Brief Communication

Field: Health Professions (Health Sciences)

Clinical governance has brought with it more clearly defined responsibilities and opportunities to develop services that facilitate the delivery of better patient care.1 Libraries are clearly part of the infrastructure necessary to meet this drive for quality improvement and the post of Clinical Support Librarian at Forest Healthcare was established to demonstrate further the value information specialists can add. While the role of ‘clinical librarian’ is not new,2 what is new for Forest Healthcare is having an additional information professional with the time to develop what is, in part, an information brokerage service for busy health care providers. This paper provides an interim report on the work done so far. Forest Healthcare is a large NHS Trust which currently provides integrated services to people mainly from Waltham Forest, West Redbridge and East London. Non-medical staff have only been encouraged to use library services and facilities since the Outer London Education Consortium (OLEC) began to fund it in 1998. Electronic networking of library information via the Trust intranet began in the same year and was jointly funded by research, medical education, the library itself and OLEC and facilitated by the IM&T Department. The network provides direct access from 12 acute clinical areas to key databases and textbooks including: Cochrane Library, medline, cinahl, hmic, bni and PsycLit. In the Spring of 1999 following the lead of Barnet Community NHS Trust and working alongside them, Forest Healthcare Trust started to look at how a clinical librarian might facilitate the use of the best available evidence wherever there is a clinical/service need. From the beginning Barnet and Forest had slightly different emphases but the same overall aim of contributing to the improvement of patient care. With the support and backing of the Library and Information Development Unit (LIDU), North Thames Deanery, they made successful bids under the MADEL ‘Blending Service with Training initiative’. Both Trusts were keen to build on existing work. They reviewed the work done in the Cairns Library in Oxford before making any decision about what might be possible locally.3 At Forest Healthcare we agreed that the job title would be Clinical Support Librarian (CSL) rather than a Clinical Librarian (CL) because we believed that this better described the role. The CSL was not going to be a member of any one clinical team but rather a resource for several. Six months on, the CSL is now an integral part of the Trust’s Library team and has taken on much of the search skills training sessions, both formal and informal. More importantly the promotional work formerly undertaken by the Trust Librarians has been extended and the Library service is being taken out to staff. The CSL is having to respond to clinicians’ needs and is working ‘on demand’ rather than in the more structured way that was originally planned. Considerable time has been spent setting up meetings with key managers across the disciplines in order to explain what can be done for them and their staff. Wherever possible training/mediation sessions have been provided wherever they are most suitable for the end user. Clinical staff have also been informed of what services are available to them by distributing posters with covering letters. Close links have been developed with Clinical Audit, Mental Health and with Community Nursing. The Clinical Audit Manager has invited the CSL to become part of the Trust’s 16 Clinical Improvement Groups. The Clinical Tutor for Mental Health has made the CSL an integral part of the evidence-based journal club, which is modelled on the CEBMH guidelines.4 The CSL is also a key presenter on the G Grade Community Nurse Development Programme. This provides grounding in management and issues relating to implementation of Clinical Governance. An hour slot has been assigned on the first day of the programme in order to introduce the role, outline areas of support available and discuss issues the group may have concerning access to information resources. This has provided an excellent opportunity to promote the role and library services and this information will hopefully be cascaded to other community staff within the teams. The CSL has facilitated a searching/appraisal workshop on the multidisciplinary ‘Maintaining Life’ Clinical Governance Programme.5 The largest part of the CSL’s time is not spent on formal sessions or in meetings but in ad hoc work with clinicians. She endeavours to make such work mediated because it allows her to draw more fully on the clinical knowledge of her clients/users in shaping and evolving effective search strategies. It also enables the clients to use the searching session as an opportunity to learn how to search more sensitively across the full range of sources on the Intranet and if necessary key sources on the Internet.6 To date the feedback on these sessions has been very positive and it appears that clinicians are increasingly using the service because a colleague has recommended it to them. It is important to point out that quite often clinicians are requesting that the CSL do a search and highlight key papers without them being present. This is more difficult but has been made slightly easier by modifications to the existing literature request form. Methodological filters7 and evidence-based checklists8 are used where appropriate. All literature searches undertaken are recorded and an evaluation form is sent out 3 weeks after the search results have been completed. The form assesses: how appropriate results were to the original request, whether users have obtained full text of any papers, if they were aware of the literature service before the CSL was in post, and whether they will use the service again. It is clear that without the support services provided by the Trust’s Library team, the CSL would not be able to obtain the full text of the papers identified. While the team’s workload may have increased, much of the burden of search skills training has been taken away from them. As well as being part of and needing this team the CSL is also part of the wider OLEC Librarians Group and the LIDU/North Thames Deanery Group. For the OLEC group, she has facilitated a skills sharing session and she also contributes to the North Thames Deanery wide ‘outreach’ librarians group. Both of these groups provide the opportunity for valuable professional liaison, as do links with the Barnet Clinical Librarians and a similar project carried out at Leicester General Hospital.9 In the next year the CSL plans to encourage and support networked library information services and she will be involved in a pilot that extends services to primary care and the community. Although not yet backed up by hard evidence from research, indications so far show that the value of the CSL role at Forest Healthcare Trust is in being able to actively promote services, taking training out to the clinical area when appropriate and being able to facilitate access to high quality evidence. In doing this the CSL is clearly reaching staff who previously might have had to leave their clinical questions unanswered (A. Weist, Unpublished Library Project Report for OLEC). Over the coming months an MSc student from City University will be working closely with the CSL and Trust Librarians to analyse responses and develop other areas for evaluation to allow comparison between users and non-users of the service. We envisage that this piece of work will enable us to ensure that the CSL continues to respond to the needs of our local health care providers. It will also give us a more objective measure of the perceived value of the CSL.