Clinical Query Service - Supporting Evidence Based Practice Emma Quinn HSE South East Library Service I read recently that the key to a great presentation is to present on something you love

HSE South East Library Service is comprised of 5 staffed libraries at Lacken, Kilkenny (former Head Office of the South Eastern Health Board); St. Luke’s General Hospital, Kilkenny; South Tipperary General Hospital, Clonmel; Waterford Regional Hospital and Wexford General Hospital. The service is staffed by 3 librarians and 7 library assistants.

I am definitely a fan of Google I am definitely a fan of Google. The quality of literature searching carried out by our library users can at times be questionable!

Workshop at Waterford Regional Hospital You may recognise some of the blurred but happy heads from the Waterford Workshop! Early 1990s, David Sackett & his colleagues at McMaster University, Ontario, Canada coined the term “evidence-based medicine” to mean the integration of best research evidence with clinical expertise and patient values. It is now often referred to as ‘evidence-based practice’ 3 day workshop entitled "Evidence-Based Practice Skills for Healthcare Professionals" was co-hosted by the HSE's Nursing & Midwifery Planning & Development in the South East, medical colleagues in Waterford Regional Hospital, in collaboration with the Centre for Evidence-Based Medicine in Oxford University. “Evidence-Based Practice is about trying to improve the quality of the information on which health care decisions are based” From: Glasziou, Paul & Del Mar, Chris (2007) Evidence-based Practice Workbook: Bridging the gap between health care research and practice. 2nd edition. Oxford. Blackwell.

The Steps in Evidence-Based Practice Formulate an answerable question Track down the best evidence of outcomes Critically appraise the evidence (to find out how good it is and what it means). Apply the evidence (integrate the results with clinical expertise and patient values).

Clinical Query Service? Mediated Search Based on the first two steps of the CEBM method: -EBP Step 1: formulate an answerable question -EBP Step 2: track down the best evidence A mediated search with a difference.

Formulate an answerable question using PICO(T) Population/Problem Intervention/Indicator Comparator/Control Outcome (Timeframe) Our questions aren’t always fully formulated in our own heads when we launch into the databases and often end up more confused. PICO is a technique / principle/ trick- call it what you will that helps us to dissect our question into its component parts and structure these into a question- an answerable question. It helps us to think about what exactly we are looking for and not looking for so that when we come to searching the journal literature we have a clear question in our head as to what we want. The very act of sitting down and working out the PICO of a question can save so much time long-term and ultimately results in a better literature search and hence a better result.

The launch of the Clinical Queries Service in the South East coincided with the introduction of the new hselibrary.ie website. The new website presents a very modern, dynamic library service and the Clinical Queries Service is seen as an important part of this.

CLICK HERE In the HSE South East Library Service the Ask a Librarian tab was replaced with a Clinical Queries tab and a new request form was created. A generic Clinical Queries email address was also set up and all queries received electronically were directed to this. Clinical queries are requested either by clicking on the Clinical Queries tab directly from the hselibrary.ie/southeast website and completing the online form or by completing a Clinical Query Request form and sending /emailing/faxing it into any of the staffed libraries.

PLEASE STATE YOUR QUERY … and LIST ANY RELEVANT KEYWORDS … or (optional) ENTER KEYWORDS UNDER THE FOLLOWING HEADINGS (PICO) PICO Population/Problem Intervention/Indicator Comparator/Control Outcome The basic lay out of the clinical queries request form which I couldn’t figure out how to put on the slide contains these key components. To facilitate our searching we also ask whether the query can be limited by age group, sex or date of publication?

On receipt of a clinical query the library staff: Analyse the query into components according to the “PICO” algorithm: Population/Problem; Intervention/Indicator; Comparator/Control; Outcome Conduct a detailed subject search on the most relevant primary database: MEDLINE for medical questions; CINAHL for questions related to nursing or allied health; PSYCINFO for questions related to mental health Conduct a secondary keyword search of other resources such as Cochrane, UpToDate, MD Consult, guidelines, etc., as appropriate Collate a selection of relevant results and return them to the requestor with details of the search strategy used and resources searched

Population/Problem = Pregnant women I am doing a literature review about the value of nuchal translucency ultrasound in obstetrics. Population/Problem = Pregnant women Intervention/Indicator = Nuchal translucency ultrasound Comparator/Control = None Outcome = Effectiveness in diagnosing foetal defects Types of query? From whom? Example of a genuine query received. Primary Database Searched: Subject Search in Medline- Search History included in the response followed up by keyword search in UpToDate. A number of full-text articles if available

Things to consider Library Staff training e.g. basic concepts of EBP, how to complete a query Uniformity in the quality of responses- library procedure created to address this Staff knowledge of medical/nursing terminology/ concepts Prioritising Patient care queries If setting up a Clinical Query Service

Feedback from users? Positive Not always forthcoming

The Future? Actively seek feedback via a user survey Usage by medical doctors poor Back to reality

Any questions?