The Impact of Hospftal Lfhswks on the Quality and Cost of Health Care Delfvery

Last September, the Health Care Financing Adminktration (HCFA) of the US Department of Health and Human Services rewrote the federal requirements for hospitals to participate in Medicare and Medicaid p~ograms. The proposed changes are intended to give hospitals more flexibilhy in delivering quality health care to patients at a lower cost .1 The new rules were published in the Fedeml Register on January 4.2 One proposed change deletes the requirement that hospitals maintain and staff a medical library. Apparently, the HCFA considers hospital library services to be a costly requirement that has no impact on quality health care. In fact, an in-house HCFA memorandum stated, “While the availabilhy of current literature may be useful, there is no evidence that the deletion of th~ standard [on medical libraries] would result in risks to patient health and safety.” The HCFA opinion of hospital library services is misinformed, to say the least. There is considerable evidence that hospital library services contribute to patient health and safety. The HCFA plan to delete federal requirements for hospital libraries is misguided—medical care costs will increase, not decrease, as’ a result. Many studies have evaluated clinical medical library (CML) programs in various hospitals.3-lZ In the CML program, a medical librarian acts as a member of the clinical team of doctors, residents, interns, nurses, and other health care professionals such as pharmacists and social workers. The librarian attends the morning report, where cases of newly admitted patients are reviewed. The librarian may also accompany the clinical team on their rounds in the hospital wards. The clinical librarian notes questions or problems concerning patient care that are raised, and researches these topics immediately in the hospital library. Relevant literature is then delivered to the clinical team on the same day. 13,14 The studies I referred to above indicate that CML programs provide “immediate benefits in the areas of patient care and research, and undergraduate, graduate, and continuing medical education.” 15 Clearly, HCFA administrators were unaware of these studies when they claimed there was “no evidence” that hospital libraries have an impact on patient care and safety. Thus, it is important to review in detail how the CML programs affect patient care. Georgia Scura and Frank Davidoff, University of Connecticut School of Medicine, examined the CML program at that institution’s health center. lb They selected SO information requests at random out of 287 searches completed over five months. House officers who received the information were interviewed. When asked if they had read the literature that they were provided, 92