University Hospitals of Leicester NHS Trust

University Hospitals of Leicester NHS Trust Adopts UpToDate Anywhere for Quick Access to Trusted, Evidence-based Clinical Information at the Point of Care

Leicester NHS Trust

University Hospitals of Leicester, known locally as Leicester's Hospitals, is one of the largest and busiest National Health Service trusts in the United Kingdom. With nearly 12,000 staff treating more than one million patients per year, the Trust is comprised of three main hospital sites: Leicester Royal Infirmary, Leicester General Hospital, Glenfield Hospital, as well as a Children's Hospital. Leicester's Hospitals is nationally and internationally recognised as a top specialist treatment centre for cardio-respiratory diseases, cancer and renal disorders.

Leicester's Hospitals adopted UpToDate in 2012 to support the focus on quality, safety and innovation in patient care. Since that time, clinicians have come to rely on UpToDate for access to the latest medical information and evidence-based recommendations for screening and treating patients.

"Clinicians in our hospitals are passionate about UpToDate," said Sarah Sutton, clinical librarian at Leicester's Hospitals. "I'm well aware of the many studies about the benefits of UpToDate and the importance of evidence-based medicine. But my high opinion of this resource really stems from the fact that all of the high-level clinicians I work with use UpToDate regularly and are so confident in it."

Sarah Sutton

"I'm well aware of the many studies about the benefits of UpToDate and the importance of evidence-based medicine. But my high opinion of this resource really stems from the fact that all of the high-level clinicians I work with use UpToDate regularly and are so confident in it."

— Sarah Sutton, Clinical Librarian University Hospitals of Leicester NHS Trust Leicester, UK

Dr. Steve Jackson, consultant physician, Diabetes and Endocrinology, is one such clinician. "UpToDate is an extremely useful tool to access before my clinic or on my ward rounds to help ensure that I am giving the safest and most efficient care to my patients," he said. "I find that it is particularly useful in guiding my decision-making when I am requesting investigations to confirm or refute my working diagnosis in that invariably fewer, and therefore cheaper, investigations are required than the number I would have otherwise requested."

Ms. Sutton added, "Studies have shown there are very real cost savings and social benefits to organisations and their patients when clinicians consistently use UpToDate in their practices."

Dr. Jackson also takes advantage of UpToDate's Patient Information content, comprising nearly 1,500 articles, which clinicians can review with patients. "I go through it with patients and then either print a copy or email it to them to consult at their leisure after the consultation. This helps to give me confidence that they understand what is expected during the natural course of their treatment."

To further expand use of this trusted clinical decision support resource, Leicester's Hospitals adopted UpToDate Anywhere to give clinicians access via an award-winning mobile app. With UpToDate Anywhere, physicians can find evidence-based answers to their clinical questions using tablets or smartphones when working on the go.

Steve Jackson

"UpToDate is an extremely useful tool to access before my clinic or on my ward rounds to help ensure that I am giving the safest and most efficient care to my patients."

— Steve Jackson, MD Consultant Physician Diabetes and Endocrinology University Hospitals of Leicester NHS Trust Leicester, UK

When UpToDate Anywhere became available, all the clinicians began clamouring for it, reported Ms. Sutton. "Mobile technology on our wards has really taken off, so our clinicians were very anxious to have this resource available in a mobile format."

Leicester's Hospitals also are implementing UpToDate as one element in "Nerve Centre," a new mobile project to streamline communications at shift changes. Nerve Centre serves as a mobile handover note system, enabling clinicians to easily capture and track important patient status updates via mobile technology. Devices featuring Nerve Centre also are loaded with UpToDate and the mobile edition of the British National Formulary, a reference that contains a wealth of information on the pharmaceuticals available under the NHS. With this arsenal of material on tablets and smartphones, clinicians will be able to get up to speed rapidly on a patient's current status and make more effective care decisions. As a next step in the drive to become paperless, the Trust is evaluating electronic patient record systems, and hopes to integrate the new system with UpToDate to inform point-of-care decisions.

Validating the Role of UpToDate in Improving Patient Safety

In its continuing effort to improve patient safety, Leicester's Hospitals also used UpToDate as a clinical resource in a study to reduce prescribing errors among junior doctors. The study, Effective Prescribing Insight for the Future (ePIFFany), was conducted as a partnership between the University of Leicester, University Hospitals of Leicester NHS Trust and Health Education East Midlands.

The study used a blend of computer-based learning and face-to-face teaching to reduce clinical errors and to improve the knowledge, skills and prescribing performance of junior doctors. UpToDate was used in the study for supporting junior doctors' access to evidence-based clinical information as well as real-time diagnostic and treatment recommendations in the workplace. Junior doctors also had the opportunity to learn in a simulation centre where they could test out their skills in a safe environment before going on to the wards, prescribing for real patients.

"Early results of the study indicate that the multifaceted educational approach improves patient safety at Leicester's Hospitals," said Dr Rakesh Patel, NIHR Academic Clinical Lecturer in Medical Education/Honorary Specialist Registrar in Nephrology and Lead Investigator of the ePIFFany study. "We observed a 50% decrease in medication errors made by the junior doctors who took part in the study, versus the control group, and no serious errors were made at all. The ePIFFany approach has the potential to save lives and money.

Rakesh Patel

"There are a number of clinical questions where there is no ‘textbook' answer, whereas reviewing evidence-based recommendations in response to these ‘real-life' questions provides an ‘UpToDate' answer."

— Rakesh Patel, MD Consultant Physician NIHR Academic Clinical Lecturer in Medical Education/Honorary Specialist Registrar in Nephrology and Lead Investigator of the ePIFFany study

UpToDate: A Key Resource for Training and Continuing Professional Development

Beyond the use of UpToDate at the point of care, Leicester's Hospitals has found UpToDate to be an effective, time-saving asset for on-the-job training and continuing professional development (CPD) for clinicians.

Leicester's Hospitals partner with the University of Leicester and De Montfort University to provide world-class training for the next generation of doctors, nurses and other healthcare professionals. UpToDate has proven to be a highly valued resource for these young clinicians.

Dr. Patel finds UpToDate to be a helpful tool to drive discussion between colleagues about areas of uncertainty in clinical practice. "There are a number of clinical questions where there is no ‘textbook' answer," he said, "whereas reviewing evidence-based recommendations in response to these ‘real-life' questions provides an ‘UpToDate' answer. Role-modelling how to manage that uncertainty to trainees at the point of care is really important for teaching them how to provide safe care to patients."

Day-to-day research using UpToDate at the point of care also contributes significantly to the continuing professional development process for senior physicians. In 2012, the United Kingdom's General Medical Council introduced a new revalidation scheme, requiring physicians to demonstrate on a regular basis that they are up to date and qualified to practice. This revalidation process includes a self-directed learning component; clinicians must be able to demonstrate that they've been keeping current with the latest medical research.

"For revalidation, physicians must provide evidence of their ongoing study," said Ms. Sutton. "UpToDate tracks the articles clinicians have read in the course of their practice, and enables clinical staff to make notes about particular articles and how they have influenced patient care. Reviewing this information helps doctors retain what they have learned when accessing UpToDate and provides a pain-free CPD tracking mechanism."

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