Using Hot Topics for searches

Recently I was asked to conduct a quick search to provide some information on Accountable Care Organisations and Accountable Care Systems.

Image Source:Love heart decorated cappuccino (milk coffe cocoa decoration).jpg by Yannick Bammert

Luckily I remembered the Hot Topics that we have been adding to the MAP over the past year. The hot topic about Accountable Care Organisations, provided a great starting point for the search highlighting some of the key reports and including a useful summary which I could use in my search report.

 

If you have any ideas for any new hot topics  to be added to the MAP, email us at map@libraryservices.nhs.uk 

 

Evaluating the Literature Searching Service

Title of project: Literature Searching service evaluation

Lead library: Integrated Library Service (ILS)
Wirral University Teaching Hospital NHS Foundation Trust
www.whnt.nhs.uk/library

Summary: The Literature Searching service provides clinicians and non-clinicians with a summary of the available evidence on their chosen topic. This may be in response to a question about patient care, to support audit and research activities, to prepare for a meeting or project, to support educational activities such as Journal Clubs, or simply to keep up to date in an area of interest.
The library service decided it would be a valuable exercise to evaluate this service to try to measure its impact on organisational activities and decision-making.

Alignment to local, regional and national drivers: The results of the evaluation highlight the ways in which the Literature Searching service is aligned with key local and national drivers.
Local drivers
During 2009/10, the key goal of the Trust was to improve the delivery of excellence in quality and safety. The Literature Searching service can support this goal by providing high quality evidence to support the clinical and business decision-making necessary during the improvement process.
National drivers
The Literature Searching service supports the QIPP (Quality, Innovation, Productivity and Prevention) agenda.
Quality: The evidence on which clinical and business decisions can be based is from high quality information sources.
Innovation: The Literature Searching service is expanding outside of the library to provide evidence searches ‘at the elbow’ of the clinician or manager, e.g. at ward rounds or team meetings.
Productivity: Evidence searches are carried out by trained Librarians, saving clinicians and managers valuable time. The results of searches are summarised in an easily digestible format promoting quicker and easier access to the evidence base.
Prevention: Where appropriate the results of a Literature Search can include ‘horizon scanning’ whereby areas of potential risk and examples of good practice in other Trusts are identified. The service also contributes to the reduction of knowledge related risk.
The white paper, Equity and Excellence: Liberating the NHS, emphasises the importance of improving healthcare outcomes and patient experience. The mobilisation of best evidence, which can be supported by an efficient Literature Searching service, is crucial to the delivery of high quality services.

Project team: The service is provided by the Clinical Librarians and Site Librarians within the Integrated Library Service.

Key Audience: The service is available to all staff within the following Trusts:

• Wirral University Teaching Hospital NHS Foundation Trust
• Clatterbridge Centre for Oncology (via Service Level Agreement)
• NHS Wirral (via Service Level Agreement)

The service responds to search requests on clinical topics as well as non-clinical.

“The story”: The Clinical Librarian Service implemented a pilot evaluation to capture data from everyone who received Literature Search results between 1st Jan 2009 and 31st March 2009. This was carried out as part of a wider regional project which involved collaboration with other Clinical Librarians in the North West. The aim of the pilot was to develop a generic evaluation questionnaire which could be localised and implemented by other library services in the region.
The pilot achieved a 62% response rate to an electronic evaluation questionnaire that was created using Survey Monkey. The pilot was considered a success and minor amendments were made to the evaluation questionnaire.
It was decided that everyone who received literature search results would be sent a link to the electronic evaluation questionnaire after a period of three months, in order to give them time to digest and utilise the information provided. This would hopefully allow us to measure ‘actual impact’ rather than ‘intended impact’.
An evaluation of the period 1st March 2010 to 31st July 2010 showed that search results received during that period had high impact on a range of Trust-wide activities, including direct patient care, management decision-making, guidelines development and educational activities.

Benefits of this service for the organisation: Evaluating this service allows users to contribute to the improvement of the service. It also allows the organisation to gain a further understanding how this service is contributing to Trust-wide goals and objectives and aligned with national NHS drivers.

Benefits for the library:

• Evaluating the Literature Searching service has many benefits for the library service:
• Impact evaluation: Assessing the impact of our services is an ongoing driver for library and information services in the NHS.
• Improving services: Feedback gathered as part of the evaluation will assist us in evaluating the quality of the existing service and identify areas for improvement.
• Demonstrating value: The evaluation process provides formal feedback on how the library service adds value to the wider organisation.
• User engagement: Evaluation allows us to involve service users in adapting and improving services.

Evaluation: The results indicate a high level of satisfaction with the delivery of the service. 100% of respondents either ‘Agreed’ or ‘Strongly Agreed’ that the search results satisfied their information needs.
92.8% of respondents either ‘Agreed’ or ‘Strongly Agreed’ that their search results were received on time, although one respondent commented that their “results [were] received in good time but not as soon as hoped for”.
However, 100% of respondents would recommend the service to a colleague. One respondent commented:
“Excellent service, good quality information really helps when researching new ideas.”

Impact assessment: The results signal a number of ways in which the service impacts on clinical and non-clinical activities.
Enhances existing knowledge of healthcare professionals
92.3% of respondents either ‘Agreed’ or ‘Strongly Agreed’ that the search results revealed new information to them, and 84.6% either ‘Agreed’ or ‘Strongly Agreed’ that the search results substantiated what they already knew. This demonstrates that the service has a role in providing new evidence to users, but additionally in acting as a quality control mechanism that enables users to corroborate their understanding with reference to the evidence.
The role of the service in highlighting gaps in the available evidence is often an equally useful outcome. One respondent said the service was “very useful as I thought I was looking in the wrong places for information but the service confirmed the lack of information available on the subject”. Another commented:
[The service] “enabled me to use information that I would otherwise have thought was out of date by confirming there was very little on the subject matter”.
Having a trained Librarian undertaking the search also enabled users to be confident that a thorough and systematic search had been conducted. One respondent commented that:
“[The service] identified work which I had not previously found, reassured me that I had not missed any other relevant work.”
Encourages usage of additional library services
As a result of receiving literature search results, 21.4% of respondents requested articles through the library, demonstrating a positive impact on usage of other library services.
53.8% of respondents said that using the literature searching service had prompted them to seek training in the use of electronic / library resources.
Promotes an organisational culture of evidence based practice
The evaluation data identified that search results are not used in isolation by the individual but are shared among a team. 71.4% of respondents shared the information with colleagues within the organisation, demonstrating that the service facilitates the dissemination of evidence into practice amongst the wider healthcare community.
Additionally, 78.6% of respondents obtained the full text of articles for further reading, indicating that the service promotes increased reference to the evidence base.
Supports a range of Trust-wide activities
The wide range of clinical and non-clinical activities that are supported by the evidence provided by the Literature Searching service demonstrates its far-reaching impact on many areas within the Trust.
Saves time
100% of respondents said that the service saved them time in finding the information they needed. This is a key benefit of the service; where searches are conducted by a librarian the clinician or manager can spend the time saved on patient care or service delivery.
Improves information handling skills
The service also demonstrates a positive impact on developing the information skills of the healthcare professionals who utilised the service. 92.9% of respondents said the service had improved their awareness of evidence-based resources. 100% of respondents said the service has improved their ability to access resources. 71.4% said the service had improved their own searching skills.

Feedback: Informal feedback suggests that in most cases literature search requests occur as a direct result of a promotional drive or marketing activity, following Librarian attendance at a team meeting, a conversation with a member of library staff or another ‘outreach’ activity.
Open-ended responses from the evaluation questionnaire reveal the various ways in which the service impacts on the organisation:
“Very positive. Improved knowledge, evidence based care and supported decision making on the ward. Invaluable.”
“The service has contributed to knowledge and the development of clinical care.”
“Improving best practice and evidence based knowledge for me and share on my work area.”
Comments also highlight the role of the service in supporting business decision-making within the Trust:
“[The evidence provided was] used towards guideline development / local practice / CIP targets”
The service has also resulted in spin-off involvement in other service improvement projects:
“Victoria Kirk has been an amazing asset to our team this year and has helped us attain PDU accreditation. Her input with helping us review the latest evidence based practice has had a major input on the service and staff development.”
Search results were used to support educational activities:
“This service was able to simplify and quicken my search that enabled [me] to give an up-date and informative journal club presentation.”
“It has given a head start for me to work on my dissertation, so has increased my motivation.”
“Helped with literature search for the purpose of a presentation, therefore
saving time and improving my resources.”
“The results have been very useful as I am currently working on a systematic review for an MSc dissertation.”

Lessons learned: The literature searching service is a highly valued service that contributes to decision-making with the organisation. Awareness of the service needs to be raised within the organisation to encourage usage.
Where searches are conducted by a librarian rather than a clinician or manager there is:

• A positive impact on time
• An improvement in the quality of information retrieved
• The potential for significant cost savings

Sustainability;next steps:

• We will continue to evaluate the literature searching service.
• We will endeavour to promote the service more widely.
• We will continue to develop the skills of our library staff to deal with the wide range of searches that are received.
• We will share the results of the evaluation within the wider organisation, with a view to more formal reporting in the departmental quarterly report.

Project output: One of the key resources produced as a result of the evaluation project was a generic literature search evaluation questionnaire that can be adapted locally by other library services within the North West. The project also generated impact assessment data which can be used for a range of marketing and reporting activities.

Timeframe: Evaluation data reported here was from a five month period from 1st March 2010 to 31st July 2010.

Contact: Victoria Kirk
Job title: Clinical Librarian
Telephone: 0151 604 6223 (internal 8610)
E-mail: Victoria.kirk@nhs.net

Date case study completed: 1st September 2010

Supporting a Practice Development Unit

Title of project: Practice Development Unit (PDU) support

Lead library: Integrated Library Service, Wirral University Teaching Hospital NHS Foundation Trust www.whnt.nhs.uk/library

Summary: The Clinical Librarian was invited to support the Wirral Renal Unit in meeting the required criteria for gaining Practice Development Unit (PDU) status accredited by the University of Leeds. The accreditation criteria required the Renal Unit to demonstrate commitment to evidence based practice and staff development.

Partner organisations: Wirral and Chester Kidney Service http://www.wirralchesterkidney.nhs.uk/

Key Audiences: Multidisciplinary team involved in renal care in Wirral University Teaching Hospital.

“The story”:
Steering Group member
As a steering group member the Clinical Librarian attended all Steering Group meetings and offered updates on the projects the library was involved in, as well as bringing to the group details of new library services and resources.

Literature Searching support
The Clinical Librarian supported staff in identifying the evidence base on the following topics:

• Evidence of the psychological impact on chronic dialysis patients
• Examples of PDU accreditation processes in other NHS Trusts – problems encountered, lessons learned, impact and evaluation
• Published literature about haemodialysis non-compliance, deviation from dialysis prescription, reasons for missed sessions and what effects this has on mortality
• Evidence about the prevention and control of blood borne virus infection for renal dialysis Sexual Dysfunction in relation to renal patients
• An overview of leadership styles, in particular transformational leadership

Journal Club support
The Clinical Librarian worked closely with the Clinical Nurse Lead who had an interest in research to establish a Journal Club. The team decided to take a more informal approach to a traditional Journal Club that would be inclusive to all levels of staff.
To many of the staff involved Journal Club was a new concept so some training in searching the literature, practicing critical appraisal and understanding some of the key concepts of evidence base practice was delivered.

Kidney Diseases blog
The Kidney Diseases blog was established in response to a request from the Renal Unit team for a way of collating and distributing alerts about the latest evidence, resources and news relating to kidney disease. Staff were also encourage to submit items for inclusion that they would like to cascade to colleagues, with the aim of reducing the quantity and length of team e-mail chains and also providing a reference point in which to share knowledge within the team. Staff continue to receive email updates from the blog.

Accreditation assessment visit
The Clinical Librarian submitted a personal statement to the assessors and delivered a verbal presentation and display stand on the day of the accreditation visit about library input to the project.

How the initiative or service is delivered: The project was led by the Clinical Librarian Service with support from library colleagues. The project involved promotional activity and attendance at steering group meetings, as well as providing a point of contact for literature search requests, training requests and general enquiries. It also required the Clinical Librarian to write a personal statement, present the involvement of the library service and be interviewed by the assessors during the accreditation visit.

Customer involvement in this piece of work – or service development? The project required the PDU leads to participate in activities to support evidence based practice within their team.

Benefits of this case – activity – service – for the customer: The PDU leads benefited from literature searching support, Journal Club support and current awareness services via a named point of contact from the Integrated Library Service to support evidence based practice and staff development. All of these developments were used as evidence in their accreditation submission.

Benefits for the library/libraries: The library service benefited from the opportunity to work alongside health professionals in actively improving service delivery. The project has resulted in a close working relationship with the Renal Unit and has raised the profile of the library service within the organisation as a whole.

Evaluation: The Leeds University accreditation team awarded the Renal Unit a full stage 2 accreditation.

Feedback: Extract from the final Accreditation visit report:

“The relationship with Victoria is a marvellous example of using her skills to bring new, credible evidence to the attention of clinicians. This work should definitely be written up and published in an appropriate journal as it provides wonderful evidence of the value of a clinical library service to the improvement of practice.”

“Victoria’s blog is a wonderful example of using the available technology to bring up-to-date evidence and research work to the attention of everyone quickly and conveniently.”

Marketing: Many of the staff involved weren’t aware of all the library services available to them, so the marketing approach was face-to-face contact with ward staff and PDU leads at the regular steering group meetings.

Collaborative working: An enthusiastic approach was taken from both the library service and the PDU leads. Collaborative working was helped by the clear criteria set by Leeds University which gave us a shared objective and timeline.

Funding streams: n/a

Lessons learned: The project established a good relationship with the staff working in the Renal Unit who continue to use library services.
The library service can successfully support teams applying for practice development status.

Sustainability; next steps: Although the team was successful in achieving accreditation status, the projects that were initiated are continuing to run, including the Journal Club and kidney diseases blog.

Sources of further information: Wirral and Chester Kidney Service http://www.wirralchesterkidney.nhs.uk/

Start date: September 2008

End date: Stage 2 accreditation achieved in November 2009

Contact: Victoria Kirk, Clinical Librarian, Victoria.kirk@nhs.net 0151 604 7223

Related resources links:
University of Leeds School of Healthcare, Enhancing Practice
http://www.healthcare.leeds.ac.uk/enterprise/enhancing-practice.htm

Date submitted: May 2010

Drugs: The Evidence

Title of project: Drugs: the evidence

Project Team: A plus other members of the library service team

Resources Required: Brass neck to gain access to sponsored medical meetings
Ability to carry out, understand and summarise the results of a brief literature search
Ability to publicise the results of the search via intranet and/or email

Timeframe: 2010-

“The Story”: Dissatisfaction with the facility for pharmaceutical company staff sponsoring Trust medical meetings to hand out publicity materials which may not present the whole evidence about the efficacy of the products they are promoting. Library staff now infiltrate these meetings, and seize examples of the publicity materials. Advertised products are then subjected to a literature search, with a concentration on high-quality, up-to-date evidence. This results in a short summary of the findings which is posted on the Intranet. Selections of these summaries are emailed out to Trust physicians and local GPs at regular intervals inviting feedback.
Searches and summaries take no more than half an hour. The idea of the service is to encourage doctors to challenge the “evidence” presented by the drugs companies, rather than to present the “last word” on the topic.

Alignment to local, regional and national drivers: Hill Report emphasis on working outside the library comfort zone e.g. in clinical areas
Annual statistical return demand to report on search emanating from non-library areas
LQAF

Impact of this project/service for the:
• customer • organisation • library
Feedback includes:
1 Tongue in cheek comments about library staff endearing themselves to drugs reps
2 Email from doctor claiming that he had evidence that drug P was less cost-effective than the evidence I had cited suggested. I emailed him the Health Technology assessment which had reached the conclusion I quoted from and have not heard from him since.
3 Query from GP Lead prescriber at local PCT about why so many patients appear to be started on medication X by Pennine Acute doctors when the evidence appears to suggest that X is no more effective than a cheaper alternative. Passed this on to Drugs Information Pharmacist (who was happy to deal with the question) as this is obviously beyond the remit of a non-clinician

Lessons Learned: Take care to cover your back by ensuring that you quote directly from evidence (usually abstracts) so as not to give the impression that a librarian is interpreting evidence and advising on clinical decisions.
I’ve ignored this advice twice, in order to demonstrate how drugs companies misled doctors by citing relative risk rather than absolute risk but ensured that what I wrote was factual rather than interpretive.
More difficult to enthuse staff on other sites with the idea of sneaking unobtrusively into medical meeting to filch leaflets than I had originally expected. I suspect that there’s still a feeling that entry into these meetings (even during the pre-meeting lunch) is rather more difficult than entering a Masonic lodge.

Sustainability / next steps? Interest in the project appears to be growing. I’ve only just started to circulate summaries to the GPs and suspect that this may create more interest with this group than I had originally anticipated, as prescribing decisions taken by hospital doctors may have considerable long-term implications once a patient’s care returns to his GP.

Contact details: John Addison. Pennine Acute Hospitals NHS Trust. john.addison@pat.nhs.uk

Date case study completed: 8 September 2010

Nursing Supplies Group

Title of project: Nursing Supplies Group

Project Team: The group will co-opt new members as required:
Head of Procurement and Supplies, (Project lead); Productive Ward lead/Senior Nurse; Clinical Librarian (Tracey Pratchett); Nurse Practitioner; Accountant; Infection Prevention Matron; Lead Nurse – Productive Ward; Clinical Skills Lead; Midwife; Ward Manager; Practice Educator Paediatrics; Occupational Health representative;
Critical care representative

Resources Required: Library resources: Clinical Librarian time (meeting attendance 4 hours per month, literature searching and synthesis approx 7.5 hours per month) Supplies account for document supply.
Intranet: Supplies Group rep will manage the Intranet content.
Cutepdf (free license)

Time frame: Oct 2009 – April 2012 (Project and Clinical Librarian involvement will continue after April 2012)

“The Story”: The University Hospitals of Morecambe Bay NHS Trust is committed to providing high quality research based care within the resources available. The purpose of the Trust Supplies Group is to consider the research around the clinical efficacy and safety of clinical items available for use and make recommendations based on clinical and cost effectiveness. The Trust Supplies Group meets once per month and the Clinical Librarian attends all meetings.
In October 2009 the Clinical Librarian was invited to attend the Trust Supplies Group to deliver literature searches to support decision making around procurement. The savings target to be delivered by the group by April 2011 was £100,000. It was agreed at the first meeting that the Clinical Librarian would carry out searches for those items where a procurement decision would have some impact on clinical practice. Early in the process it became apparent that the group needed more than the delivery of a standard list of results and subsequently, evidence was synthesised into a standard 2 page format which would underpin recommendations made by the group when necessary (some procurement decisions are a straightforward swap and no evidence base needed). Once recommendations are agreed and the change to procurement practice made, the summary is posted onto the Supplies Group Intranet pages.

Alignment to local, regional and national drivers: The procurement of consumables by NHS acute and Foundation trusts (Feb 2011) National Audit Office “NHS hospitals often pay more than they need to when buying basic supplies, the National Audit Office has reported. A combination of inadequate information and fragmented purchasing means that NHS hospitals’ procurement of consumables is poor value for money.”
University Hospitals of Morecambe Bay NHS Foundation Trust Strategic Objective No 5 Business Plan 2011-2012:
“Give our patients value for money and provide sustained long term financial viability”

Impact of this project/service for the:
• customer • organisation • library
In 2010-11 the Nursing Supplies Group saved £100,000 and in 2011-2012 savings of just under £250,000 on procurement across the Trust.
A representative from the Supplies Group contributed to the interview element a current NW evaluation of Clinical Librarian services so it will be interesting to find out more about the perceived impact of the Clinical Librarian impact on the group and its decision making practices. The interviews were conducted by a Clinical Librarian from outside the Trust, to avoid bias.
The Library has made links with a number of Trust staff and have achieved greater understanding of the issues relating to procurement and clinical practice.
Winner of the Sally Hernando Award 2012.

Lessons Learned: Not every product change requires a detailed literature search, searches are only required when a product change may result in a change in clinical practice.
Excellent opportunity for library staff to collaborate with cross bay teams and have greater impact on evidence based procurement decision making.
Ongoing Clinical Librarian contribution is valued by other members of the Supplies Group.

Sustainability /next steps? The Clinical Librarian continues to be embedded in the Nursing Supplies Group for the foreseeable future and the work has been integrated into day to day workload.
However, the role of the group and the Clinical librarian’s role within that group may change as procurement practices become standardised across the Trust and different issues/approaches arise.

Contact details: Tracey Pratchett Clinical Librarian; University Hospitals of Morecambe Bay NHS Foundation Trust
(01524) 516224
Tracey.pratchett@mbht.nhs.uk

Date case study completed: 28th February 2012