Clinical search effectiveness: An assessment of the contribution of the computer-assisted information services of hospital libraries to clinical decision-making by physicians

The contribution of libraries to health care is among the most important issues in medical librarianship. This study examined the contribution of the computer-assisted information services of hospital libraries to clinical decision making. Four lines of research intersect in this study: research on information transfer among health professionals, research on clinical problem solving and decision making, evaluation of information retrieval system performance, and evaluation of health sciences library information services. Four notions of effectiveness that emerge from these lines of research were identified and the perspective of situational effectiveness was selected as most appropriate for this study.;A research design combining qualitative and quantitative methods was devised for the study. A random sample of hospital libraries was selected. Critical incident techniques were used to explore the circumstances of 132 physicians who requested the assistance of their library in locating information pertinent to the care of one of their patients. Incidents in which physicians obtained the information needed for clinical decision making and judged the information important for resolving the clinical problem that prompted their request were considered effective. Incidents in which important changes in patient care resulted were considered critical. Incidents in which, for any reason, the information provided to the physician failed to contribute to case-related decision making were considered ineffective.;Physicians in twenty-nine medical specialties participated in the study. Their patient cases represented all National Library of Medicine disease classifications. More than three-quarters of the incidents examined in this study were effective and more than one-half were critical. The distribution of participating hospitals was representative of the regional distribution of hospitals which maintain libraries. Factors related to the collections, services, budget, and staffing of the libraries were not explanatory of ineffective incidents. Illustrative scenarios (i.e., case reports) of fifteen effective, critical, and ineffective incidents are presented.