Clinical News

IBD audit reports (25 September 2014)

Thursday, 25 September 2014 15:07

The latest national audit report was published, 25 September 2014. It address the provision of IBD services and management of biological therapies for adult and paediatric patients and the full reports can be read on the RCP website: https://www.rcplondon.ac.uk/projects/ibdauditround4. The results of these reports show a varied picture of service provision for patients with IBD in the UK. In order to enable services to deliver high-quality care, the UK IBD audit is calling for greater prioritisation of IBD care among national decision makers, to support the clinical teams treating patients with this chronic condition. These findings further support UK IBD audit reports published earlier in 2014 about inpatient care and patient experience. The BSG is supporting the call for a national strategy for IBD to be published in order to better prioritse care for patients. Evidence from the audit highlights the need for a national strategy to ensure that services in England and Wales are the best they can be for patients.

Commenting on the UK audit of Inflammatory Bowel Disease (IBD) service provision, carried out by the Royal College of Physicians, British Society of Gastroenterology (BSG) IBD Section Chair, Professor Chris Probert said:

"The Audit shows a number of key improvements in IBD services across the UK, however there is still a long way to go in developing the quality of services in specific areas and we have been overwhelmed by the support of our members to achieve this.

"With diagnoses of IBD on the increase there is absolutely no room for complacency and it is absolutely vital that gastroenterologists, nurses, surgeons and others who deliver care for IBD patients learn from the Audit in order to deliver the change that patients deserve.

"The BSG will continue to play a leading role in developing and promoting a national IBD strategy which seeks to harness the collective benefits of the Audit, the IBD Registry and the IBD Standards. In addition, we also have to look at new patient referrals from a primary care setting – one concern is that in some areas IBD services are being burdened by unnecessary referrals for irritable bowel syndrome which could have been prevented by the utilisation of new tests available to primary care at an earlier stage.

"As a profession we wholeheartedly welcome the progress made by the Royal College of Physicians' IBD Audit which is a fundamental aspect of measuring and developing services, and we look forward to continuing our work with the College and patient charities such as Crohn's & Colitis UK to improve IBD services across the UK."

NICE Evidence Update: Acute Upper Gastrointestinal Bleeding

August 2014

A summary of selected new evidence relevant to NICE clinical guideline 141 'Acute upper gastrointestinal bleeding: management' (2012)

This Evidence Update provides a summary of selected new evidence published since the literature search was last conducted for the following NICE guidance: Acute upper gastrointestinal bleeding. NICE clinical guideline 141 (2012) A search was conducted for new evidence from 23 September 2011 to 20 February 2014. A total of 6061 pieces of evidence were initially identified. After removal of duplicates, a series of automated and manual sifts were conducted to produce a list of the most relevant references.

Vacancies on NICE Quality Standards Advisory Committees (QSAC)

Tuesday, 08 July 2014 10:07

NICE is currently recruiting for additional members to join their Quality Standards Advisory Committees (QSAC) to support delivery of the library of quality standards topics.

NICE's quality standards are central to supporting the Government's vision for a health and social care system focussed on delivering the best possible outcomes for people who use services. Derived from NICE guidance and other accredited sources, they are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. The standards are also used to develop indicators for potential inclusion within the Clinical Commissioning Groups Outcome Indicator Set (CCGOIS) and Quality and Outcomes Framework (QOF) for general practice.

ERCP – The Way Forward, A Standards Framework

Mark Wilkinson, (BSG Endoscopy, working party convenor and chairman) et al.

June 2014

Executive Summary:

To improve the quality and availability of ERCP in the UK, a working party was set up incorporating a number of stakeholders (Appendix 3) to make recommendations to achieve this goal. The attached framework document is the output of that process. It is recognised that not all changes can be achieved immediately, but that these are the standards to be aimed for. Though regulatory frameworks differ among the 4 nations of the UK (and delegates from Scotland, Wales and Ireland were represented on the working party) it is intended that this framework will be applicable to the whole of the UK.

In brief its recommendations are:

  1. ERCP should only be carried out in facilities dedicated to high standards of performance and safety, as measured by key performance indicators.
  2. That there should be a minimum of 75 cases per annum for ERCP endoscopists, and 150 cases minimum per facility, although we should be aiming for a minimum of 100 cases and 200 cases respectively.
  3. That ERCP services should work collaboratively in a regional or hub-and-spoke model, with simple and rapid referral pathways established.
  4. That facilities for urgent or emergency ERCP should be widely available.
  5. That minimum standards for independent practitioners should be based on intention to treat and include a >=85% cannulation rate of virgin papillae, CBD stone clearance for >=75% of those undergoing 1st ever ERCP, and for patients with an extra-hepatic stricture, successful stenting with cytology or histology where appropriate at 1st ERCP in >=80%.
  6. That performance criteria should be monitored by a detailed audit and feedback process via a strengthened JAG/GRS process, and be incorporated into consultant appraisal.
  7. That the organisation and standards for training for ERCP should follow from the above performance criteria.
  8. That newly appointed consultants are mentored to ensure a safe and effective transition from trainee to independent practitioner.
  9. That high quality performance in ERCP service and training should support high quality research.
  10. There should be a national registry of ERCP cases to monitor practice and outcomes which will aid a cycle of continuous improvement and provide research data to plan better care in the future.

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