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Right Decision Service newsletter: April 2024

Welcome to the Right Decision Service (RDS) newsletter for April 2024. 

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May.  If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

  • 93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
  • 91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
  • 85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
  • Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

 

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

  • RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
  • It supports devolved decision-making across the multi-professional team (85% of respondents)
  • 76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
  • 72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

  • RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

  • RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Toolkits in development

Some of the toolkits the RDS team is currently working on:

  • SARCS (Sexual Assault Response Coordination Service)
  • Staffing method framework – Care Inspectorate.
  • SIGN 171 - Diabetes in pregnancy
  • SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
  • Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions.  We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine.  The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Endometrial Ablation (123)

Please report any inaccuracies or issues with this guideline using our online form

Heavy menstrual bleeding (HMB) is an important cause of morbidity affecting 1 in 5 of the population and leads to 21% of gynaecology referrals from general practitioners. Endometrial ablation is an effective treatment for HMB and can be performed under local anaesthesia as an office procedure or under general anaesthesia in theatre.

History

  • Date of LMP
  • Frequency and duration of menses
  • Previous treatments for menorrhagia
  • Previous caesarean sections or uterine surgery
  • Contraception - ablation should not be used as a method of contraception and women must be willing to make appropriate contraceptive provision

Examination

  • Pelvic examination
  • BMI if being considered for ablation under GA

Investigations

  • All women undergoing endometrial ablation should have an endometrial biopsy, ideally in advance of the procedure (well tolerated endometrial biopsy is an indication that ablation is suitable to be carried out under local anaesthetic in a clinic setting rather general anaesthetic in theatre)
  • All women undergoing endometrial ablation should have a pelvic ultrasound prior to the procedure to determine uterine size and morphology and to assess the endometrial cavity. A measurement of any previous LUSCS scar should be made (scar thickness < 8 mm – consider treating only endometrium above level of scar).
  • If there is doubt regarding suitability of the cavity for an ablation, then consideration should be given to performing hysteroscopy to confirm suitability before dating for the procedure.
  • Hysteroscopic assessment of the endometrial cavity must be made prior to the procedure. This should be performed immediately following dilation of the cervix, prior to insertion of the ablation device. This is essential to exclude perforation or creation of a false passage.

Contra-indications to endometrial ablation

  • Woman wishes to retain her fertility
  • Genital tract malignancy
  • Unexplained vaginal bleeding
  • Acute pelvic infection
  • Uterine abnormalities e.g. septate uterus
  • Previous classical caesarean section
  • Other contra-indications will depend on the technique employed e.g. regularity of the uterine cavity, presence and size of fibroids. The surgeon should be familiar with the manufacturer’s guidelines for all products that are used and their limitations.

Ablation technique

This guideline refers only to second generation ablation techniques in use in GG&C. It does not refer to first generation techniques such as TCRE and rollerball ablation. The ablation method used will depend on local expertise and availability of equipment.

Novasure®

This uses impedance controlled bipolar energy to cause ablation using a gold mesh electrode to conform to the contours of the uterine cavity. Depth of ablation is 2-3mm at the cornu and 5-7mm in the main body of the uterus. Treatment time is 90-120 seconds. There is an added safety feature using carbon dioxide to test for uterine perforation before treatment. Safety and efficacy have not been assessed in uterine cavities with a sounded length of greater than 10cm.

Complications of second generation devices

Minor complications are common and include pain and nausea. Serious complications are relatively rare but have been reported e.g. uterine perforation and damage to adjacent structures e.g. bowel. Patients should receive an information leaflet giving instructions about post-operative pain and how to access out-of-hours emergency gynaecology services.

Patients who require readmission following an ablation procedure should be assessed by senior staff to rule out intra-abdominal injury. Where there is any doubt, laparoscopy or laparotomy should be performed.

Antibiotic Prophylaxis

Antibiotic prophylaxis is not required.

Patient information

RCOG. Endometrial ablation (2015)

Appendix: Ablation proforma

Ablation proforma

Editorial Information

Last reviewed: 30/04/2018

Next review date: 30/04/2023

Author(s): Claire Higgins.

Approved By: Gynaecology Clinical Governance Group

Document Id: 123