Maidstone and Tunbridge Wells NHS Trust

Clinicians Value UpToDate® for Evidence-Based Care at Maidstone and Tunbridge Wells NHS Trust

The Trust currently works from two main clinical sites: Maidstone Hospital and Tunbridge Wells Hospital at Pembury. In addition, the Trust provides specialist cancer services through its flagship cancer centre at Maidstone and a unit at Kent & Canterbury Hospital. Combined, these facilities employ approximately 4,750 full-time equivalent staff.

MTW strives to rank nationally in the top 20% of Trusts based on quality of service. The Trust is at the forefront of developments in minimally invasive laparoscopic surgery in the NHS and is increasing the range of other highly specialised services available locally to patients, including centres of expertise in trauma, maternity, paediatrics, orthopaedics, and planned complex surgery.

In 2011, the Trust participated in a regional three-month trial of UpToDate — an electronic clinical decision support resource. The responses from physicians and other clinicians were extremely positive, reports Rebecca England, Site Manager: E-Resources with MTW's Library and Knowledge Services team. "Clinicians found UpToDate to be intuitive and easy to use, and they valued instant access to evidence- based information, particularly when diagnosing and treating unusual cases or rare conditions," said Ms. England. "The online solution clearly helped to support our objective to always put the patient first."

The Trust elected to adopt UpToDate and has made it available on every workstation at both of the Trust's hospitals. Clinicians quickly embraced the point-of-care resource, which is available from the intranet's home page. In 2013, clinician use of UpToDate — as measured by the number of topics reviewed, patient education materials accessed, medical calculators used, and medical graphics and images viewed — grew by 42% over 2012.

Survey: 96% of Respondents Would Recommend UpToDate to Colleagues

The Library and Knowledge Services Team developed a brief survey to ensure that UpToDate was having a positive impact on patient care and was providing value equivalent to the investment. The team promoted the survey via email and blog posts, generating 84 responses.

"Results from the survey indicated that clinicians are clearly using UpToDate at the point of care and that it is a highly valued resource," said Ms. England. "We were pleased with the positive results and the many real-life examples of how UpToDate is helping clinicians. They provided a wealth of information, which helps to prove this resource is instrumental in providing excellent patient care."

One clinician noted, "It is invaluable to have an authoritative resource that enables us to read up on a condition at the point of care." Another remarked, "UpToDate is reliable and clinically accurate at the point of care and gives really useful information when faced with a clinical problem. There is nothing else anywhere near this good besides taking the consultant to the bedside with you!"

In addition to providing anecdotal feedback, the survey responses also validated UpToDate's impact on patient care. Respondents confirmed:

Survey: UpToDate’s impact on patient care

Clinicians reported why they liked using UpToDate by selecting one or more responses. The highest-rated reasons were:

Survey: Highest-rated reasons clinicians like using UpToDate

In addition, 70% of clinicians reported they have applied UpToDate search results in clinical practice. When asked for examples, several clinicians offered specific clinical scenarios where they found UpToDate to be useful:

UpToDate is a time-saving resource for CPD
  • Management of Bell’s palsy
  • Treatment of mesenteric panniculitis
  • Indications for surgery in severe osteoporotic kyphosis
  • Treating for threadworm
  • Treatment of Whipple’s disease
  • Management of Lyme disease
  • Causes of neurological sequelae
  • Administration of folinic acid for methotrexate toxicity
  • Diagnosing a patient with thoracic aortic aneurysm
  • Treatment of Ehlers-Danlos syndrome

An Accredited Resource for Continuing Professional Development

In addition to using UpToDate at the point of care, Ms. England noted that Trust clinicians also find UpToDate to be a time-saving resource for continuing professional development (CPD). 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 current and qualified to practice. This revalidation process includes a self-directed learning component; clinicians must be able to demonstrate that they've been keeping up with the latest medical research.

When clinicians research a clinical question, UpToDate tracks the search activity and the time spent reading topics. Clinical staff can also make notes for future reference about specific articles and how they were used in patient care. UpToDate is accredited and recognised by colleges, associations, and authorities from around the world, and it provides evidence for clinicians of their ongoing study.

"UpToDate has become one of our clinicians' favorite resources for a variety of reasons," concluded Ms. England.

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1 Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med. 2011 Nov 16. doi: 10.1002/jhm.944.

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