A project that is seeking to deliver a digital health solution, no matter how modern, innovative, or futuristic that solution may be, must start with a strong evidence base. A project such as the CAREPATH work programme, to develop consensus clinical guidelines for elderly patients with dementia and co-morbidities, a project that intends to be replicable in future work, must have strong foundations and good processes.

Health Education England (HEE) commissioned the report Library and Knowledge Services Value Proposition: The Gift of Time [i]. The key message was that NHS Library and Knowledge Services take the ‘heavy lifting’ out of getting evidence into practice and provide the ‘gift of time’ to healthcare professionals by providing them with accurate, recent, and appropriate evidence for their work and requirements.

Ensuring a Library and Knowledge Services professional (hereon referred to as ‘clinical librarian’) as a team member and coauthor rather than just a coauthor with no other input to the project, produces systematic reviews with reproducible searches and higher scoring literature searching components [ii]. Further it has been shown that clinical librarian involvement in developing search strategies results in better and broader search methods. An issue is that the involvement of clinical librarians in systematic reviews and other healthcare research projects are often under-reported, so their positive impact is not widely recognised [iii]. Robust and reproducible searches are critically important in the development of consensus clinical guidelines where there is an explicit intent to use the processes from creating one consensus guideline to develop others.

For the systematic review of literature that was used as the evidence base for the consensus clinical guideline part of the CAREPATH project, a clinical librarian was involved in the development of the search terms and strategy. The clinical team working on the CAREPATH project realised that the use of clinical librarians could enhance the work and lead to better outcomes for this part of the project. A clinical librarian was enmeshed with the team to inform all relevant aspects of the work.

The lead group in this section of the CAREPATH work was the team at University Hospitals Coventry and Warwickshire NHS Trust (UHCW). Within that NHS Trust they have a Clinical Evidence Based Information Service, an integral part of the wider Library and Knowledge Service, that provides expert support in searching, retrieval and critical appraisal of clinical evidence. The presence of this team and their use had a significant positive impact on the outcome of this piece of work.

The clinical librarian worked closely with the clinical team to undertake tasks such as deduplication and screening of the initial systematic review results, supporting decision making in inclusion and exclusion criteria for the screening, and use of suitable scoring tools for the selected articles. The clinical librarian and a clinician screened the clinical guidelines drawn from the systematic review and reduced the number of inclusions from 170 to 52. Having a non-clinical and clinical professional screening the articles meant that each was looking at the guidelines from a different viewpoint, but the two agreed on most inclusions or exclusions. Confidence that the correct guidelines retained for review at the end of the screening process was high.

It was decided to use the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to score the 52 clinical guidelines selected after the screening process. A clinical member of staff and the clinical librarian worked together to provide training and ongoing support for the clinical staff in using the AGREE II instrument. It was a truly collaborative process.

Having a named clinical librarian as a contact point for the dispersed and disparate clinical members of the working group allowed them to feel supported in undertaking tasks that some members were not familiar with, for example using the AGREE II tool for scoring clinical guidelines. The clinical members reported that they were able to approach these tasks with more confidence because of that support. The clinical librarian was able to observe trends in learning needs or other support issues as they arose and develop individual, or group interventions as required.

The clinical librarian also ensured that the process remained robust and reproducible such as the development and implementation of the modified Delphi approach. It was demonstrated during this project that having a clinical librarian as a team member involved in the whole process adds value to the project. This project is a clear demonstration of the HEE Value Proposition in action as clinical librarians and clinicians worked together to use the best quality evidence to produce a high-quality end product.