The impact of NHS-funded library services in South Central Strategic Health Authority Report 3: a survey of recipients of mediated literature searches conducted in March 2009 1. Introduction This report collates the data gathered from a pilot study to test the usefulness of surveying library users who have requested a mediated literature search as a technique to illuminate the impact on patient care of the various services provided by NHS-funded library and information services. This survey of a sample of recipients of literature searches was conducted across libraries in South Central, in parallel to holding one-to-one interviews with individuals from two staff groups of Buckinghamshire Hospitals NHS Trust.. An online survey, mailed to all trust staff, was conducted prior to these. 2. Objectives This component of the pilot study was designed to: Test a questionnaire to assess the impact on patient care of the literature searching service offered by library staff Obtain rich quantitative and qualitative data regarding the impact of library services on patient care amongst purposive library users Identify the uses to which information provided by library services is applied 3. Method A short questionnaire was sent electronically to South Central SHA libraries, with a request to keep a list of the name, search topic, and e-mail address of everyone for whom they completed a mediated search. The form could either be e-mailed to users, or printed and posted. Similarly, the recipient could either complete online and e-mail back, or print off and post. Library managers were asked to distribute the questionnaire, on or around Monday 27 April with a closing date of Thursday 14 May for the return of completed questionnaires. The questionnaire used is provided as Appendix 1. 4. Results 38 questionnaires were returned and the quantitative responses are shown in Table 1 below (and the search topics themselves are listed in Appendix 2). The responses were spread between Mental Health, Acute and Primary Care Trusts, with the greatest response from Mental Health (three ‘Other’ organisations were cited; (these were in fact clinical divisions of an Acute Trust). The returns demonstrate greatest use by Nurses and Midwives, followed by equal use by Medical and Dental staff and Allied Health Professionals. Only two searches on which respondents reported were undertaken by “students”. 4.1 The impact of the information provided– quantitative data Table 1 Questionnaire responses: quantitative data 0 Didthsearclyou DidthenformauvylpAVOICHNGEsc impactonyurlegh?fwORGANISTPFELU M e N u r s i n g a n d A l l i e A d M a A d d i t i o n a n l a P g e r o r i a f e l , s A d s i o d M i d d H i t i o m i n n a l / e n i s S i c i f e l t h l C i e s d w a a t r a c E a l s a l i s s e C e d D g s S d T n d e f e a n / a n R r o i c e t i f i c t e a r y P l i n t i v n t a c e a i c e ( P l e o a n s t a e o l s m m i s n h p s e e i o t r a i t i c d e i d d v n e v i c ’ t g e e i n a l l o g o p i v f l u e r u e n n c t h d m e e n e n n i c d t t o e i d n o t c h a n g e a n y a s d e n e u v a i d p U o c i c f e c d g o l i n t s e r u t h e l i t y e c n e i v f e o e g s l e e r p s o g r a p r t h t i e r y n h o t h t o f o p a a n n l i f e o f s o s p i t a l U n n e U c n e s n s e a c a n r y e s c n t e s U a n , i t d i d n ' t h e l p m e a I t I t c I o s n h r e f r e f i r m e a r e d d t h s h e m y e i n d s e d i t f o r c o u r i o d i d n ' t i m p u a s c t e d o n v l e e i t a r h r g i s s u o e 5 1 l s 2 1 1 1 3 1 3 5 3 0 5 6 3 1 7 1 7 2 0 7 4 2 6 2 8 1 1 9 0 5 1 s 3 4 4 4 4 9 2 0 8 9 1 f 5 2 n 1 n 4 4 6 1 s g 2 1 9 4 3 1 t t s s s w e i n 0 7 2 2 1 i t s s e y i c e e i o s 5 2 1 ) g l s t s t s l i e t i o h 1 9 0 l l T g h g i s r y i t y p u n i s o 0 9 d l s t e t s t s r s n n i t s s n s e g c n e r e i s r r a t o b g n l i t y t i o r g v c v r i o a t s s s s i o r t a f e r t a a t s e s t a r e m i l y m e t m e d t e r r v r p r y i n n s a e r c e o t e l d u u o n f a c u e e l t h i f y i n t i n a n g c t h f c p a e u i n e u t e s e n a f t m e r s n r y o l l e s p p r g o f e e c t h e o t h i s u s g r l o c r e a f c o i t a o m o t i e s r s g g l a o o m i s t i n r y r o r y o s a p e t r e d a s d i n i a e s v n a p e m y d m e a l l e i n y t r e r a d a e v r y i t h h i n t s e o s d l e f o i c t s n s r t p c d o r o n l s s s c r n o e t i e i r e o u e a w o i t a d a e e w d h t i e r e i t a o f i e m o o n a u c n i d e d t e l e y a p t s c n n r k e r q e e t i s k o s f o m y o m e t i o r n w u a r r m a r s I i t s m y p f o I u I , s r y n U o I t I o f t i e a a c s t h o a p w t o P H U N N l p o g n a r e & c a a D C d a C u a c n c A u , i c e A d Q u i t a n P r C r v M a o o R , e i c i l l a d A c e C e F e A d h G u o t a r e n r i c n c t u n t e i o r v l e h A n S M e O t h L S N C N 1 0 These data indicate that for this sample of respondents, literature searches are predominantly being used to support 1) guideline or pathway development and 2) service development and planning. While many searches are still reported as being significant in supporting coursework or work on dissertations, the responses indicate that libraries are playing a significant role in supporting evidence based practice, rather than formal education. Nevertheless, learning something new and confirming prior knowledge and belief is also highlighted by respondents. The significance of sharing information obtained via literature searches with colleagues and of using information provided by the library to give advice to colleagues (and to a lesser extent to patients and carers) suggests that the value of this service lives on and is disseminated by users, demonstrating the part that libraries play in enabling a culture of learning throughout NHS organisations. 4.2 The impact of the information provided– qualitative data The qualitative data from the survey is recorded in Table 2, below. Users were given a free text section to outline anything that they did differently as a result of the information received. 23 people responded to this question (60% of this small sample). Table 3: Qualitative narrative data I will be writing up a report which will hopefully influence supervision practice by senior clinicians I contributed towards an audit project, a qualitative project on the experiences of people with learning disabilities on seeing a psychologist. I informed my clinical work with systemic approaches. I satisfied my curiosity on topics such as borderline personality disorder and approaches such as DBT and CAT. I revised for up coming courses, etc... This service is invaluable and the librarians are instrumental in helping me It is helpful in tailoring the intervention I use with patients more specifically I feel better able to carry out my own literature research having received support and tutoring The information requested was very helpful for improving the accuracy of our reports In the last question there is no mention of support with research which was the primary reason I asked for help Provided evidence for clinical pathway development The information will be used to inform both commissioning and patient care. It will form part of a research bid to help improve the qualities of patient care A funding proposal could be evaluated on the basis of evidence base I was better prepared for a meeting by having this knowledge. I also knew what I didn't need which is half the battle. I then went on to do further research on the internet The literature I received was purely for an essay assignment on my course Completed my course which improved my practice I was able to carry out further literature searches using the information provided. It was a useful tool in gaining knowledge for my dissertation A meeting will be held at DMT within Older peoples Mental Health Services to look at the evidence base for recovery, and to look at developing a strategic approach ahead We used the particular piece of work you did around bench marking to help me write a paper for TMT and PEC re Podiatry Services so as to ensure that the different aspects are taken into account not just numbers of population but deprivation indicators etc The outcome of this paper has led on to further work re a full service review in order to understand how the service is working and what new models of care are available. The info went Chief Exec level. As ever the library staff were extremely helpful in providing help and information in very short notice. The information enabled me to carry out a research proposal. I am almost certain that this proposal will enable to change/implement visiting hours in maternity unit especially on labour ward. I am planning to have a working party in order to take this proposal further. If I can provide you with further information please let me know. Development of departmental policy is ongoing It has provided me with confidence when looking after a patient on pulmonary oedema as I know now the important aspects of the nursing care and I understand the pharmacological treatment. I feel that the patient will be now more safely looked after as I have also learnt how to recognize the signs/symptoms of a pulmonary oedema and I have passed my knowledge to my colleagues. Thank you very much for your support. I am now able to start work on a flowchart for managing constipation in malignant spinal cord compression to allow a consistent, evidence-based approach by my team. The evidence so far is helpful in terms of more current thinking and what would be acceptable to patients and carers. The evidence will definitely influence my practice and intended outcomes for both patients, families and the acute trust.. I work on policy development rather than front line patient care. The literature searches we get from Cairns are absolutely essential to our work This literature search was used to confirm knowledge and update a policy under review Can empower the young people I work with, with a sense of research literature behind my practice. Has been helpful in increasing my awareness in future practice 5. Conclusions This survey was conducted as a short term pilot, with a limited number of responses from a sample of users over just three weeks. Hence, the results are only indicative. Nevertheless, the questionnaire proved very effective in obtaining data that meets the objectives of the study. The questionnaire identified the primary uses to which the information supplied via these literature searches were applied. Respondents reported on ways in which the literature searches impacted on patient care, and the survey gathered narrative data which ‘tells the story’ of the impact of this mediated service supplied by NHS-funded library services upon the work of library users and ultimately on patient care. Sue Lacey Bryant and Mark Bryant 31 May 2009. Appendix 1 Questionnaire IMPACT OF THE LIBRARY’S LITERATURE SEARCH SERVICE Dear Colleague, You recently requested a search on: Library staff insert subject here I would be grateful if you could complete the following survey, designed to assess the impact on patient care of the literature searching service that the library offers. Your feedback will help us improve the quality of our information and library services. Library staff - insert your name here YOU YOUR NAME: YOUR PROFESSIONAL GROUP: Medical and Dental Nursing and Midwifery Registered Allied Health Professionals Additional Clinical Services Managerial, Administrative and Clerical Additional Professional / Scientific / Technical Estates and Ancillary Students THE ORGANISATION YOU WORK FOR: PCT Acute Mental health Other (Please specify) CONTACT DETAILS (optional): Tel: e-mail: YOUR INFORMATION SEARCH Please answer each question ticking all responses that apply. DID THE INFORMATION PROVIDED INFLUENCE ANY OF THE FOLLOWING? Commissioning Contracting Audit Legal or ethical issues Funded research Service development and planning Advice given to colleagues Managing costs No, it didn’t influence any of these DID THIS SEARCH LEAD YOU TO CHANGE SOME ASPECT OF PATIENT CARE OR TREATMENT? Diagnosis Choice of tests Choice of drugs or other treatments Reduce the length of hospital stay Advice given to patients or carers Quality of life for patients or family Guideline or pathway development No, it did not change any aspects of patient care or treatment DID THE INFORMATION HELP YOU AVOID ANY OF THE FOLLOWING? Unnecessary hospital admissions Patient mortality Hospital acquired infections Unnecessary surgery Unnecessary tests or procedures Unnecessary outpatient visits Unnecessary referrals Unnecessary costs No, it didn't help me avoid adverse events DID THE INFORMATION YOU FOUND HAVE ANY IMPACT ON YOUR LEARNING OR TEACHING? It satisfied my curiosity It refreshed my memory of the topic It confirmed my prior knowledge or belief I shared the information with colleagues I learned something new I used it for course work or a dissertation I used it for supervision I used it for teaching purposes No, it didn't impact on my learning or teaching PLEASE TELL US ABOUT ANYTHING YOU DID DIFFERENTLY AS A RESULT OF RECEIVING THIS LITERATURE SEARCH. THANK YOU FOR YOUR CO-OPERATION PLEASE RETURN THIS FORM ELECTRONICALLY TO OR BY POST IN THE ENVELOPE PROVIDED 7 Appendix 2 Search Topics South Central SHA Libraries: sample of literature searches Mar 09 Clinical supervision in psychiatry law and mental capacity in learning difficulties DBT and suicide/self-harming adolescents benefits of pilgrimages feasibility of services for social and therapeutic horticulture for people with long term mental health problems/ supporting these people back into employment/social enterprises checking statistics on mental health Not given erectile dysfunctionas an independent predictor of vascular disease sorry I can't remember benefits of continuity of care health inequalities and the Credit crunch Skills/competences for commissioning Curriculum design in lifelong learning Moving and Handling/NHS claims/statistics Socioeconomic migration influence on mental illness with ethnic minorities Infection/isolation effects on patients Recovery principles applied to younger working adults/evidence effective with people with dementia Care of dying babies and their family Nurse led sexual health services Benchmarking against simlar PCTs Integrated care pathways for the discharge of difficult clients, including those with schizophrenia/borderline personality disorder/bipolar disorder chronic leg ulcers and silver impregnated dressings. Infection control and limiting visiting hours on the labour ward in the maternity unit Use of trendelenburg position with anaesthetised patients. Psychological impact pof Crohns disease on adolescents Using drilling to treat avascular necrosis of the talus Diabetic diet Management of pulmonary oedema - nursing aspects Bowel and constipation management in paraplegia….. teaching medical students geriatric medicine Anti VEGF agents in treatment of macular disease - not ARMD Conscious sedation in cardiac journals Integrated care pathways for the discharge of difficult clients, including those with schizophrenia/borderline personality disorder/bipolar disorder Knee or hip schools 2-4 weeks prior to surgery Is entonox an occupational hazard for midwives? 8 Overiding consent regarding parental involvement in adolescent mental health care ADHD and maternal substance abuse Use of traditional Chinese medicine as effective antibiotics against intestinal bacteria. 9