Evidence searches for care of specific patients

Guidance for this type of search.

Notes

The suggested time to allocate to this type of search is 1.5 - 5 hours. 

Please read:

  • "All evidence searches" (see "Quick links") before proceeding
  • and the "Supplement" section for examples of this type of search

Planning

These searches should be prioritised.

If you receive the request during a clinical meeting where an immediate answer is required, you will not be able to plan your search.

Check Clinical Decision Support tools, depending on your organisation’s provision, and NICE Guidance for on-the-spot answers.:

  • BMJ Best Practice (now freely available to all NHS staff)
  • DynaMed (££)
  • UpToDate (££)
  • Visual DX (££)

If a specific/focused search of Clinical Decision Support Tools retrieves nothing, try searching within the text of broader entries or scanning a broader entry’s headings and sub-headings.

In addition, search high-tier evidence sources such as:

  • Cochrane Library
  • Cochrane Clinical Answers
  • Trip Database, etc.

If you cannot find an answer to the question immediately then advise the requester, offer to continue the search after the meeting, and follow the steps in “Execution” below.

If you receive the request outside of a clinical meeting, what is your deadline? If the search is to inform clinical decision-making, when does the decision need to be made and when is the search report required, by whom, and in what format?

If the requester needs to make a clinical decision in the next hour, that is your deadline!

In other contexts, it makes much more sense to negotiate your deadline with the requester based on when they are next seeing the patient: If they are next seeing them at an outpatient clinic in a month’s time, then a fortnight’s deadline should be fine, for example.

Check with the requester:

  • how recent the evidence should be?
  • do they want high tier evidence only?
  • would they like case studies/case series?
  • would they like results from this country only?
  • do they want to know how other Trusts would treat this patient?

Execution

Try searching guidance sources such as:

  • NICE Guidance
  • NICE Clinical Knowledge Summaries (CKS)
  • Trip Database.

Search high-tier evidence sources such as:

  • Cochrane Clinical Answers
  • PubMed Clinical Queries, etc.

Search bibliographic databases and preprint servers, limiting your search results to the specific age range etc. of the patient in question.

For clinical questions, depending on the topic, a search of at least one of the following databses is is essential and several of them, preferable:

  • Medline
  • Embase
  • CINAHL
  • Emcare
  • BNI etc.

Limit your databases search to reviews, guidelines, meta-analyses etc. using limits/filters (unless your requester would like case reports etc.), at least initially.

If your search retrieves nothing then relax these limits to include all kinds of results, and all kinds of patients if you are still retrieving nothing.

Be aware that these limits exclude the most recent results that have not had indexing terms added yet and consider searching within the past year without those limits.

Find our how other Trusts would treat this patient

If the requester wants to know how other Trusts would treat this patient, perform an advanced Google search for the condition/intervention limited to the UK. 

Limit by domain

Limit the search to sites ending with “…nhs.uk” URLs using the limits site:nhs.ukor  inurl:nhs.

Limit by file type

Limit with doctype:doc or doctype:pdf limits to pick up policy documents and guidelines from around the country.

See "Advanced Google" in "Quick links" within for more information. Search within the NHS England website too – it includes NHS Improvement’s content since their merger.

Consider an email to mailing lists where KLS colleagues at other Trusts may be able to help, see mailing list enquiries.

 

Results

Include links to relevant entries from Clinical Decision Support tools, copy and paste the most important parts that answer your requester’s question into your report, or send entire entries to the user (where copyright restrictions allow).

Include instructions of how to access the full entries - to save the requester time, you can check if they have an NHS OpenAthens name/password, and create one for them if required, notifying them in your report.

If you have found no high tier evidence then state so, as this may be an answer to your requester’s question itself.

Be sure to emphasise in your report or communications with the requester that time limitations may preclude a comprehensive search, and so the results returned cannot be considered comprehensive.

As proving your service’s clinical utility is very impactful, be extra sure to request and record feedback from the requester on how your search helped.