Providing Expert Collaboration for the Development and Implementation of Evidence-Based Practices

Objectives : To describe how library expertise in assessing evidence in clinical settings is being integrated into major institution-wide efforts to standardize and promote evidencebased patient care throughout Vanderbilt University Medical Center (VUMC). These initiatives have provided an opportunity to clearly demonstrate the uniqueness of expert medical librarian skills and have medical center-wide impact on clinical practices and patient outcomes.

Methods : Lending its unique expertise in evidence-based medicine, the Eskind Biomedical Library partnered with interdisciplinary teams charged by VUMC leadership to define and promote evidence-based practices throughout the medical center. In collaboration with the chief quality informatics officer leading the effort, library personnel played a central role in the development and application of methods for identifying and evaluating evidence to support a large-scale push for more rigorous practice of evidence-based medicine. Knowledge management strategies for defining and documenting processes were also developed to ensure ongoing success of the project. The team is engaged in a parallel effort in response to a call for expanded evidence-based medicine practices in distributed outpatient settings. Expanding on contributions to order set development, the team evaluated solutions and provided key insights on the selection and adoption of an evidence-based order set product for use throughout the medical center.

Results : The start-up phase of the clinical practice project is complete, with implementation of evidence-based practice changes in ordering routine preoperative chest X rays. Library expertise was employed in the development of methods for investigating evidence, identifying synthesized evidence, and filtering and grading the evidence, with reported findings informing institutional practices. Contributions were also made to documentation of methods and sources, development of systemic approaches to clinical topics, and preliminary investigation of potential future clinical changes, including areas of potential imaging overuse. Updated standards were implemented via informatics and educational methods, with preliminary results suggesting that a reduction in excess chest X rays has been achieved. Additional reduction is expected and represents both an improvement in adherence to evidence-based care and potential cost savings for the institution.

Conclusions : With full integration into the evidence subgroup for this project, library experts have been able to spread knowledge about the varying quality of different forms of evidence, contribute to good knowledge management practices, and have the opportunity to collaborate with a wide range of clinical, research, informatics, and leadership personnel. Librarians also maintain a presence with the outpatient order set and evidence team, providing insights and expertise for additional evidence-based investigations.