Subido por Joselyn M Sandoval A

Wildridge et al-2002-Health Information & Libraries Journal

Brief communication
Blackwell Science, Ltd
How CLIP became ECLIPSE: a mnemonic
to assist in searching for health policy/
management information
Brief communication
Valerie Wildridge* & Lucy Bell†, *Enquiry Services
Librarian, King’s Fund, †formerly Research
Librarian, King’s Fund Information and Library
Service, Cavendish Square, London, UK
Experience shows that a thorough reference
interview and a carefully thought out search
strategy more often than not result in an effective
search. Within evidence-based practice, clinicians
have developed a set of structured questions,
known as PICO ( patient and/or problem, intervention, comparison intervention, and clinical
outcomes1). This mnemonic is now commonly
used by health information professionals when
searching for the best current evidence. However,
the need for well-structured search strategies is
not restricted to clinical queries; health librarians
are also increasingly being called on to provide
management-related bibliographic references
which also require well-planned search strategies.
The problem is that the PICO formula is not
appropriate for this type of enquiry. This Brief
Communication suggests an alternative to PICO
as a framework to help when searching for health
and social care management information.
Clinical vs. health care terminology
In July 2000, a request for training in medical
terminology appeared on the lis-medical e-mail
list. Coincidentally, this followed a training session
Correspondence: Valerie Wildridge, Enquiry Services Librarian, King’s
Fund Information and Library Service, 11-13 Cavendish Square,
London W1G 0AN, UK. E-mail: [email protected]
on searching the HMIC database which was held
at a London Hospital. We concluded that this
call presented an ideal opportunity to develop our
own training session into a seminar on health and
social care management terminology. The aim was
to concentrate particularly on terms differing
from those in the clinical world. Unlike medical
terminology which, on the whole, is more stable,
health policy/management terminology is constantly changing and full of buzz words. It is also
often considered to be ‘softer’ than clinical
terminology. Searching for information using this
terminology requires a shift in approach. The
answers to the enquirer’s questions may not be as
rigorously scientific, quantitative or systematic as
those retrieved in clinical searches. While PICO
can assist to a certain extent, it will not cover the
full range of questions necessary to tease out all
the elements of a management- or policy-related
enquiry. We therefore looked for an alternative
aid and came up with the mnemonic CLIP in
an attempt to bring a systematic approach to a
potentially non-systematic topic.
What was CLIP?
The components of CLIP were:
• Client group—at whom is the service aimed? For
example, older people, black and ethnic minority
groups, people with a specific condition.
• Location—where is the service sited? Is it in
primary care, secondary care, across the entire
• Improvement or Information or Innovation—
what does your user want to find out? For
example, are they looking for a model of good
practice, how to improve a service, how a
service is organized?
• Professionals—who is involved in providing/
improving the service? For example, doctors,
nurses, lay people, social services.
© Blackwell Science Ltd 2002 Health Information and Libraries Journal, 19, pp.113–115
Brief communication
We recognized that, as with PICO and other
search strategies, not all of the elements in CLIP
would be relevant to every search; however, we
calculated that each should be considered at the
CLIP was introduced at the seminar run at
the King’s Fund in February 2001. This was
further developed both for a poster session, with
accompanying ‘giveaway’ postcards at the
Evidence-based Librarianship (EBL) conference
held in Sheffield, U.K., in September 2001,
and for a repeat of the terminology seminar
later that same month. On both occasions it
generated much interest and feedback from
the librarians attending these events indicated
that CLIP was useful in conceptualizing literature
In developing CLIP, we were concerned that
the ‘I’ component of the mnemonic did not work
as well as the other parts. This was because it held
three concepts within one, and was thus not easily
memorable. Originally, we had felt that it was
important to include the three words in one
concept and wanted to emphasize the need, when
formulating a search, to consider the different
purposes for which the information might be
used. Depending on which of the ‘I’s relate to
the question, the structure of the search would
be different. A colleague, on being asked to
provide feedback on CLIP, reinforced our
reservations on the ‘I’ component. He also made
some other useful suggestions which helped us
remodel our mnemonic and so, CLIP evolved
the idea of a service would always be somewhere
in the background; it did not need to be spelled
out. With hindsight we have realized that it is
helpful to reiterate that a particular service is
involved. For some searches this will be essential.
The model now reads:
• Expectation—what does the search requester
want the information for (the original ‘I’s)?
• Client Group.
• Location.
• Impact—what is the change in the service, if any,
which is being looked for? What would constitute
success? How is this being measured?
• Professionals.
• Service—for which service are you looking for
information? For example, outpatient services,
nurse-led clinics, intermediate care.
Original query
The original Client Group, Location and Professionals elements of CLIP were retained in the
new tool, ECLIPSE. An ‘E’ for Expectation was
then placed at the beginning to encapsulate the
essential ideas of ‘Improvement’, ‘Innovation’
or ‘Information’. The ‘I’ was changed to represent
‘Impact’ and ‘SErvice’ was added at the end.
‘Impact’ can be seen as similar to ‘outcomes’
in the PICO model. The ‘SErvice’ part of ECLIPSE
draws out something which we had hoped was underlying every management or policy search. In the
original version of the tool, we had assumed that
What have you got on rehabilitation?
ECLIPSE in action
How does ECLIPSE work in practice? What an
enquirer claims to want isn’t always necessarily
what he or she in fact needs. This is no different
for the enquirers contacting the King’s Fund
Library. A typical question we receive might be
‘What have you got on rehabilitation?’ An
immediate and simplistic response might be:
‘several hundred references’ (!). Using ECLIPSE
both as part of the reference interview and in
the formulation of the search strategy, the hits
for this question can be whittled down. The
enquirer may then receive a more manageable
number of references that closely meet his or
her needs.
Expectation. I’m looking to improve the discharge procedure from the hospital to the community where rehabilitation will continue. What
have other people done?
Client group. People with head injuries.
Location. Community.
© Blackwell Science Ltd 2002 Health Information and Libraries Journal, 19, pp.113– 115
Brief communication
Impact. Improved continuity of care; patient
satisfaction increased; greater sense of
communication between professionals.
Professionals. Hospital nurses, community staff,
social services.
Service. Community rehabilitation service.
Actual query
There is a lack of continuity of care in my area for
people with head injuries who are discharged from
hospital to the community rehabilitation service.
I would like to improve the discharge procedure to
avoid this problem. The service involves both
community health staff and social services. Has
anyone else experienced similar problems and how
have they overcome them?
the end of the same year, had further developed
the tecnhnique into ECLIPSE. Since its inception,
our use of CLIP/ECLIPSE has focused our minds
more systematically on our reference interview
questions. It has also been of great benefit when
training new staff.
It is our hope that the wider health information
community will also find it a useful model when
searching for health and social care management
information. It is important that it continues to
evolve and perhaps, like PICO, comes into everyday use. We welcome all feedback on its usefulness
in order to make certain that it meets the needs of
fellow health information professionals.
We would like to thank Andrew Booth for his
suggestions and encouragement in developing the
ECLIPSE model.
ECLIPSE in the future
Use of the mnemonic CLIP as a search aid evolved
from the use of certain questions which we, as
experienced health policy librarians, found we
automatically asked in a reference interview. We
started using it at the beginning of 2001 and by
1 Sackett, D. L., Straus, S. E. Richardson, W. S., Rosenberg,
W. M. & Haynes, R. B. Evidence-Based Medicine: How to
Practice and Teach EBM. 2nd edn. London: Churchill
Livingstone, 2000.
© Blackwell Science Ltd 2002 Health Information and Libraries Journal, 19, pp.113–115