Morning report is a training method used in internal medicine to help house officers (junior doctors) make better diagnoses. Medical librarians are trained to perform literature searches, with the aim of finding the best evidence to answer a clinical question. This case-control study (evidence level 3b) by Banks et al at Louisiana State University Health Sciences Centre put these two aspects of hospital life together.

Over a period of 8 months, the morning reports on 105 newly admitted patients were augmented by the literature searches conducted by the faculty librarian immediately after each meeting to identify key references which answered two questions posed at the end of the morning report session. The "best" citations were selected by the "chair of the department of medicine or the chief resident identified as providing the most clinically sound answers to the questions", and these were then passed around the ward team in time for the next day's morning report. The house officers had to fill out a form to compare and assess the quality of the information and decide whether the information would alter their management of a patient. Each case was then summarized by the librarian and a chief resident or the chair of the department of medicine.

This group was compared with 105 patients with the same primary International Classification of Diseases (ICD-9) diagnostic code, who were drawn out of a computerized list of 19,210 in-patients who had been admitted to the same hospital in the previous 5 years and 7 months.

Summary of findings

Outcome                                     Control group        Librarian-assisted group
Median length of stay                   5 days                   3 days
Median hospital charge                 $10,663                 $7,045
Readmissions within 30 days            16.8%                    16.4%

This study suggests that morning report, informed by the clinical evidence, is "a powerful educational intervention that may decrease patients' Length of Stay and cost of care". The physicians who took part in the study were able to increase their knowledge and awareness of the library services available to them, including the searching expertise that the librarians could offer to improve the patient care that the physicians could offer.

The authors note that a larger study is justified, especially to identify reasons for the success of this study.

Links

Banks D.E et al. Decreased hospital length of stay associated with presentation of cases at morning report with librarian support. J Med Libr Assoc. 95 (4) October 2007.

Centre for Evidence-Based Medicine's Levels of Evidence RFT document