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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 0 151 148 145 142 139 136 133 130 127 124 121 118 115 112 109 106 103 100 97 94 91 88 85 82 79 76 73 70 67 64 61 58 55 52 49 46 43 40 37 34 31 28 25 22 19 16 13 10 7 4 1 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….?