Hi! It’s been a while (7 years!) since I posted anything on this blog, but lately I’ve been eager to share some of my experiences in health/hospital librarianship during the COVID-19 pandemic. Last week I wrote this Tweet and received many responses from folks who shared they’d like to hear about what my team has been up to during this pandemic.
There’s been a lot of discourse on Twitter and in the media regarding public health and labour concerns of keeping public and academic libraries open, and advocacy for closing (which, they all should). When I share with family, friends, and social media that I’m still going to work, folks don’t always make the connection that while yes, I’m a librarian, I also work in a healthcare setting and my library serves hospital leadership and front-line health workers who urgently need information and resource supports.
Because I recognize the activities, services, and impact of hospital libraries might be unknown or seem opaque to a lot of folks, I wanted to share some details about what my library team has been doing during this pandemic. I’m excited to share how we’re continuing to support staff and physicians, how our activities have pivoted in an “all hands on deck” crisis, how library staff are recognized for their expertise from hospital leadership, and how our libraries (i.e. staff, services, collections/resources, and spaces) are valued and needed at this time. I’m extremely proud of the work we’re doing, and of our contributions to supporting front-line health workers and combating the COVID-19 pandemic.
Where I work:
I work for a multi-site health system in Toronto comprised of three teaching hospitals fully-affiliated with the University of Toronto. The organization upholds a strong focus on research, patient care, and quality improvement. Each of the three sites is unique: a community hospital, a downtown trauma and emergency centre, and a rehabilitation and long-term care facility. I can only speak to things happening within the health system where I work. The types of projects or activities, departmental pressures, and redeployment staffing needs differ across healthcare organizations, so the library activities I’m sharing may be unique to my team’s experience in our particular organization. At my organization I’m the manager of the health sciences libraries, archives, and knowledge mobilization program.
What’s the role of a library worker in a hospital environment?
Presumably, many reading this don’t work in healthcare or in libraries, and (perhaps even if you do) might not be familiar with the function or services of hospital libraries. So firstly I wanted to briefly review the roles and activities of our library within our particular health system and hospital sites. Again, this may not be true for all hospital librarians, but is the case for my team in our organization:
- Our library supports ALL staff and physicians of our hospital network. This includes clinicians (i.e. health care professionals working directly with patients such as physicians, dietitians, pharmacists, respiratory therapists, nurses, etc.), scientists and researchers, administrative staff, educators, and students; these are our library’s “users”. Our library does not serve patients, their families, or the community.
- Generally speaking, our library supports the “information and knowledge needs” of our users. This translates to:
- facilitating access to information sources (e.g. clinical point-of-care tools, medical and academic databases, journals, eBooks, interlibrary loan, etc.);
- supporting and collaborating with users to fulfill literature searches, research projects, knowledge synthesis activities (i.e. systematic reviews, scoping reviews, meta-analysis, etc.);
- curating information/knowledge for their use and care practice (through the creation of online resource guides, organizing and contributing to clinical rounds, supporting publication of research projects, etc.).
- A fundamental underlying principle of library work in health settings is the importance of evidence-based medicine and evidence-based practice. Clinical staff (and administrative staff alike) operate by learning from and building-upon the evidence. Simplistically put, this is often done by reviewing the literature to understand what questions have been asked, how they were studied, and examining what outcomes have been determined. A direct result of the need to consult evidence translates to the role of library workers: to construct and systematize search methodologies, collect results, and synthesize evidence to support and guide decision-making. These practices are true not just for pure sciences, but also in the social sciences (e.g. examining social determinants of health), and quality improvement projects (e.g. how to improve hand hygiene compliance among personal support workers in long-term care homes). Everyone should start their new project by exploring the evidence to position their research, and build-upon what knowledge or evidence has already been proven.
- Finally, our library supports staff learning by delivering training on how to use medical and health sciences databases, teaching skill-building for managing citations, preparing for research activities, mobilizing knowledge, and scholarly communications, and even offer workshops for Microsoft PowerPoint and Excel (e.g. advanced features, pivot tables), and visualization tools for infographics.
What’s changed for hospital library staff during the COVID-19 pandemic?
Effective March 13th, we closed our library spaces and in-person access/service points at all three sites. My team (6 librarians, 2 library technicians) began working virtually from home. To stay connected we adopted Slack, and are using Zoom for virtual/teleconference meetings. While we continue to operate “business as usual” services (i.e. fulfilling reference/information requests and literature searches, Zoom-based workshops, interlibrary loan for e-resources, library committee projects), the current priority of our work is supporting COVID-19 projects, initiatives, and the needs of clinical units as they arise.
What’s impressed me most about these circumstances is how my library team has risen to new and unanticipated challenges, and to witness how our expertise (“library skills”) is contributing to interdepartmental team efforts to achieve the same end goal. I want to share the ways my library team is working differently during this pandemic, and highlight some of the ways we’re contributing to new, interdepartmental COVID-19 projects:
Supporting the COVID-19 Command Centre
In early March 2020 a Command Centre was established for our health network’s senior leadership to hold daily briefings to review COVID-19 updates, ICU capacity, and other emergency preparedness precautions. From the beginning, a librarian from our team has been a dedicated resource to the Command Centre for supplying news alerts, statistical updates, including a short a précis of Canadian and international news from key policy makers—Canadian Health Ministers, politicians, the CDC—and has set up automated search alerts.
COVID-19-Related Literature Searches
Building on what I mentioned earlier with evidence-based practice, since mid-March we’ve received over 30 requests specifically for COVID-19 information and literature. These requests have come from practitioners and hospital leadership related to caring for COVID-19 patients and their pre-existing health conditions, exploring different nursing team models and precautions for COVID-19 in specific units, and looking for guidance to inform best practices for our approaches to simulation training. Some of the literature search topics/requests we’ve received are listed below.
- Exploring social determinants of health and equity considerations for COVID-19 (Rapid review)
- “Looking for evidence of new staffing models of care for patients with COVID-19, including: critical care teams, primary care vs team nursing, pod models, roles of different disciplines such as RT and PT. Models of care for dealing with the surge of patients and staff shortage.” (Grey literature search)
- “What literature is there on various nurse staffing models in the ICU during a nursing shortage?”
- “What literature is there on COVID-19 and acute kidney injury” (requested from Diabetes Complex Care team)
- “What literature is available on COVID-19 and ICUs (in relation to time from admission to hospital to transfer to ICU; LOS in ICU (with/wihout ventilator); LOS post-ICU)?”
- “Working on a mathematical model for the ideal approach to quarantine/isolation for COVID-19” (requested from Emergency Medicine)
COVID-19 Resource Guide
Yes, it’s cliché in library circles, but we built a LibGuide ¯\_(ツ)_/¯ We wanted to curate COVID-19-specific resources on a platform that was mobile-responsive, accessible outside the hospital’s IP range, could be updated quickly, and was easy to navigate. Key resources we incorporated into the guide included:
- COVID-19 pre-print publications;
- pre-defined/pre-built searches for COVID-19 topics in popular databases;
- newly-available and open COVID-19 content from other publishers and library vendors, such as ebook packages, and access to clinical tools like UpToDate;
- open access content;
- approved training materials for clinical teams.
As of April 20th at 6PM, the COVID-19 Resource Guide had 1860 views in 35 days since it launched!
Collaboration & Redeployment with other Departments
In most hospitals, “non-essential” workers (e.g. staff in administrative areas who don’t directly support patient care) may be redeployed to different departments across the organization to support emerging staffing needs or fill staffing gaps (within the individual’s existing training, skills and abilities). Some departments can become stretched very thin as a result of heightened demands, and a solution is to redeploy staff from another (closed) department to support the short-staffed team/department.
An example of a short-staffed department in our organization’s context is Virtual Care/Telemedicine. Briefly, this department is responsible for providing the technological framework and solutions for clinical staff and physicians to meet with patients virtually (by phone, and/or videoconference), these activities are accompanied by a roster of requirements to protect patient personal privacy and patient health information. With physical distancing being a fundamental solution to mitigate virus spread during this pandemic, the demands on Virtual Care have skyrocketed. Primary care providers need information, best practice instructions, troubleshooting FAQs, and access to guidelines and teleconference accounts. A librarian on my team has been partially-redeployed to the Virtual Care team to support efforts to streamline these details for a new website developed for clinical staff and physicians needing virtual care support.
New PPE Directives
Another major project occupying a great deal of time and energy of a librarian on my team (including daily meetings, working over weekends to meet tight deadlines) is the creation and development of visual aids and infographics to support change management of PPE (personal protective equipment) directives. PPE conservation strategies have been top-of-mind for many as rapidly evolving supply chain management issues progress. There’s a global shortage of PPE, so new education resources are required to instruct all patient-facing hospital staff on how to don, doff, re-use and extend the use of their PPE. This is an ongoing project, and the team (comprised of infection prevention control, clinical educators, supply chain management, librarians, and administrative staff) has produced nearly a dozen new visual aids supporting education for change management.
Easing Anxiety and Stress through COVID-19
Shortly after non-essential staff (i.e. primarily non-clinical teams) were directed to begin working from home, it was clear that this “new normal” would have an impact on the mental health of our organization’s staff (regardless of their work arrangement). Our team wanted to provide some resources to assist individuals in managing stress and anxiety, so we compiled a list of online resources (eBooks, mobile apps, websites) to help anyone needing support. You can find the blog post here.
While all library spaces and in-person service points are closed to users, new (and unexpected) needs have emerged for these spaces. For example, due to the library’s location and proximity to the Assessment Centre at one of our sites, the library is now a meeting space and break room for the clinical teams who staff the Assessment Centre. At another site we’re using vacant library space to train critical care teams, train redeployed non-clinical staff for donning and doffing personal protective equipment, and adapting computer work spaces (such as our computer lab, pictured below) for patient charting in adherence to physical distancing.
There was even a conversation I had with my Director about re-purposing an empty library for sleeping space to clinical teams who staff COVID-positive units. This solution would have required the temporary relocation of all print collections (!!!) to mitigate any risk of contamination/spread through surfaces of library materials. Thankfully, other spaces were identified for sleeping, and that idea was not pursued.
We’re at a point in Canada where signs are pointing to a flattening of the curve, it’s encouraging and feels optimistic. But as pressures remain on our health system, the library team will continue to be nimble, flexible, and helpful in all of the ways it can, along with working as a team to keep spirits up, support one another, and stay positive. We obviously don’t know when the library spaces will re-open, or when my team will be expected to return to working onsite, but we’ve shown that we’re absolutely essential in supporting patient care areas, which is rewarding and a great source of pride.
This experience has also allowed us to troubleshoot our processes (for remote service delivery, virtual collaboration and communication), and refine our web properties and online services. Necessity is definitely the mother of invention, and it’s also true that when new challenges or opportunities arise, it’s the perfect time to experiment and try things differently.
Thank you for reading! Stay healthy, keep calm, and take care.