National Clinical Librarian Impact Study Cathryn James Clinical Librarian Pip Divall Clinical Librarian Service Manager

Background July 2016 – HEE QIG created a Task & Finish group Based on work by NW CLs & Alison Brettle Twitter chat on #ukmedlibs on 15th March 2016 https://ukmedlibs.wordpress.com/2016/03/16/transcript-and-analytics-for-impact-of-clinical-librarian-services-chat/ Chaired by Mic Heaton (Derby) Group convened based on regional representation PD Group membership Helen Alper Sue Robertson Cathryn James Pip Divall Emily Hurt Margaret Scarce (Daniel McDonald – Australia)

Aim To evaluate the impact of Clinical Librarian (CL) services in the National Health Service (NHS); To identify examples of how the role of the CL has an impact in the NHS To add value to the impact of CL across the UK. CJ What were trying to find out? Rich picture of the work we do Get some good stories Cathryn James, Derby Teaching Hospitals NHS Foundation Trust

Methods Using Brettle et al as a guide Mixed methods Questionnaire & interviews TaF group met in person and later through teleconference Ethics approval from Derby Teaching Hospitals Foundation Trust (registered as an audit) CJ Group membership First meeting 5th Dec 2016 Louise Hull, University Hospitals of Leicester NHS Trust

What is a Clinical Librarian? “Clinical librarians seek to provide quality assured information to health professionals at the point of need, to support clinical decision making.”  HILL, P., 2008. Report of a national review of NHS health library services in England: From knowledge to health in the 21st century. Department of Health. PD Peter Hill report reference Discussion around this went back and forth, went with a pragmatic, open defintion, also used by Brettle. Bennet Jones & Katie Barnard, North Bristol NHS Trust

Questionnaire phase Methods Amended from Brettle’s original work Piloted in Derby & Leicester and further amended from feedback Smart Survey for data collection CJ Software used No of questionnaires sent out Lindsay Snell, Derby Teaching Hospitals NHS Foundation Trust

Questionnaire phase Results 1962 surveys sent out 697 questionnaires returned (35% response rate) 41 organisations England, Wales, Scotland 91% of responses were related to literature searches CJ Partial responses were included where enough data was available, 194 partials, 503 fully completed. Response rate shows engagement of staff with the services – Leicester response rate was 50% Australia: sent out 350, got 77 responses – 22% response rate Other 10% were training sessions ands journal clubs Yvonne Stubbington, St Helens and Knowsley Teaching Hospitals NHS Trust

Results: Survey Response by staff group Questionnaire phase Results: Survey Response by staff group Not just for doctors! A broad mix of customers.

Results: How searches were received Questionnaire phase Results: How searches were received Mostly through email, potentially signifying a relationship with named librarians. In person represents that CLs have a visible presence.

Questionnaire phase Question themes Patient Centred Care & Health Outcomes Decision Making & Evidence-based Practice Clinical Decision Making & EBP Continuing Professional Development Supporting Research Quality of Care & Service Development Efficiency, Accountability & Safety PD

Results: Patient Centred Care and Health outcomes Questionnaire phase Results: Patient Centred Care and Health outcomes PD

Results: Quality of Care and Service Development Questionnaire phase Results: Quality of Care and Service Development PD

Results: Efficiency, Accountability and Safety Questionnaire phase Results: Efficiency, Accountability and Safety PD 48% demonstrating value for money 62% has or may to improve patient/staff safety.

Interview phase Methods Semi-structured topic guide based on questionnaire Purposive sampling 8 organisations undertook interviews 25 interviews with Clinical Staff CJ Thanks to Karen Trifunovic here for the transcription work? Thanks to Alison Brettle for providing training on interviewing technique Chesterfield 2 Derby 10 Leicester 5 Weston 3 North Bristol 1 Buckinghamshire 2 Portsmouth 1 St Helens and Knowsley 1(part of original North West cohort?) Sarah Sutton, University Hospitals of Leicester NHS Trust

Interview phase Data analysis All interviews transcribed Thematic analysis of transcripts Data triangulated by CJ and PD CJ CJ & PD independently and then triangulated Thematic analysis of interview transcripts – still ongoing. Watch out for our paper! Lisa Lawrence, Derby Teaching Hospitals NHS Foundation Trust

Results: Major themes identified Interview phase Results: Major themes identified Improved patient experience Improved clinical collaboration Supporting innovative practice Leadership and supervision It is rare but actually having some evidence behind that to back me up and the biggest help was being able to counsel the patient and his family with them knowing that we had done our research. CJ Improved patient experience – emotional support, individualised care, increased QoL, shared decision making Came through in several question answers Improved clinical collaboration Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams Supporting innovative practice Finding where gaps in research are & using best evidence for best outcome Leadership and supervision Surprising result – using the evidence to lead a team through change A lot confirmed what we suspected, but some results were more surprising than others.

Results: Major themes identified Interview phase Results: Major themes identified …led to me and Dr R. sitting down and coming up with a much more streamlined referral pathway and certainly from the community hospitals where I am mainly based I now wait 7 to 10 days to get a PEG in whereas previously it was taking weeks to sort out, so yes I think it has led to us then sitting down and going through a very focussed way of coming up with local guidelines. Improved patient experience Improved clinical collaboration Supporting innovative practice Leadership and supervision PD Improved patient experience – emotional support, individualised care, increased QoL, shared decision making Came through in several question answers Improved clinical collaboration Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams Supporting innovative practice Finding where gaps in research are & using best evidence for best outcome Leadership and supervision Surprising result – using the evidence to lead a team through change A lot confirmed what we suspected, but some results were more surprising than others.

Results: Major themes identified Interview phase Results: Major themes identified Improved patient experience Improved clinical collaboration Supporting innovative practice Leadership and supervision As a result of the use of the oral care sponge, or the mouth care sponge, it has led to a decision in the organisation to remove it from our organisation As it’s an ineffective tool, and that has led to a massive change in practice. Improved patient experience – emotional support, individualised care, increased QoL, shared decision making Came through in several question answers Improved clinical collaboration Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams Supporting innovative practice Finding where gaps in research are & using best evidence for best outcome Leadership and supervision Surprising result – using the evidence to lead a team through change A lot confirmed what we suspected, but some results were more surprising than others.

Results: Major themes identified Interview phase Results: Major themes identified So off the back of the literature search, we then realised one of the things that we hadn’t done was a peer-led support scheme in the ED…currently ongoing, is a pilot where fifth-year students spend time in the emergency department with third-year medical students, to try and support them in their practice… it’s changed decision making in terms of trialling and intervention Improved patient experience Improved clinical collaboration Supporting innovative practice Leadership and supervision Improved patient experience – emotional support, individualised care, increased QoL, shared decision making Came through in several question answers Improved clinical collaboration Local and national collaboration – evidence to share with clinical teams (Suzanne Dawson), Derby experience – respiratory journal club extended to other teams Supporting innovative practice Finding where gaps in research are & using best evidence for best outcome Leadership and supervision Surprising result – using the evidence to lead a team through change A lot confirmed what we suspected, but some results were more surprising than others.

Clinical Librarian Skills What our users said about us Relevant Personal Cheerful Valuable Reliable Time Savers Beneficial Indispensable Timely Professional Efficient What our users said about the CLs

Limitations Potential for “oversurveying” our customers Interpretation of who to send the surveys to Lack of engagement from some regions Potential interviewer bias CJ North West potentially oversurveyed, but their survey returns were good. Recently participated in Brettle study so expected less interest and was pleasantly surprised. The whole process has been a learning process for Pip & Cathryn! Hannah Wood, Weston Area Health NHS Trust

Conclusions Data analysis ongoing Shown complexity of the CL role CLs save the time of clinicians We do make a difference in supporting evidence-based decision making PD Emily Hurt, Lancashire Teaching Hospitals NHS Foundation Trust

Acknowledgements With thanks to… NHS HEE Quality and Impact Group Alison Brettle & NW CLs Interviewees & interviewers Participating libraries Karen Trifunovic and all transcribers Keith Nockels, formerly University Hospitals of Leicester NHS Trust

Contact details Cathryn James, Clinical Librarian Derby Teaching Hospitals Foundation Trust cathrynjames@nhs.net / @Jamespjcjames Pip Divall, Clinical Librarian Service Manager University Hospitals of Leicester NHS Trust pip.divall@uhl-tr.nhs.uk / @pipdivall