Brian Riley, Orlov Nicola, Werner Debra, Martin Shannon K, Arora Vineet M, Alkureishi Maria
Medical Student, University of Chicago Pritzker School of Medicine, Chicago, IL.
Assistant Professor of Pediatrics, Department of Academic Pediatrics, University of Chicago, Chicago, IL.
J Med Libr Assoc. 2018 Apr;106(2):175-183. doi: 10.5195/jmla.2018.254. Epub 2018 Apr 1.
The investigation sought to determine the effects of a clinical librarian (CL) on inpatient team clinical questioning quality and quantity, learner self-reported literature searching skills, and use of evidence-based medicine (EBM).
Clinical questioning was observed over 50 days of inpatient pediatric and internal medicine attending rounds. A CL was present for 25 days and absent for 25 days. Questioning was compared between groups. Question quality was assessed by a blinded evaluator, who used a rubric adapted from the Fresno Test of Competence in Evidence-Based Medicine. Team members were surveyed to assess perceived impacts of the CL on rounds.
Rounds with a CL (CLR) were associated with significantly increased median number of questions asked (5 questions CLR vs. 3 NCLR; <0.01) and answered (3 CLR vs. 2 NCLR; <0.01) compared to rounds without a CL (NCLR). CLR were also associated with increased mean time spent asking (1.39 minutes CLR vs. 0.52 NCLR; <0.01) and answering (2.15 minutes CLR vs. 1.05 NCLR; =0.02) questions. Rounding time per patient was not significantly different between CLR and NCLR. Questions during CLR were 2 times higher in adapted Fresno Test quality than during NCLR (<0.01). Select participants described how the CL's presence improved their EBM skills and care decisions.
Inpatient CLR were associated with more and improved clinical questioning and subjectively perceived to improve clinicians' EBM skills. CLs may directly affect patient care; further study is required to assess this. CLs on inpatient rounds may be an effective means for clinicians to learn and use EBM skills.
本研究旨在确定临床图书馆员（CL）对住院团队临床提问的质量和数量、学习者自我报告的文献检索技能以及循证医学（EBM）应用的影响。
在50天的儿科和内科住院医师查房期间观察临床提问情况。CL参与查房25天，未参与查房25天。对两组查房期间的提问情况进行比较。由一位不知情的评估者使用改编自弗雷斯诺循证医学能力测试的评分标准来评估问题质量。对团队成员进行调查，以评估CL对查房的感知影响。
与无CL参与的查房（NCLR）相比，有CL参与的查房（CLR）中，所提问题的中位数显著增加（CLR为5个问题，NCLR为3个问题；<0.01），所回答问题的中位数也显著增加（CLR为3个问题，NCLR为2个问题；<0.01）。CLR还与提问（CLR平均用时1.39分钟，NCLR为0.52分钟；<0.01）和回答问题（CLR平均用时2.15分钟，NCLR为1.05分钟；=0.02）的平均时间增加有关。每位患者的查房时间在CLR和NCLR之间无显著差异。CLR期间的问题在改编后的弗雷斯诺测试质量方面比NCLR期间高2倍（<0.01）。部分参与者描述了CL的参与如何提高了他们的循证医学技能和护理决策能力。
住院患者的CLR与更多且质量更高的临床提问相关，并且主观上认为能提高临床医生的循证医学技能。CL可能直接影响患者护理；需要进一步研究以评估这一点。住院查房中的CL可能是临床医生学习和应用循证医学技能的有效手段。
