Best practice: Setting up a service that enables consultants, junior doctors, nursing and allied health staff to put research evidence into practice.

Who did it: Jacqui LeMay, Anna Brown, Aislinn Conway, Mandeep Heer, Paul Martin from the Library & Knowledge Services, University Hospitals of Coventry and Warwickshire NHS Trust

In 2009, we succeeded in obtaining trust approval to create what we have called a Clinical Evidence Based Information Service (CEBIS).

CEBIS aims to promote, educate and facilitate the use of research evidence in practice.

This service was based on a pilot “clinical librarian service” that ran from 2004-2009. On the back of this, three CEBIS specialists were recruited in 2010.

As an integral part of the clinical team, the CEBIS specialist provides a ranked summary of available evidence in response to questions raised.

She then jointly works with a junior doctor/s to produce a critique of the evidence for open discussion and decision making within the specialty’s evidence in practice group (EPG). 

CEBIS aimed to:

•  improve information literacy, resource awareness and critical appraisal skills
• enable evidence-based decision making for quality patient care in a timely and effective manner
• provide an archive of evidence summaries and presentations for reference and education

Core CEBIS stakeholders, those with a responsibility to participate in CEBIS work include: consultants, junior doctors, nursing and allied health staff.

Other stakeholders may include students on placement, corporate employees, internal or external experts or nominated persons.

The short term impact has been the implementation of the CEBIS model within the trust with a number of specialties having adopted CEBIS as an integral part of their working practice.

Evidence summaries, and particularly EPGs have resulted in changes to practice and cost savings within the trust. 

Feedback has been extremely positive.  The need to improve information literacy has been highlighted.

As a result, we have initiated a small pilot CEBIS mentorship programme for foundation year 2 doctors to be evaluated at the end of the year.

In the longer term, a CEBIS system is being developed which will be available on the trust intranet.  This will be an operational tool and searchable interface for all the work produced by CEBIS.

It will also link to our hospital patient management system, enabling clinical staff to refer questions to CEBIS or view relevant evidence directly from the patient record.

This is an example of partnership and cooperation that has provided a model for education in evidence-based practice and the implementation of informed clinical decision making.

Some stakeholder comments:

• a novel and innovative way of integrating information acquisition and dissemination to the clinical team and patients in a busy clinical environment.
•  highlights the evidence in practice debate in relation to ‘poor evidence’ available on which to make clinical decisions.
• enables open and unbiased discussion in the development of ‘best practice’ in regards to clinical management.
• has given to support my service, to resolve challenging clinical cases utilising evidence based medicine approach and to improve clinical pathways reducing unnecessary clinical appointments and cost
•  I have found this as a valuable resource, not only for training junior doctors but also to make them aware of the wealth of resources and tools available, that would make a real improvement in patient care.

For further information about CEBIS contact Jacqui LeMay, Head of Knowledge Services, University Hospitals of Coventry and Warwickshire NHS Trust - jacqui.lemay@uhcw.nhs.uk