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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

Early signs and symptoms of preterm labour (1037)

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

Definition

Preterm birth, defined as delivery at less than 37 completed weeks of gestation, is the single biggest cause of neonatal morbidity and mortality.

It is estimated that around 1 in 13 babies are born prematurely in the UK every year. This statistic has been largely unchanged over the last 10 years.

Three quarters of these births are due to spontaneous onset labour and not all of these women have risk factors for pre term labour.

What is the importance of early diagnosis of pre-term labour?

Early diagnosis of pre-term labour can allow time to potentially- Early diagnosis can allow time to implement antenatal optimisation bundle checklist. Do you use this at RAH? Its two simple infographics which could be utilised here?

  • Delay delivery in order to administer antepartum steroids and Magnesium sulphate to reduce morbidity by up to 30% (1).
  • Early diagnosis may also permit transfer of the fetus in-utero to a centre where neonatal intensive care unit facilities are available.

Can we recognise pre-term labour?

Women can experience a range of subtle and non-specific symptoms during the prodromal period leading up to pre-term labour. These symptoms can develop over days to weeks prior to established pre-term labour(3). 

Although with low predictive value, these symptoms cause women to present themselves to health care services providing the opportunity for early diagnosis.

Signs and symptoms may include (4) (Please refer to attached infograph)

  • Abdominal Cramps- with or without diarrhoea
  • Backache- low, dull constant
  • Contractions 
  • Vaginal Discharge (increase in the amount of discharge) or bleeding
  • un-Easiness- feeling “not right”
  • Fetal movements /urine Frequency– changed
  • Gush of fluid loss - preterm rupture of membranes
  • Heaviness or pelvic pressure—the feeling that the baby is pushing down

Subtle changes in uterine activity patterns have been detected a few days to several weeks before overt pre-term labour (5). Uterine activity may or may not be perceived by patients at all and are not necessarily painful. It has been observed that only about half of women can feel painful uterine activity in the days preceding pre-term labour. About a third of patients can report no uterine contractions (3). One in five patients admitted with suspected pre-term uterine activity go on to develop established pre-term labour.

What are the obstacles to diagnosis?

  • Delay in presentation as women can attribute their symptoms to stress or normal discomfort of pregnancy. Pre-term labour is often not recognised by the patient as a possible cause of their symptoms.
  • Not “piecing it together” a woman who has had recurrent presentations with non-specific symptoms- attention to pattern and progress of symptoms can help triage these patients appropriately.

What can we improve?

The first presentation to health care by the patient is dependent on them perceiving their symptoms to be concerning. It will be helpful to make patients aware of possible association of the non-specific symptoms with threated pre-term labour particularly if they are persistent or progressive.

It will be advisable to arrange an obstetric medical review (ST3+ or clinically experienced ST2)for women with symptoms so that a speculum examination can be done. There should be an awareness of red flags for pre-term labour.

Appendix: Infographic - The 'A-H' of Pre-term Labour

Editorial Information

Last reviewed: 31/12/2021

Next review date: 31/07/2025

Author(s): Julie Murphy.

Version: 1

Approved By: Obstetrics Clincal Governance Group

Document Id: 1037

References
  1. Antenatal Optimisation for Preterm Infants less than 34 weeks:A Quality Improvement Toolkit.
  2. Cooper, R. L., Goldenberg, R. L., Davis, R. O., Cutter, G. R., DuBard, M. B., Corliss, D. K., & Andrews, J. B. (1990). Warning symptoms, uterine contractions, and cervical examination findings in women at risk for preterm delivery. American Journal of Obstetrics and Gynecology, 162, 748-754.
  3. Weiss M, Saks N, Harris S.(2002).Resolving the uncertainty of preterm symptoms: women's experiences with the onset of preterm labor. J Obstet Gynecol Neonatal Nurs. Jan-Feb 2002;31(1):66-76.
  4. Maloni, J. A. (2000). Preventing preterm birth: Evidence-based interventions shift toward prevention. AWHONN Lifelines, 4(4), 26-33.
  5. Iams, J. D., Stilson, R., Johnson, F. F., Williams, R. A., & Rice, R. (1990). Symptoms that precede preterm labor and preterm premature rupture of the membranes. American Journal of Obstetrics and Gynecology, 162, 486-490.