POC tool improves efficiency of care

The increasing use of smart devices in the healthcare environment is requiring many health libraries to look more closely at how they provide information, and to offer more flexible access to medical information. Indeed, many health libraries are reporting that loans of printed material are in decline, while the use of electronic books and journals is increasing.1 An increasing number of NHS organisations are considering the use of online evidence-based information solutions. One such offering comes from Wolters Kluwer Health in the form of UpToDate. Dr Denise Basow, president and editor-in-chief of UpToDate comments on the benefits that a point-of-care evidence-based tool can offer: “One of the main benefits of having a continuously updated information resource is that experts are willing to make recommendations,” she said. “Within the pages of a textbook they may be willing to summarise the literature, but very few are willing to make recommendations on how to care for patients because by the time the textbook is published their recommendations are likely to be outdated. “The concept behind UpToDate has always been that we systematically review the literature. We ask our authors, all experts in their field, to present what they think is the best literature. We also have a group of around 50 in-house physician editors, all of whom are trained in clinical epidemiology and evidence-based medicine. When we receive information from an expert it goes through a very thorough and lengthy review by the inhouse editorial staff who check the evidence to make sure that the best literature is available to answer a particular question.

 Peer review process

“We also have a separate peer-review process which provides a third-layer of review. This ensures that any published information will have at least three levels of review, often more, depending on the topic. “We too, have a very robust feedback mechanism so if a physician cannot find the answer to a question they can give us feedback. A lot of the content that we add to the programme comes from this subscriber feedback.” Many on-line information solutions will synthesise information from a variety of sources, bringing together standard textbook information with summaries of the findings of the latest research. UpToDate consists of a search engine that allows subscribers to search through 20 clinical specialty areas, bringing up a list of potential topics that may match the query. Users select a topic and can then read the summary text to give a quick answer to a question – if a broader evidence-base is required it is also possible to drill deeper into the topic. This allows clinicians to either use the tool quickly, at the point-of-care, and/or to spend more time reading the literature that supports the initial recommendations. Explaining how and why one Trust chose to use the UpToDate system, John Addison, library manager at the Pennine Acute Hospitals NHS Trust, said: “We first started looking at a variety of online clinical decision support systems in 2010. Although we had been happy with our existing electronic clinical resources, our major supplier of journals made the decision to remove from sale the bundle that we had always used, which included information from around 500 titles. For what we paid for the bundle we would only have been able to purchase around 50 individual titles. This was why we started to look around to see if there was anything else available that might offer us better value for money.” One of the solutions the Trust looked at was UpToDate. “We contacted the company and were offered a free twomonth trial,” said John Addison. With ever tighter budgets, librarians need to be able to demonstrate value for money from the resources they purchase today. “To make sure that we had enough evidence from the doctors at the Trust to justify purchasing the system we created a survey for doctors to fill in after using the system.” At the same time the Trust was contacted by two other on-line information suppliers, who also agreed to a free two-month trial. “We made the decision to run these trials consecutively. After each trial we asked doctors to complete the same survey questions and compared the answers,” said John Addison. “Without doubt the results were overwhelmingly in favour of UpToDate.” Where the system scored particularly well was its ease and smoothness of searching and presentation. The fact that it also contains a huge number of topics also helped. “Users told us that with UpToDate the information could be found much more quickly than with the other systems trialled,” said John Addison.