Wednesday, July 08, 2009

reducing the holes in the swiss cheese of access to evidence and knowledge.

Interesting commentary in BMJ this past week:

Degos L, Amalberti R, Bacou J, Carlet J, Bruneau C. Breaking the mould inpatient safety. BMJ. 2009 Jun 29;338:b2585.

In this piece that calls for a broader approach to understanding and improving patient safety, the authors state:

"Safety may be defined as increasing the patient’s chance of receiving appropriate care that is in line with evidence based medicine. Any obstacle to such access is considered as a loss of chance and a potential failure of the health care system."

How many of our organization consider the potential failures associated with this statement?

Doesn't this quote beg for those of us that deal with the more explicit side of knowledge delivery (ie access to the published literature, guidelines etc) get more involved in helping organizations understand the obstacles to deliving care that is in line with evidence based medicine due to lack of access to the evidence that informs that care?

I recently had discussions with members of a team I work with that were frustrated with the lack of access to a primary scientific journal via their large academic insitutions library. We had to work around the system, ask yet another team member to send us what we needed. One article I need I still don't have. Good thing it wasn't for emergent clinical care, eh? Does that sort of inefficiency and evidence access failure have the potential to contribute to care problems? Interesting question.

We need to, as Susan Carr. editor of PSQH recently stated "shine our light" and weigh in on discussions involving access to knowledge and the "evidence" to understand how they impact safety. We should participate in blogs, online communities, and other tools to share what we know. If we have a seat at the "patient safety table" at our organizations, we should try and ask the right questions to help our peers and clinical colleagues understand this type of failure. We need to generate interest to help generate primary research opportunities and proactive failure analyses to understand how to best focus our efforts in this area.

If there are activities looking at the problems arrising from failure to access the appropriate bibliographic evidence in real time, please share your news about them here. I have to believe that someone out there is looking at this issue and is hopefully involving a myriad of professionals and individuals with personal (read patients and families) and work experience (read clinicians, administrators and "blunt end" professionals) in sorting out the problems. We all have a stake in making this piece of the safety pie less full of holes ;-).


Judy said...

Hi Lorri, You are right on with this and I have to read that BMJ article. I am presenting a system-wide hospital e-library proposal this week at the hospital system Quality Value Added Team. I will have to distribute the article. We have four hospitals, only 2 real libraries staffed with one librarian each, and an online collection at only my library. It's been a constant fight over my 5 years here to keep the library going. So sad when I think that I or my family members/friends might be patients here. MLA needs to continue and expand its support of hospital librarians. Hospital librarians need to unite to make this article's message clear. EBM must be practced and it cannot with out library support! Thanks! - Judy Kraemer, MLIS, MBA

Lorri Zipperer said...
This comment has been removed by the author.
Lorri Zipperer said...

Judy - thanks for your comment. I am sorry to hear that you are experiencing this issues, but I fear you are not alone. Another approach that might be useful is to talk about the lack of reliabiilty in the process without appropraite methods and personnel in place to assure that reliabilty. I wrote about the reliabilty issue a while back: see page 3 at: (slow upload) and still feel this is another context within which we can place our work and how it contributes to safe health care. Be in touch or share your stories on the CoP for librarians on patient safety at: