Elective care pathway analyser for referral to treatment

Elective care pathway analyser for referral to treatment
NHS Improvement 16 July 2018 updated 10 April 2019

• A tool to help you identify the main reasons for delays in referral to treatment and help operational teams to focus on interventions that will have the biggest impact on reducing waiting times.

‘Top Tips’ for Reconfiguring Vascular Services

‘Top Tips’ for Reconfiguring Vascular Services
Vascular Society of Great Britain and Ireland July 2018

• These ‘top tips’ are aimed at anyone, and everyone, involved in the reconfiguration of local vascular services to produce a united network of partner hospitals.

Early and locally advanced breast cancer: diagnosis and management - NICE guideline

Early and locally advanced breast cancer: diagnosis and management [NG101]
NICE guideline July 2018

• This guideline covers diagnosing and managing early and locally advanced breast cancer.

Patient and Public Voice assurance group for Specialised Commissioning

Patient and Public Voice assurance group for Specialised Commissioning terms of reference
NHS England 30 July 2018

• These terms of reference outlines the roles and responsibilities of members of the Patient and Public Voice Assurance Group (PPV AG), as well as information about accountability, governance and voting arrangements.

Outpatient video consultations are feasible but challenging for the NHS

Outpatient video consultations are feasible but challenging for the NHS
NIHR Signal 24 July 2018

• Analysis of a high-quality implementation study (1) examining the benefits and challenges of outpatient video consultation in three services: diabetes, antenatal diabetes and in follow-up after cancer surgery in a large NHS trust. 
• The study concluded that ad hoc Skype appointments seemed valuable to help people manage their diabetes and avoided the need to travel for people recovering from pancreatic cancer surgery. However, only a minority of out-patient appointments were thought clinically appropriate or practical to be conducted via video.

(1) Greenhalgh T, Shaw S, Wherton J, et al. Real-world implementation of video outpatient consultations at macro, meso, and micro levels: mixed-method study. J Med Internet Res. 2018;20(4):e150.

Direct tests for liver disease

What is the most accurate and cost-effective direct test (ELF test™, hyaluronic acid, P3NP, Fibroscan® or ARFI elastography) for detecting and staging liver fibrosis and/or cirrhosis in patients with diagnosed or suspected non-alcoholic fatty liver disease, alcohol-related liver disease, or viral hepatitis?
Healthcare Improvement Scotland, SHTG team, 23 July 2018

• Performance of the ELF test™, hyaluronic acid, P3NP , Fibroscan® and ARFI elastography for the detection and staging of liver fibrosis and cirrhosis in a secondary or tertiary care setting.
• Advice statement available here.

Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer

Impact of straight to test pathways on time to diagnosis in oesophageal and gastric cancer
BMJ Open Qual 2018;7:e000328. 21 July 2018

• A trial using a straight to test pathway (STTP) for suspected oesophageal/gastric cancer saved a mean of 7 days from referral to treatment (with a 95% CI of 3 to 11 days, p<0.008) and a mean of 16 days from referral to diagnosis, when compared with a traditional referral pathway. The number of diagnostic tests performed using STTP or traditional referral pathways were similar.
• Study: Six hospital trusts across  the East Midlands Clinical Network. 340 patients followed the STTP pathway and 495 followed the traditional route.

Abstract

CQC Radiology review

Radiology review: A national review of radiology reporting within the NHS in England 

CQC 19 July 2018

• A CQC review of NHS radiology services in England 2016-17 found
• The timescales for reporting on radiology examinations, and arrangements for monitoring and managing backlogs, vary widely between trusts.
• There are few national standards that trusts can benchmark themselves against. 
• Even trusts that were monitoring their performance did not always report on time.
• Issues with staffing, including an average vacancy rate of 14% across trusts that responded. This supports existing evidence about the national difficulties in recruiting and retaining radiologists.

Developing criteria-led discharge in an oncology setting

Developing criteria-led discharge in an oncology setting
NHS Improvement 26 June 2018

• The oncology clinical service at Leeds Teaching Hospitals Trust developed and trialled a criteria-led discharge tool to allow senior medical teams to set individual criteria for both elective and non-elective oncology patients.

Sensory Rooms for Pediatric Patients with Neurocognitive Disorders

Sensory Rooms for Pediatric Patients with Neurocognitive Disorders: Clinical Effectiveness and Guidelines
Canadian Agency for Drugs and Technologies in Health, 12 June 2018

• No literature was identified regarding the clinical effectiveness of sensory rooms for paediatric patients with neurocognitive disorders. Additionally, no evidence-based guidelines were identified regarding the use of sensory rooms or environments for paediatric patients with neurocognitive disorders.

Urology: GIRFT Programme National Specialty Report

Urology: GIRFT Programme National Specialty Report
GIRFT 10 July 2018

• The GIRFT programme has examined in detail the way that urology is currently provided in England based on 134 visits to NHS trusts in England that provide urology services. It examined overall departmental workload and organisation, approaches to common conditions and performance against a range of indicators. 
• The report sets out 18 recommendations to improve the way urology services are provided in the NHS in England including changes to service configuration within trusts, changes to staffing arrangements – extending the role of specialist nurses and asking consultants to focus more on emergency care – and a greater emphasis on networking between urology departments.

Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis.

Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis.
BMJ Open. 2018 Jul 11;8(7):e021784. doi: 10.1136/bmjopen-2018-021784

• A meta-analysis (70 studies) of the association between different comorbid conditions on safety (short-term outcomes) and effectiveness (long-term outcomes) in patients undergoing hip and knee replacement surgery.  
• Twelve studies reported on the likelihood of revision surgery in patients with comorbid conditions. Overall, revision surgery tended to be more likely in patients with comorbid conditions (6 out of 11) but the evidence remains weak. The pooled OR ranged from 1.11 (95% CI 1.02 to 1.21) for patients with high blood pressure to 1.96 (95% CI 1.16 to 3.30) for patients with liver disease. No studies reported the risk of revision surgery in patients with poor circulation or stroke.

Abstract

Improving care for people with MS: the potential of data and technology

Improving care for people with MS: the potential of data and technology
Nuffield Trust 10 July 2018

• An MS Society-commissioned report mapping out what technology is already available for people with MS, what more could be done with what is available and how data and technology could be better exploited in future to improve MS health care.
• The report examines four key areas in the lives and care of people with MS where the potential of data and technology could be harnessed to make a significant difference:
• Helping people with MS take more control of their care
• Accessible and coordinated care
• Improving access to the right treatments at the right time
• Using data to better meet patient needs

Specialised commissioning prioritisation results – June 2018

Specialised commissioning prioritisation results – June 2018
NHS England 7 July 2018

• Treatments approved through NHS England’s latest specialised commissioning prioritisation.
• Treatments are grouped into five levels of priority, with those that cost less and offer more clinical benefit for patients relative to the other treatments being considered classified as level one, and treatments with the lowest relative clinical benefit and highest cost placed in the lowest category (level five).

Level 1:

Teriparatide for osteoporosis in men
Level 2:
Anakinra and tocilizumab for adult onset stills disease
Anakinra for autoinflammatory
Keraprosthesis for corneal blindness
Left Atrial Appendage Occlusion for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults)
Susoctocog alfa for acquired haemophilia A
Level 3:
Bendamustine with rituximab for first line treatment of advanced indolent non-hodgkins lymphoma
Bendamustine with rituximab for the treatment of relapsed mantle cell lymphoma
Selective dorsal rhizotomy
Lomitapide for homozygous familial hypercholesterolemia
Total pancreatectomy with islet transplantation for chronic pancreatitis
Level 4:
Human coagulation factor X for hereditary factor X deficiency
Selexipag for pulmonary arterial hypertension
Level 5:
Everolimus for refractory seizures associated with tuberous sclerosis complex

The following treatments and services will also be routinely commissioned with immediate effect:
Emicizumab as prophylaxis in people with congenital haemophilia A with factor VIII inhibitors.
Bendamustine with rituximab for first line treatment of mantle cell lymphoma in adults.
Service specification DNA nucleotide excision repair disorders services.

Specialised commissioning prioritisation results – June 2018

Specialised commissioning prioritisation results – June 2018
NHS England 7 July 2018

• A list of the latest innovative new treatments approved by NHS England. Non drug innovations include:
• Left Atrial Appendage Occlusion for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults)
• Selective dorsal rhizotomy
• Total pancreatectomy with islet transplantation for chronic pancreatitis

National Competency Framework for Registered Practitioners: Level 1 Patients and Enhanced Care Areas

National Competency Framework for Registered Practitioners: Level 1 Patients and Enhanced Care areas
Faculty of Intensive Care Medicine, Enhanced Care Working Party, 7 July 2018

• The latest evidence based competencies for registered practitioners working in enhanced care areas and with Level 1 patients on general wards.

The incremental predictive value of frailty measures in elderly patients undergoing cardiac surgery: A systematic review.

The incremental predictive value of frailty measures in elderly patients undergoing cardiac surgery: A systematic review.
Clin Cardiol. 5 Jul 2018,  doi: 10.1002/clc.23021

• Analysis of 12 studies concludes that addition of frailty measures to existing preioperative risk models improved the prediction performance for mortality, but the incorporation of frailty assessment into the perioperative risk assessment needs further evidence before making health policy recommendations.

Abstract

Developing the NHS long term plan: evidence based interventions

Developing the NHS long term plan: evidence based interventions
NHS England Board paper, 4 July 2018

• NHS England has begum a consultation on the Evidence-Based Interventions programme which will limit the use of a 17 surgical interventions commissioned by CCGs.
• The consultation proposes that four interventions should no longer be routinely commissioned by CCGs unless accompanied by a successful Individual Funding Request (IFR) and 13 interventions should only be performed when specific evidence based clinical criteria are met. It is proposed that Category 1 interventions will be set at zero tariff in National Tariff without a successful IFR.
• Proposals also suggest that changes in the NHS Standard Contract will require commissioners and providers to comply and enable commissioners to withhold payment.
• This is Phase 1 of the programme which will test the approach and implementation.
• See the consultation document (paper 4b) for details. 
• Phase 2 will be launched in early 2019 and will consult on further interventions and will also include specialised services which are commissioned by NHS England.

Can nurse specialist working practices reduce the burdens of lung cancer?

Can nurse specialist working practices reduce the burdens of lung cancer?
University of Nottingham, 4 July 2018

• A new study has found that patients with lung cancer experience significantly better outcomes in terms of life expectancy, avoiding unnecessary hospital admissions and managing the effects of treatment when cared for by specialist lung cancer nurses.
• The research was based on anonymised patient healthcare records available from PHE and a nationwide survey of lung cancer nurse specialists (LCNS), analysing more than 100,000 people with lung cancer and more than 200 nurses across England.
• The research carried out by the University of Nottingham and London South Bank University, was presented at the National Cancer Registration and Analysis Service (NCRAS) conference on 21 June 2018.

Quality of Life in Long-term Cancer Survivors

Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology
Office of Health Economics 3 July 2018

• This literature review examines whether there is evidence to support the assumption that the QoL of long-term cancer survivors (LTCS) can be similar to that of age-/sex-matched population samples. 
• Twenty papers were included in the review, representing 23 studies covering a range of different cancers, with the majority collecting data from over 100 LTCS.
• Notwithstanding the very limited evidence base and potential limitations, of the studies reporting comparisons with population norms, the majority provided evidence that the QoL of LTCS is similar to that of the general population. However, it is unclear how generalisable the results are, due to the different study settings.