Case Study: Becoming one of the team in Critical Care by Victoria Treadway

What did you do? I work closely with the Critical Care team in a large, acute teaching hospital.  This involves attending ward rounds, providing literature searching services and supporting their Journal Club.  Having worked with Critical Care since 2009 I have built up good relationships with the team and have been able to present at conferences about the work we’ve done together.  I also produced a video of the ward round.

During ward rounds I follow the discussions that take place at the bedside about each patient.  When questions arise relating to that patient’s condition or treatment, I search on an iPad for the latest evidence on that topic.  This might be guidelines, systematic reviews, evidence summaries, and occasionally case reports if it’s a rare condition.  I feed back verbally what I’ve found and often pass the iPad around so that the team can share and discuss the findings.  Sometimes the evidence is used to confirm a particular course of action, and sometimes it raises new options for the management of that patient.  I keep a log of each question, the evidence that was found and the outcome, as a way of recording impact.

 

What worked? One of the Critical Care Consultants has championed the library service from the outset, which was key to the success of the project.  He was able to advocate and promote the service on our behalf to his colleagues and senior managers.

I think it’s been crucial to get to know the staff well, in order to gain their confidence.  By making time to talk to people, it’s been possible to develop good relationships and share the pressures that they face in what is an intense clinical environment.

Having an elevator pitch is essential in communicating quickly who I am and what I’m doing.  Working with a whole department involves meeting a lot of new faces and often people are curious about what a librarian is doing on ward round!  Slowly, once people got to know me, they started to approach me outside ward round for help with assignments, research projects and service development.

 

What didn’t work? A key challenge has been balancing the needs of one department with the demands of my day to day job.  I’m a sole Clinical Librarian in a Trust of over 5,500 staff so I’m always busy!  I’ve dealt with this through good time management and communication.  My work with Critical Care has always been a good example of supporting patient care that we have used to market the service to other departments, so it has other benefits too.

We’ve faced some IT challenges along the way as well.  Fortunately wifi has been established in the hospital for a while, but it did take some negotiation and discussions at quite a high level to obtain an iPad for use on ward round.

As with any new service, some people are sceptical and resistant to change, and it’s been a particular challenge for me to shake off traditional perceptions of librarianship and try to demonstrate to people how health librarians can add value to healthcare.  Happily, the Critical Care team are forward-thinking and have embraced the service.

 

What did you learn? I suppose I always knew that librarianship was a people profession, but working with Critical Care it has really struck me how important it is to build and maintain good relationships with people, and to talk to people face to face rather than by email.

I’ve also learned that what works in one department might not necessarily work in another.  At the moment Critical Care is the only department in which we support ward rounds, and I think that’s very much due to their unique culture.  For me, the main lesson has been to get to know a team well, and adapt the service to meet their individual requirements.  This might mean providing input at meetings or on committees, on ward round, or just through keeping regular contact with the department.

 

What are your “next steps”? I want to explore ways that I can improve the service, in particular, how I can better disseminate and share the results of ward round evidence searches.  Ultimately I’d love to be able to use my work with Critical Care to demonstrate the contribution that a Clinical Librarian can make to patient care.

 

Victoria Treadway (BA Hons, MA)
Clinical Librarian
Trust Library and Knowledge Service
Wirral University Teaching Hospital NHS Foundation Trust

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