spent on the patient, possibly more diagnostic tests, and interventions. I suppose it all balances out, but it made me think about which clinical questions make it to the Clinical Librarian.

It's a eally interesting study, as we're always looking for ways that CLs make an impact on patient care, and it can be hard to define what it is we do. Often we're using anecdotal evidence to make a case for our necessity, and this article provides the kind of evidence that people should be listening to. What do you think?

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