These examples illustrate the contribution of our knowledge specialists. Each example saved weeks of work and, through their impact on local commissioning, has the potential to save tens of thousands of pounds. For more information on any of these, or to request your own knowledge search, please contact us on evidence@knowledge4commissioning.nhs.uk

Anticoagulation Monitoring Services

In-depth research for a medicines management team project looking at possible service improvement/re-design, with a view to tendering the service to a community provider

What we did: Performed detailed database and internet searches, checked NICE, NHS Evidence, Map of Medicine

What we found: A wide variety of guideline documents, UK and international models and service specifications, information about Clinical Decision Support Software and INR point of care testing

Impact: Knowledge gained informed the project analysis report, which concluded that it may be more efficient and cost-effective to continue using the exisiting current secondary care provider. Plans now in place to develop a high quality, robust and measurable business case and service specification

Is there any evidence outside the UK of improved patient outcomes in integrated care?

What we did: Database and internet searches, collated the evidence and signposted the best quality material

Impact: Gave a good insight into integrated care and was helpful in seeing how others had developed it

Best practice initiatives to reduce inappropriate GP referrals to acute neurological services

What we did: Searched for local examples in the UK, service specifications, referral guidelines; searched Map of Medicine; spoke to network contacts

What we found: Quite a lot of useful material; interestingly, more on neurology than other specialties

Impact: This was tied into a local recovery plan. It led to further work on the concept of GP direct access to CT head scanning and improvements to the local headache pathway

Why don’t 25-35 year-olds turn up for cervical screening?

Would incentives like massage improve attendance? What about screening on non-clinical sites?

What we did: A database search, checked NHS Evidence, searched the Cochrane Library

What we found: 22 research reports, from UK, Europe, N. America, Australasia, plus a recent Cochrane Review covering 38 trials

Conclusion: Effective and ineffective interventions identified

Impact: Changed local practice and should increase uptake

Can we give IV furosemide in primary care to heart failure patients?

Why? It reduces admissions, causes less disruption to patient’s lives, maximises their time at home

What we did: A database search, checked NHS Evidence, checked NICE, searched the internet

What we found: Quite a bit of research evidence, including 47 articles, 2 clinical protocols, 1 Cochrane Review, 1 NICE guideline

Conclusion: With appropriate support and patient monitoring, yes you can give IV furosemide in primary care

Impact: This is now happening in the Brighton & Hove area

Referral and treatment of chronic pain

Including best practice and guidelines from other organisations, both UK and international. Particularly interested in spinal epidural or spinal cord stimulation. Also wanted examples of patient feedback survey tools

What we did: Searched research journals for material on spinal anaesthesia; searched contacts, networks and the internet for guidelines; used contacts and networks to identify relevant survey tools

What we found: NICE guidance, useful examples of localised referral guidelines

Impact: Informed local guidelines. This work is still in process, a routine patient feedback survey will form part of the service


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