Editor’s note: The health sciences librarians and healthcare professionals we work with are on the front lines responding to the COVID-19 pandemic. We are honored to be able to bring you some of their accounts about what those efforts look like.
Heidi Sue Adams, MS, AHIP(D)
Lead Medical Librarian
Kalispell Regional Medical Center
Copyright by and used with permission of BMJ Insiders.
“Acting as a solo, during a time when information requests have increased”
As the COVID-19 pandemic challenges healthcare systems worldwide, some hospital librarians find themselves being labeled “essential”, having to shift their key priorities, and taking on new responsibilities – often unrelated to the library.
On May 15, 2020, Heidi Sue gave us a peek inside the Kalispell Regional Medical Center in Montana.
Please describe the type of transformation you have witnessed at Kalispell Regional Healthcare (KRH) during the past few months.
Transformation seems to be the one constant for our organization. Especially within the last 30 months.
I started working here when there were less than 800 employees, and now we’re over 4,000. I started out as a solo librarian with multiple volunteers and school-to-work interns, in recent years we were a team of three. I was recently recognized for my 20-year anniversary at KRH; this is the second medical library I’ve worked in during my career – the first one was four years at a medical college.
Some recent changes have included a new Administration, including an awesome, dynamic new CEO, and a new Admin team with multiple additional roles filled. We also have multiple new service lines and recently acquired a critical access hospital.
The COVID-19 pandemic resulted in the hospital moving to Incident Command status. We have been following CDC, US Government, and state mandates. Staff have been furloughed, are now part of a labor pool, or deemed essential. The essential employees still coming to work are either working as usual, some with more hours; working in a new temporary role; or managing usual work with additional tasks.
The Medical Library has seen a reduction in the amount of people in the physical space. Those who are in here are here more frequently than before COVID-19. I also experienced an increased number of reference questions and mediated literature searches. Coronavirus is happening in addition to the other clinical scenarios we have had all along.
Our typical staff is two FTE and one volunteer. Right now, there are no volunteers due to COVID-19, and coincidentally, our second FTE librarian left in late January. Then our hospital enacted Incident Command, and we went to essential staff only. The second librarian position was not approved for hiring; our hospital furloughed many of our staff throughout our organization.
Thus, I have been acting as a solo, during a time when information requests have increased. I am in here every day, including my days off. I have found support through hospital library listservs and am also encouraged that we have offered a PRN medical librarian position to a top choice candidate.
Which communication channels have you found to be the most reliable to quickly disseminate COVID-19 content and updates?
My methods of communication include placing links on the internal website, providing direct emails, and being part of verbal conversations with physicians and other clinical staff.
A few resources I reference include:
- Montana State Library’s “Montana Response: COVID-19 Coronavirus”
- Information provided by colleagues on the hospital libraries’ email listserv
- The Medical Library Association’s list of resources
- Some of our library vendor reps have provided me with tangible information which was immediately useful for our physicians and not seen elsewhere, and didn’t require further seeking of information
I always try to make information immediately applicable and digestible for enhanced clinical experience. I make it a point to know which of our physicians prefer print (single or double sided, larger font or regular font), online, video, audio, etc. Tailoring our information services to their main method of absorbing information results in behavior change.
There is a continuous influx of COVID-19 medical literature being published. How are you helping hospital staff navigate through the clutter to find quality content?
Information overload became apparent very early on. Especially when information that wasn’t validated was eventually revealed to be inaccurate. I placed resource links on our library intranet, opting for quality over quantity.
I selectively disseminate content to our Chief Medical Officer, RNs in our Quality Department and Infection Prevention, and the Logistics Coordinator on our Incident Command team.
I also send content directly to specialty physicians that is relevant to their practice, useful at the point of care when treating coronavirus positive patients, and that also helps them stay safe and protected. This primarily includes oncology, gastroenterology, pulmonology, critical care, family practice, and neonatal specialties.
Have clinician content needs changed? If so, how has your library adapted to support this need?
Some of our specialist physicians wanted refresher material for covering critical care shifts, so the library obtained basic medical school resources for those requested topics.
The medical library, which is connected to the physician’s lounge, has continually been used by physicians who remain actively seeing patients. The other librarian’s office inside the medical library with me is now being used by our awesome Hospitalists Coordinator; so many of the hospitalists have been coming in here as well, who previously were not physical library users. There aren’t as many nurses coming in here who used to come in quite a bit.
I also experienced an increase in requests from several leaders in the organization who are in the process of obtaining their master’s degree and are now trying to juggle their increased Incident Command status roles/responsibilities with their school deadlines.
Have you experienced any access or technology bandwidth challenges?
No. I was already well-equipped to begin with. We donated some of our computer cameras to other areas of our hospital needing those for newly mandated online meetings.
Have the priorities of your library changed? Are you taking on activities that are not typical for a librarian?
I heard pleas from our Environmental Services manager to have assistance with cleanings in our own departments. Since the Medical Library is next to the Physician’s Lounge and conference/computer room, I took it upon myself to request cleaning supplies, receive a quick tutorial on the process (I learned the difference between cleaning and disinfecting), and now incorporate daily disinfecting of our areas every morning.
In the meantime, our Volunteer Coordinator who now has no volunteers on campus asked if I would be willing to do the hospital-wide mail rounds until the volunteers return. There’s a lot of confidentiality involved with the mail and transporting surgery binders, which made it challenging to keep training the myriad of different employees reporting via the Labor Pool, so I happily agreed to do this. I use that daily task as my break involving a good, vigorous walk and to spread good cheer and uplifting morale to those areas.
We are all adhering to the specific requirements such as wearing masks, knowing where our hands are at all times, cleaning/disinfecting, social distancing/online meetings, no visitors, etc. It is not yet known when our Incident Command status will end and people can go back to their regular positions and furloughed staff and volunteers can return.
Have you needed to educate or provide resources/materials to external groups, such as patients, patient family members, or the media?
I provide selective, infrequent coronavirus information useful for physicians caring for patients. Our Communications & Marketing team is handling communicating to external groups, with oversight from our CEO. The two main physicians providing information are our Chief Medical Officer and our Infectious Diseases physician.
Our Incident Command Team has an Information team comprised of those who are not MLS/MLIS, but have other communications-related experience, including previous law enforcement/crowd control and communicating to the public.
A good deal of the content regarding COVID-19 is not credible, or substantial. Have you needed to educate anyone internally or externally on information literacy?
Yes. However, I’m pretty isolated in that I’m not part of the hospital committees who are discussing these issues, and which information to present or not present. I had a chiropractor from our community call me asking for information to dispel one of his patients’ spreading rumors that we have multiple coronavirus positive patients in our hospital (we didn’t at that time); I provided two credible sources.
KRH has an extensive presence throughout Montana. How have you been sharing information with colleagues and learning from various COVID-19 experiences throughout the state?
We have an awesome Incident Command team providing information throughout our area for both community and staff (we’re the largest employer in our valley). I’ve been providing information solely for our clinical staff, though I have fielded a small number of community calls that I refer to our Incident Command resources managed by others in our organization.
What upcoming challenges do you foresee your hospital library facing?
Keeping up with demand for services, educating new decision makers about our skills and our value to the organization while being scrutinized for not being revenue-producing. (I market us as “we leverage the clinician’s time.”)
In addition, one of the major transformations we have had in our organization is moving all services to a productivity reporting style. Our numbers “in the red” are now in the green, but the workload is overwhelming.
I have been tabulating our statistics for years but can’t quite figure out the formula to make it work to be green with two FTE. However, I did realize that all these years I’ve counted one literature search as “one”, irrespective of it being five minutes or five hours. For this new fiscal year, I’m starting to count one for the first hour and then an additional one count for subsequent hours. It is a work in progress, and I would dearly love to hear from others who have experience reporting library productivity numbers to a non-library entity (benchmarking with Medical Library Association’s numbers doesn’t work for our hospital administration’s productivity numbers’ standard).
Tell me something good!
One of the amazing moments was information provided by a physician colleague early on, during the time when many staff members were facing uncertainty with the news of other area hospitals undergoing surge along with healthcare providers becoming infected and dying. This newly retired physician told me about a video featuring a physician from New York, which he thought was the best video for healthcare providers to listen to and learn from. With his permission, I reviewed that video, added a bulleted synopsis in my own words, and provided it to our CMO explicitly stating it was from the retired physician.
That video and synopsis apparently reassured our medical staff, and from there we were all able to move forward with purpose and clarity in handling the pandemic as it came upon us. We really didn’t have the surge that other areas experienced due to our proactiveness; we really do have an awesome group of decision-makers leading us. You can view the video here. (Please note: the information in this video is most likely outdated and being shared for interest purposes only.)
When I saw that video was long, I wrote a synopsis to make it usable for the physician who literally only has minutes to spare. Sure, a retired physician has time to review the whole video, but our front-line staff who I have been seeing *running around with mask strings flying behind them* do not have the luxury of time.
The increased anxiety and workload throughout the hospital must be palpable. How are you managing to navigate this challenging time, and do you have any tips for your librarian colleagues?
I am fortunate to have high resiliency and self-coping skills which have greatly been enhanced due to my outside librarianship activities. Here are some ideas for my colleagues:
Prioritize those “feel good activities” previously put off, such as:
- listening to music, dancing
- looking at pictures that uplift you
- cooking, painting, artwork, creative activities
- being (undivided attention) with those you love, (kids, friends, pets)
Prioritize internal balancing, adding thoughts of appreciation for all things you think of, all things you see to the point that you appreciate everything.
- Intentionally pay attention to your own intuition…develop it further.
- Intentionally change your vocabulary to incorporate more high-vibrational words. There is an insightful book which shows EKG readings of certain words and phrases. For example, the phrase “killing two birds with one stone” could easily be replaced with “feeding two birds with one hand” and has a different feel. Also, to increase abundance in your life, try replying to offers with “I have plenty!”.
Recognize that when you are reluctant to receive gifts in all forms, you may also be blocking your own abundance; it is a gift for people to give to you in the first place. “Gracious receiving dignifies the act of giving.”
- Learn about Masaru Emoto’s Miracle of Water
Learn new personal self-development techniques (Ho’oponopono, Tapping, specific prayers, mantras, healing touch, meditation, anything to uplift your “internal environment”) to the point of feeling more grounded/stable/peace/uplifted as a regular way of life, your new standard of being in the world as part of your daily living.
Consider adding more uplifting people in your immediate circle of support; seek outside of your immediate community for online mentoring groups if needed.