Delivering CLEAR : clinical enquiry and response service

Catriona Denoon, NHSGGC Library Network“Perspectives on sourcing information in health and social care”

workshop, March 2013

About us

• NHSGGC Library Network• We offer a range of literature search

services for staff in NHS Greater Glasgow and Clyde, and partner organisations

• Includes a team of 6 librarians (4.5 fte) who focus on literature searching and training

About CLEAR

A CLEAR digest is a brief summary of published evidence in response to a clinical question.

It aims to provide clinicians with summarised evidence on queries about patient care.

CLEAR is delivered by a team working to service criteria and a defined method. The team comprises staff from NHS HIS and NHSGGC.

CLEAR works in partnership with NHS24, Health Management Library, and health board library services. Any search requests outwith the scope of the service are referred to another library.

www.clear.scot.nhs.uk

A CLEAR response is

• a list of key references from validated clinical information sources, or

• a brief digest of issues and recommendations from these summaries.

• The service does not provide interpretation of results and does not analyse or synthesise any of the retrieved information.

Questions are posted by NHS Scotland staff via the form on the CLEAR website. Enquirers must be logged in using their Athens username and password to post a question.

A mobile version of the CLEAR service is currently being tested.

Creating a CLEAR response1. search the literature using the protocol2. draft the written response3. send the response for QA and amend if required4. post the response on the web and deliver to the enquirer5. complete the admin database

The search question is mapped to the PICO formula where possible.

Search strategies should include clear concepts and synonyms, and not just the terms supplied by the enquirer.

Resources usedStage 1: SIGN guidelines, NICE guidelines, Clinical

Knowledge Summaries, Scottish Government Publications, Healthcare Improvement Scotland Advice and Guidance

Stage 2: Dynamed

Stage 3: Cochrane Reviews, HTA database

Stage 4: Medline, Embase, Cinahl

Additional: TRIP & TRIPAnswers

How it worksBegin at Stage 1.

– If the answer is found in Stage 1, stop the search– If the answer is found in Stage 2, stop the search etc …

• If the answer is not found within the resources listed in Stage 1-3, continue to the primary literature in Stage 4.

• All searches include a search of the TRIP database for previous TRIP answers and UK guidelines.

• If no answer is found within the protocol, can refer to local library service for a wider search.

Documentation

Quality assuranceAll digests are quality assured, involving:

• a rerun of the search and a reference check by an information scientist, and

• a review of the digest by a health services researcher.

• A standard checklist is completed and returned to the searcher. The amended digest is then uploaded to the website.

Timescales for query responses

• 5 days is standard• 3 days• 24 hours

Examples of questions received & where information was found

“What is the evidence to support the use of hydrotherapy or rebound exercise in patients with cerebral palsy and learning disability.” Dynamed, NICE, Cinahl

“What activities should be avoided in a patient with cervical spine nerve compression at C6?” Prodigy, Cochrane, TRIPAnswers

“What is the evidence for using preformed metal crowns versus amalgam placement in primary teeth.” Dynamed, Cochrane, TRIP, SIGN

Issues for NHSGGC

• Time! & managing workload• Developing local literature search services• Staff development• Partnership working

Any questions?