Transcript Slide 1

Bridging the Gap:
Knowledge and Information
Services Collaboration
Katherine Cheema, Quality Observatory, NHS South East Coast
Emma Aldrich, Maidstone & Tunbridge Wells NHS Trust
Who are we?
Katherine Cheema:
• Specialist Information Analyst at NHS South
East Coast Quality Observatory with interests in
healthcare associated infections, maternity and
neonates and long term conditions.
Emma Aldrich:
• Knowledge Manager, working within the Library
and Knowledge Team at Maidstone & Tunbridge
Wells NHS Trust with interests in rolling out
knowledge management tools across the trust
Problem…….
• Evidence
– The need for it……
– ….and the apparent lack of it
• Quantitative, numerical, driven by the
performance agenda
• Information for judgement!
• Issues with commissioner resources and skills
Case study
• MRSA trajectories
– Traditionally acute trust focussed
– But almost 50% cases acquired in the
community
– How can these cases be factored into PCO
focussed envelopes?
– On the basis of the information generally
available such an exercise would be very
difficult
….Solution
• Bring together the surveillance data and the
research evidence:
• Define an end point for community MRSA
which is
– realistic in terms of ability for organisations
to achieve
– representative of the research to date and
the surveillance information available
• So rather than ‘best guesses’ and an
assumption of a blanket reduction in CAMRSA across all organisations……
We have something more structured utilising all the
quantitative and qualitative knowledge we have available
at each stage of the model……..
ALL CASES
PRE 48-HOUR CASES (COMMUNITY
ACQUIRED)
Pre-48 hour cases
(Source: HPA DCS)
POST 48-HOUR CASES (TRUST ACQUIRED)
Post-48 hour avoidable
cases
(Source: Local
retrospective review)
Post-48 hour
unavoidable/complex
cases
(Source:Local
retrospective review)
DEFINED
%
REDUCTIO
N
FUTURE TRAJECTORIES
Sounds simple….?
Ask a Librarian…..
• 15 years experience of searching healthcare
databases
• Advanced searching skills, filters, subheading
searches
• Specificity, sensitivity
• Teaming clinical/ mathematical skills with
evidence seeking skills
The Process
Scoping the Project
Finding search terms
Databases and
Limits
Background Knowledge:
Meetings, emails
MeSH and .tw. searches for:
MRSA/ Staph Infections/ C-Diff
Healthcare/ Hospital/ Community
Associated/ Acquired infections
Cross infection/ nosocomial infections/
Disease transmission
Communicable/ Infectious diseases
Community Health Services/
Community Health Nursing/ Primary
healthcare/ Homecare Services
Databases:
Medline
Embase
Cinahl
BNI
HMIC
Health Business
Elite
Cochrane Library
SEC Dashboard,
Knowledge Matters
Websites:
National Resource for
Infection Control
DOH
HPA
NICE
NHS Library (general
searches)
Prevalence
Prevention & Control.fs.
Transmission.fs.
Limits:
English Language
The Process
• Results reviewed collaboratively
- Articles selected
- Searches refined and re-run
• Joint critical appraisal
• Literature review
Results
• Ability to develop a statistical model of
community acquired MRSA to predict incidence
using existing surveillance data sources and the
associated evidence base
• Interest from local health economies on utilising
findings for own improvement programmes and
strategies
• Development of recommendations with regards
definitions used in monitoring of community
acquired MRSA cases at a strategic level
MRSA PCO Objective 2010-2011: modelling options and
explorer
Select acute trust (a-z): Brighton And Hove City
trust:
Baseline data is all cases attributed to PCT responsible
population from October 2008 to September 2009.
Rates are measured per 100,000 head of resident
population.
All MRSA bacteraemia rate per 100,000 head of population
14
12
Selected trust MRSA objective details
& calculation method
Baseline rate:
6.235
10
Baseline cases:
8
16
Median status:
ABOVE
Best quartile
status:
ABOVE
Methodology applied: Reduce rate per
100,000 bed days to median or by 20%,
whichever is the greater challenge
6
4
2
0
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Trust (anon)
Rate
Median
Best quartile
MRSA objective (cases):
11
Reduction from baseline
required (cases):
5
Reduction where 20% rate
reduction applied (cases):
3
Proposed MRSA stretch limit
(cases):
9
What can we learn? Personal
reflections…
• Greater understanding of what each function
does – broadening knowledge of where NHS
staff can go for information
• Process different for LKS professional – greater
involvement than usual in results/ follow up:
seeing it through to the end
• Discovery of how much more ‘information’ there
is out there, and that there are people with the
expertise to search, review and collate it
What can we learn? Implications for the
wider NHS…
• This project – A meeting and discussion
between two regional leads which evolved into a
unique collaboration.
• The collaborative approach must continue to
underpin the commissioning and service
improvement processes and the promotion of
quality.
• Active marketing of library resources and staff
expertise, including outside of the acute sector
• A formal communication mechanism to be put in
place to ensure that these collaborative projects
can be undertaken easily in the future.
Any questions….?