Rachel Steele, Clinical Librarian, Tees, Esk and Wear Valleys NHS Foundation Trust

1. Synthesising and summarising the evidence in practice: how two clinical librarians in the North East are using their learning from the 2017 LIHNN workshops to offer differing search services for clinical and service transformation staff Rachel Steele, Clinical Librarian, Tees, Esk and Wear Valleys NHS Foundation Trust and Gill Foster, NHS Digital June 2018

2. Background (1) • Challenges of translating research findings into practice • 55 new trials are reported in medicine every day (Wallace, 2014) • Among patients in the community and in primary care settings • ‘more than 50% of those with depression do not receive accurate diagnoses or any prescription of depression treatment’ • of those who are prescribed treatment, more than 50% do not receive adequate doses of antidepressants • and fewer than 10% receive evidence-based psychotherapy (Katon and Seelig, 2008) • ‘… Similar low levels of adherence to evidence-based guidelines have been found for other disorders such as substance abuse’ (Taylor and Grey, 2010, p. 7)

3. Background (2) • But, mental health professionals (e.g. psychiatrists) are amenable to evidence based practice (henceforth EBP) in principle (Lawrie et al., 2000) • Mental health clinicians generate a significant number of clinical questions in their work… (Steele and Tiffin, 2014)

4. Clinical Librarians – A Key Role in “Evidence in Practice” Agenda • An evidence summary is a critically appraised thematic syntheses of the published research evidence base (following a detailed literature search) • Role can be key aspect of an organisational approach to knowledge transfer

5. Clinical Librarian One Year in TEWV • 82 requests received • 50% related to evidence for individual patient care (classic EBP conception); • 23% related to generic clinical issues; • 27% were on management/corporate topics.

6. Consultant Psychiatrist Feedback • ‘When compared to all the other aspects of clinical governance the MDT practises, I have no doubt the addition of the CL to the team has made the single largestimprovement.’

7. Trust Staff’s response to how Clinical Librarian Evidence Summaries had actual (or anticipated) impact

8. Success of the Clinical Librarian role • Practitioners and managers clearly value the model of the Clinical Librarian synthesising and critically appraising, as well as searching for, evidence in practice • Complexity of searching for, and synthesising, information lower down the evidence hierarchy

9. Personalised medicine: ‘personalised evidence’ • Evidence higher up the hierarchy (e.g. RCTs) may be given more weight in decision making • However, research which is lower down the evidence hierarchy may have greater salience to the clinical problem at hand • E.g. Case studies may be more influential than more generic “population based” studies (e.g. Victoria Climbie; Christopher Clunes) • Novel concept of personalised evidence

10. Personalised medicine: ‘personalised evidence’ • Thus, there is a tension between level of evidence and it’s salience • This can be conceptualised as a matrix • Conveniently we can simplify this matrix into four quadrants (Steele and Tiffin, 2014).

12. Practical points re the production of evidence summaries • Research design based on the hierarchy of evidence (e.g. Systematic reviews then primary research…) • Thematic syntheses • Individual studies • Presentation: • Must know (80%), Should know (15%), Could Know (5%)

13. Sample summary Individuals studies summarised for a more ‘factual’ question

14. Sample summary A very general question – thematic summary used to explore this question

15. Sample summary Synopsis of individual studies

16. Sample summary First a general overview of findings; then a thematic summary (1)

17. Sample summary First a general overview of findings; then a thematic summary (2)

18. Summary and synthesis for service queries Service transformation and technology • New services • Improving services • Different ways of working • New technologies for staff • New technologies for patients • Impact and evidence • Funding applications

19. Reference interview • General reference interview Focus on: • Purpose of the enquiry • Who is it for? • What are they going to do with it? • What do they already know? • What do they expect the search results to do for them? • Deadlines • Query anything you don’t understand

20. Practical summarising for services • Guidance / regulation • Government statements /standards • Incentives / funding • Statistics • Patient pathway • Interventions / innovations • Contacts

21. Sample summary Paediatric triage – meeting with NHS England

22. Sample summary: Frailty – to read on a train

23. Sample summary: Unnecessary ED attendance

24. Sample summary: Guidance on video consultation

25. Item summaries • Group evidence/items by hierarchy • Use section headings • Running numbers (in case of query) • Summary of document/project that shows why it relates to the query • Summarise or highlight key phrases • Link to full text items or note availability • For projects/innovations – add contacts

26. Sample summary of an item

27. Feedback / service evaluation Individual in the PDR, e.g. • “I asked for a couple of sets of info not really in the current remit, Gill researched and provided a really good set of info that I was able to use with NHS E” • “Gill’s approach and knowledge is a real benefit to the programme”

28. Contact us…. Rachel Steele, Tees Esk & Wear Valleys rachelsteele@nhs.net 0191 441 5910 Gill Foster, NHS Digital gillian.foster5@nhs.net 07714 837 587

29. Questions?