The medical library: A hospital’s most underappreciated asset

By Hilton Hudson, MD, FACS

The impact of medical librarians is well documented. In one experiment, a group of primary care providers had the opportunity to send clinical questions to a rapid-response medical librarian. They received their replies in an average of 14 minutes, and 86% of those replies were described as having a positive impact on care. Two studies indicated patient length of stay was reduced when clinicians requested medical library searches related to a patient’s case.

Libraries can also help medical professionals avoid worst-case scenarios. In 2001, Ellen Roche was administered the drug hexamethonium as part of a clinical study on asthma at Johns Hopkins University. Roche was 24 and otherwise healthy, but died as a result of irreversible lung damage caused by the drug. Further examination by medical librarians revealed the drug had a history of causing lung damage, a dramatic illustration of the importance of reviewing all available medical literature to guard against catastrophe.

Why, then, are medical libraries among the first services to be cut when hospitals and health systems trim their budgets?

In December 2021, as the COVID-19 pandemic led to hospital department closures around the U.S., the Medical Library Association (MLA) issued a plea touting the benefits of its services. Those benefits are worth revisiting as the share of hospitals with registered medical libraries continues to fall. Docline, the National Library of Medicine’s interlibrary loan request routing system, showed a decrease from 3,166 medical libraries in 2007 to 2,140 in 2017. Currently the network of the National Library of Medicine shows 1,701 members in its online directory, a number that includes some college and university hospitals.

Knowledge-based information

Among healthcare professionals, the hunger for the most current knowledge requires constant feeding. Medical knowledge is always evolving. The latest research will always inform a hospital’s best practices, regardless of the type of medicine being practiced. Research bears this out.

If these reasons weren’t compelling enough to maintain a current medical library, The Joint Commission is charged with ensuring libraries sufficiently meet their standard for providing knowledge-based information (KBI), a pillar of accreditation.

In 2022, the MLA updated its standards of practice for hospital libraries and librarians to reflect recent changes to the healthcare ecosystem, including:

• Bringing to light the increasing involvement of librarians with IT applications and teams, including KBI source links in electronic health records, mobile application support, and interactions with electronic resource products and vendors
• Broadening the concept of library space to include virtual libraries as well as physical
• Highlighting new research available for calculating staffing ratios and coordinating staffing with library service levels
• Expanding roles in teaching, researching, and appraising evidence-based literature across clinical specialties and to hospital staff at every level
• Expanding the suggested duties of the librarian to include support for publishing and adhering to copyright laws, developing a needs assessment and strategic plan for the library, and planning physical and virtual library spaces, including an intra- or internet presence

Evolving with the information age

Historically, maintaining a medical library involved stocking medical books and journals on a shelf and employing a librarian who physically retrieved each item upon request. As the recent changes to the MLA standards indicate, that is no longer the case. It’s now possible―and in some cases, necessary―for hospitals and health systems to maintain an online library detached from a physical space.

The Johns Hopkins case illustrates the critical need for doctors and nurses to have unfettered access to e-books, articles, and other relevant literature at a moment’s notice. Unlike the physical libraries of yesteryear, the virtual library offers immediate access to literature through nothing more than a smartphone or tablet. With this ease of use comes reduced costs.

Consider the impact of consolidation and digitization on a health system that allows clinicians from multiple hospitals to share access to a centralized digital library. Historically, every building in that system would need to subscribe to a physical copy of multiple academic journals to ensure access to the KBI its personnel needed. Now, everyone in the system has access to their own digital library on the go while sharing the cost of subscriptions.

Medical librarians still serve a critical role in this environment. They’re good at knowing what doctors need, whether they’re working on-site or remotely. A doctor who needs one book now might have no idea his hospital’s librarian is servicing five other hospitals simultaneously when the e-book he needs is fetched minutes later with a relevant passage highlighted. These “virtual libraries” enable health systems to maintain access to the KBI they need for accreditation, and to promote best practices on-site.

Cost/benefit analysis

Positive health outcomes should be enough to justify the expense of a medical library, but today’s hospitals and health systems view every line-item expense with unprecedented scrutiny. Investing in a medical library is not enough; the investment must be wise within the context of the overall budget.

Consolidating library services among multiple hospitals and moving to digital subscriptions are popular means for saving money. Medical librarians can also ask critical questions such as: Should every hospital in our system subscribe to every title in this publisher’s bundle? Conversely, can increasing our investment in certain library services actually increase our spending power?

Consider the impact of extending library services to patients and their loved ones. A medical librarian might be able to send information about a patient’s upcoming surgical procedure to that patient’s entire family―a welcome alternative to telling them, “Just Google it.” In this way, a hospital with a medical library might set itself apart from others in the region among potential future patients.

Almost anyone in a healthcare ecosystem―doctors, nurses, patients, administrators, therapists, and technicians―can benefit from a medical library’s services. Having up-to-date, reliable medical information close at hand is in some cases more a necessity than a luxury. While the size and shape of medical libraries have changed dramatically in recent years, their utility has remained constant, making them a justified expense for hospitals with shrinking budgets.

Hilton M. Hudson, MD, FACS, is a board-certified cardiothoracic surgeon and the chief of cardiothoracic surgery at Franciscan’s Michigan City and Olympia Fields health systems. He is also the CEO of HPC International, the leading educational purchased services supplier for healthcare, corporations, and academic institutions.