Directory of Diagnostic Services for Commissioning Organisations

Directory of Diagnostic Servicesfor Commissioning Organisations

NHSNHS Improvement

Diagnostics

HEART

LUNG

CANCER

DIAGNOSTICS

STROKE

NHS Improvement - Diagnostics

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DIRECTORY OF DIAGNOSTIC SERVICES FOR COMMISSIONING ORGANISATIONS Commissioning safe, effective and efficient diagnostic investigation services is vital to delivering the best of patient care. DH estimates suggest that around 1 billion diagnostic investigations are carried out in the NHS each year. Diagnostic services are a key component of every clinical pathway underpinning 80% of all clinical decisions and contributing across the end to end pathway of care. Technological innovation is changing the way in which diagnostic investigations can be carried out. Accelerating the introduction of these scientific developments will bring great benefits to patients: the miniaturisation and portability of equipment so tests can be taken to patients; smart technology that improves the accuracy of diagnostic investigations and their reporting; integrated IT systems delivering images and results rapidly to where they are needed for clinical decision making will make a difference to our patient’s experience of their healthcare. To ensure your patients benefit, as commissioners you will want to be confident you are commissioning the best diagnostic services. This guide brings together in one place information about all of the diagnostic modalities to inform your decisions about commissioning diagnostic services. The resources have been developed by National Clinical Directors (NCDs) for endoscopy, imaging, pathology and physiological diagnostics in conjunction with NHS Improvement and the innovative services that they have worked with. This directory is supported by a companion guide “Top Tips to overcome the challenge of commissioning diagnostic services” which has been produced by NHS Improvement. We hope you find it useful. Dr Ian Barnes, National Clinical Director for Pathology, DH Prof Erika Denton, National Clinical Director for Imaging, DH Prof Sue Hill, Chief Scientific Officer and National Clinical Director for Physiological Diagnostics, DH Dr Roland Valori, National Clinical Director for Endoscopy, DH Key:

Policy Service improvement Case studies

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CROSS DIAGNOSTICS

Title/author/date of publication

Description Link

The Operating Framework for the NHS in England ‐ 2012/13 Department of Health November 2011

2012/13 is the second year of the quality and productivity challenge and the final year of transition to the new commissioning and management system for the NHS. NHS leaders will have to respond to four inter‐related challenges: the need to maintain a continued strong performance on finance and service quality; the need to address the difficult changes to service provision required to meet the QIPP challenge in the medium term; the need to complete the transition to the new delivery system set out in Liberating the NHS; and the urgent need to ensure that elderly and vulnerable patients receive dignified and passionate care in every part of the NHS.

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131428.pdf

First steps towards quality improvement: A simple guide to improving services NHS Improvement December 2011

If you are involved at any level in improving health or social care, this resource will provide the information you need for your first steps towards making quality improvements, giving your improvement project the best possible chance of success.

http://www.improvement.nhs.uk/diagnostics/DiagnosticsHome/Publications.aspx

Bringing Lean to Life NHS Improvement May 2010

Healthcare teams are dedicated and skilled professionals who are under pressure to do their best – but often with inadequate processes. "Bringing Lean to Life" provides a basic introduction and overview of Lean; the culture, principles and tools to understand, tackle and resolve issues within healthcare. It is not intended as a complete guide to implementing Lean as a management system.

http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=44OglPqPr4k%3d&tabid=56

Equality for all: Delivering safe care – seven days a week NHS Improvement January 2012

This guide, endorsed by Sir Bruce Keogh, provides case studies and examples of service delivery models that are being used across the NHS to deliver clinical services outside the standard working hours and across the weekend period. The forward by a patient provides a very powerful and compelling story to support care 7 days a week.

http://www.improvement.nhs.uk/documents/SevenDayWorking.pdf

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The best of clinical pathway redesign NHS Improvement July 2011

Practical examples of delivering benefits to patients, endorsed by NICE and Sir David Nicholson, with examples on the NHS Evidence website. Whether you are based in a local hospital, GP practice, SHA or clinical network, or in social care there are initiatives that could help you deliver your own quality and productivity challenges.

http://www.improvement.nhs.uk/documents/bestofclinicalpathwayredesign.pdf

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ENDOSCOPY


Description Link

Joint Advisory Group on GI Endoscopy

The Joint Advisory Group (JAG) Download Centre has a number of resources on endoscopy, including information about the Global Rating Scale (GRS), the JAG Accreditation scheme, national policies and reports, and information for endoscopy units.

www.thejag.org.uk/AboutUs/DownloadCentre.aspx

AQP Offers: Community Endoscopy Services

The NHS Supply2Health website provides support for endoscopy units applying to provide Any Qualified Provider (AQP) services.

https://www.supply2health.nhs.uk/5QN/Lists/AQPOffers/DispForm.aspx?ID=5

Rapid review of endoscopy services NHS Improvement March 2012

Demand for endoscopy is increasing and it is vital that all units make best use of existing capacity and manage capacity to meet demand. This document shares some of the learning from innovative services which can be adopted elsewhere to support local improvement initiatives.

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133058.pdf

7 day working: extended endoscopy service NHS Improvement February 2012

Case study: Royal Liverpool and Broadgreen University Hospitals NHS Trust

Seven Day Working Case Studies

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GENETICS


Description Link

Building on our inheritance Department of Health January 2012

A report by the Human Gemonics Strategy Group on Genomic technology in healthcare.

http://www.improvement.nhs.uk/diagnostics/PathologyKeyResources/Other.aspx

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PATHOLOGY


Description Link

The Pathology Services Commissioning Toolkit Department of Health May 2012

A toolkit for commissioners of community pathology services (for example direct access) who: • have undertaken a strategic review of their existing community

pathology services • wish to improve service quality, effectiveness, affordability and

value for money. The toolkit is divided into 3 parts: 1. Provides an overview of the provision of pathology services. 2. Describes each of the 11 steps to commissioning. 3. Includes tools referred to in the 11 steps for example templates.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134385

Atlas of Variation November 2011

The NHS Atlas of Variation presents a series of maps of variation in service delivery selected by DH National Clinical Directors and others as being of importance to their clinical specialty. The aim is to put variations in activity, expenditure, quality, outcome, value, and equity firmly on the health service agenda for the next decade; and to stimulate the NHS to both search for unwarranted variation and also to tackle the causes and drivers of that variation. Examples from diagnostics services are included.


Quality, Innovation and Pathology Health Service Journal 16 September 2010

Pathology is a frequently overlooked area in the NHS but has the potential to unlock up to £500m per year in efficiency savings. Ingrid Torjesen listens in as some of the most influential makers, managers and medical leaders discuss how this can be achieved.


Report of the Second Phase of the Review of NHS Pathology Services Department of Health December 2008

The report of the second phase of the Independent Review of NHS Pathology Services in England, chaired by Lord Carter of Coles. The report focuses on three main themes:

• improving quality and patient safety • improving efficiency • identifying the mechanisms for delivering change.

The review estimates that significant savings could be made by the NHS through consolidating pathology services, and makes specific


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recommendations for change. The case for consolidation is based on activity and cost data collected from a representative sample of NHS pathology pilot sites in England.

Response to the Report of the Second Phase of the Independent Review of NHS Pathology Services in England Department of Health December 2008

Response to the recommendations of the Independent Pathology Review chaired by Lord Carter of Coles. DH continues to develop its pathology programme, taking forward the agenda set out in the Independent Review’s report on quality, patient safety and efficiency, in the context of the framework set by High Quality Care For All. A key focus of the programme is stakeholder engagement, (including patients) to develop a truly patient‐focused pathology service that supports personalised, high quality care. The service will be clinically led and empower patients by giving them access to information to make choices and manage their care effectively.


Workforce planning in pathology toolkit Department of Health October 2008

Commissioned by the DH Chief Scientific Officer's Office, this free tool supports workforce planning in pathology. It aims is to: • log what the scientific workforce currently does in individual

pathology services • help managers model changes to the workforce profile when, for

example, demand for tests varies; work is redesigned; competence requirements are reassessed; or improvements are made in productivity.


Report of the Review of NHS Pathology Services In England Department of Health August 2006

In September 2005, an Independent Review of Pathology Services chaired by Lord Carter of Coles, was set up to advise Ministers, in the context of current resource constraints, on the timeliness, reliability, capacity and efficiency of current pathology services in England, benchmarked against international standards and the feasibility of and benefits arising from wide‐scale service reconfiguration, innovation and modernisation and involvement of the independent sector. In this Report, the Review Panel sets out its findings and conclusions, and makes recommendations for the development and improvement of pathology services. The Review concludes that one of the greatest obstacles has been the lack of good quality useable data about costs, activity and performance


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within NHS pathology services. From the evidence received it is convinced that there is scope to achieve significant benefits from further reform of pathology.

Service improvement in Blood Sciences: How to improve quality, delivery and efficiency for laboratory providers and their customers NHS Improvement January 2013

This step by step guide demonstrates at each of the five stages of the blood sciences pathway how quality, delivery and efficiency can improve services for patients and users of the service. It demonstrates the need for user engagement and the fundamental need for clinical and managerial leadership. It highlights where blood sciences aligns to four of the five Domains to support the NHS Operating Framework. The guide contains case studies and key learning.

http://www.improvement.nhs.uk/documents/Blood_Sciences.pdf

Service improvement in Microbiology: Why, What and How

NHS Improvement

July 2012

This improvement guide provides a step by step approach to improving microbiology services using Lean Methodology, illustrated with 36 individual case studies. It describes how improvements can be made in quality, safety, and productivity, with innovative ways of working. Recommendations are made in 3 key areas as a result of work with clinical teams.

http://www.improvement.nhs.uk/documents/Microbiology_Guide.pdf

Leading the way in blood sciences The Biomedical Scientist October 2011

Article from ‘The Biomedical Scientist’ by Dave Hamer, National Clinical Lead for Blood Sciences Service Improvement and Manager of Bolton NHS Trust Pathology Services. The article describes how the application of Lean methodology has transformed the delivery of blood sciences services in Bolton.


What a difference a day makes NHS Improvement January 2011

This guide demonstrates that small improvements at each step of the end to end pathway, such as supporting users to deliver effective MDTs, redesigning outpatient clinics, and improving the patient experience and outcomes can improve service delivery in pathology.

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=yaJNBxk6u%2fA%3d&tabid=113

Learning how to achieve a seven day turnaround in histopathology NHS Improvement November 2010

This step by step improvement guide demonstrates how to reduce the interval between specimens being taken and results being made available. The impact for patients means a reduction in the period of uncertainty and help to ensure that treatment can be started as soon as clinically appropriate. Reducing turnaround times can lead to a redesign of the whole GI pathway, including redesign of out‐patients clinics and lengths of stay.

http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=2X8saN8rBA8%3d&tabid=56

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First steps in improving phlebotomy: The challenge to improve quality, productivity and patient experience NHS Improvement May 2011

Lord Carter’s review of pathology services highlighted the importance of improving access to phlebotomy. This improvement guide sets out the small measurable changes achievable through applying Lean Methodology that can both improve service quality and delivery, and improve the patient experience.

http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=NeYr5Xcz8xA%3d&tabid=56

ACP News Autumn 2010

In this issue of the ‘ACP News’, Lesley Wright and Ian Barnes describe the benefits of using lean methodology to transform pathology services, with examples from MRSA testing and cervical cytology.


Learning from Pathology service improvement sites NHS Improvement August 2006

This publication demonstrates that achievements can be made rapidly, for little or no cost. In his review of pathology services, Lord Carter endorsed the approach implemented by the NHS pathology service improvement team.

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=Q04ozDjBYfM%3d&tabid=73

Improving histopathology management: 7‐day turnaround time May 2012

QIPP website: Histopathology case studies http://www.improvement.nhs.uk/qipp/MenuLevel1/Diagnosis/Pathology/Histopathology.aspx

The role of visual management in the pathology lean improvement process NHS Improvement January 2012

Case study: University Hospital of North Staffordshire NHS Trust

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=gyyhDFOLiF0%3d&tabid=74

7 day working: 24 hour, seven day microbiology services NHS Improvement September 2011

Case study: Royal Free Hampstead NHS Trust http://www.improvement.nhs.uk/diagnostics/PathologyImprovement/Sevendayservices.aspx

Sustaining continuous improvement in histopathology ‐ two years on

Case study: Calderdale and Huddersfield NHS Foundation Trust http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=Hf0WgOBYcbY%3d&tabid=74

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NHS Improvement January 2010 Re‐designing specimen transport to smooth workflow and improve productivity NHS Improvement January 2010

Case study: University Hospital of North Staffordshire NHS Trust

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=Kw23vDsZSNE%3d&tabid=74

Kanban systems for material management October 2008

Case study: Northampton General Hospital NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=2apXDTMRLKw%3d&tabid=74

Workload Level Loading in Specimen Delivery October 2008

Case study: Northampton General Hospital NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=MZnaEwCgTb4%3d&tabid=74

Improving the immunology process changes October 2008

Case study: Northampton General Hospital NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=2Dvn3rWZ3Yw%3d&tabid=74

CYTOLOGY NHS Cervical Screening Programme Annual Review 2011 NHS Cancer Screening Programmes

Data from 2011 shows a significant improvement in the service the NHS Cervical Screening Programme provides to women. The turnaround times, and the time from screening to the availability of results, has been significantly reduced with 98.6 per cent of cases being reported by laboratories within 14 days, compared with 43 per cent five years ago. Shorter turnaround times mean less anxiety for women, quicker treatment and a more efficient system.

http://www.improvement.nhs.uk/diagnostics/CytologyKeyResources/Other.aspx

NHS Cancer Reform Strategy Second Annual Report NHS Cancer Screening Programmes December 2009

This report provides an opportunity to identify major priorities for 2010.


NHS Cervical Screening Programme Annual Review

The NHS Cervical Screening Programme has set up a pilot scheme with NHS Improvement to work towards meeting the two‐week turnaround


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2008 NHS Cancer Screening Programmes

time for cytology samples which was promised in the Cancer Reform Strategy. A shorter turnaround time will mean less anxiety for the patient, quicker treatment and a more efficient system overall.

ScHARR Report ‐ Cervical Screening Report NHS Cancer Screening Programmes February 2006

This report to the NHS Cancer Screening Programme gives an assessment of a seven‐day turnaround for the reporting of cervical smear results which focuses upon laboratory practice.


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Cytology Self‐Assessment tool NHS Improvement

This web‐based cytology self‐ assessment tool is an online support for all users in the cytology pathway to assess themselves against the key improvements that Phase 1 sites have applied to achieve the 14 day target. It is designed to be used in conjunction with the Cytology Improvement Guide launched in November 2009.

http://www.improvement.nhs.uk/Cytology/assessmenttool/

Continuous improvement in cytology ‐ sustaining and accelerating improvement NHS Improvement September 2010

This improvement guide demonstrates how the cytology pilot sites have continued to embed and sustain their improvements throughout the cytology pathway. It includes practical examples for reducing turnaround times, improving quality, safety and productivity.

http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=i%2b7gaxF9q%2bs%3d&tabid=56

Cytology Improvement Guide ‐ Achieving a 14 day turnaround time in Cytology NHS Improvement November 2009

This step by step improvement guide highlights the findings and improvements from the pilot sites who tested how the 14 day standards can be achieved using Lean Methodology. This practical guide is supported by tried and tested case studies across the whole patient pathway which all staff involved in the screening pathway can adopt and adapt to meet their local setting.

http://www.improvement.nhs.uk/cytology_guide.pdf

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IMAGING


Description Link

Implementing 7 Day working in Imaging Departments: Good Practice Guidance Department of Health January 2012

A report from the National Imaging Clinical Advisory Group which highlights good practice on implementing 7 day working in imaging departments. It identifies the issues, gives evidence and provides case studies resolving these to ensure a patient focussed and consultant delivered service.


Exit from the National PACS Programme NHS CFH PACS Programme Team, 2012

This contains a wide range of supporting materials to aid Trusts in the local procurement of replacement PACS and RIS systems along with data migration and implementation of these new systems.

http://www.connectingforhealth.nhs.uk/systemsandservices/pacs/beyond

Guidelines for imaging during a major incident ‐ Introduction letter Department of Health and Defence Medical Services June 2011

These guidelines for imaging, outlined from Professor Erika Denton, are based on the most recent Clinical Guidelines for Operations (CGOs) published in 2010: RCR guidelines for trauma radiology in severely injured patients and recent military clinical experience.

http://www.improvement.nhs.uk/diagnostics/RadiologyKeyResources/DHpublications.aspx

Imaging guidelines for major incidents Department of Health and Defence Medical Services June 2011

This document has been developed jointly by the Defence Medical Services and Department of Health and provides a concise common approach to imaging in the event of a major incident. This forms part of ongoing work to develop emergency preparedness for the NHS and is based on shared learning gained from managing major trauma cases as part of military operations.


Post mortem imaging guidelines for mass casualties Department of Health and Defence Medical Services June 2011

These Standard Operating Procedures (SOPs) have been produced to detail the procedures to be followed in the CT investigation of fatalities in a mass casualty.


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Managing high value equipment in the NHS in England National Audit Office April 2011

This report examines the management of three types of high value equipment in the NHS in England. It covers Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scanners, used for diagnosis, and Linear Accelerator (Linac) machines for cancer treatment. It provides key recommendations; demonstrates international benchmarking; highlights variation in utilisation; and explores workforce issues.


Interventional radiology: Guidance for service delivery National Clinical Imaging Advisory Board: Sponsor DH November 2010

A report from the National Clinical Imaging Advisory Board provides a summary of the evidence base to show how Interventional Radiology (IR) services can contribute to improved outcomes, safety and experience. It proposes a framework of options for IR service development to guide providers and commissioners in ensuring appropriate provision for patients.

http://www.improvement.nhs.uk/diagnostics/RadiologyKeyResources/Other.aspx#IR

Interventional radiology: Regional Networks for Major Trauma NHS Clinical Advisory Groups Report September 2010

This document contains advice offered by the NHS Clinical Advisory Groups (CAG) for Major Trauma to their colleagues in the NHS. Strategic Health Authorities (SHAs) declared their intentions to support the establishment of improved regional services for Major Trauma, primarily through the development of regional Trauma Networks in 2008. The Revised Operating Framework of June 2010 confirmed that the expectation that these commitments would be fulfilled, despite the recent change of Government.

http://www.improvement.nhs.uk/diagnostics/RadiologyKeyResources/Other.aspx#IR

Delivering quality imaging services for children National Imaging Board March 2010

This document describes the structure of services that should be commissioned to support the provision of effective paediatric imaging services. It was produced jointly by the National Clinical Leads for Imaging and Children and Families. It is intended to inform commissioners and identify how service providers can offer high quality, innovative, paediatric imaging services.


PACS and the NHS National Breast Screening Programme NHS CFH PACS Programme Team, 2010

This document describes the work done by the NHS CFH PACS Programme to support their NHS National Breast Screening Programme.

http://www.connectingforhealth.nhs.uk/systemsandservices/pacs/projects/breastscreening/index_html

Introduction to PACS and These documents explain the concept of PACS and how this has http://www.connectingforhealth.nhs.uk/systemsands

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the PACS Programme: NHS CFH PACS Programme Team, 2003 ‐ 2010

revolutionised the management of diagnostic images with the NHS. This includes a comparison of operating models before and after the introduction of PACS, Case Studies and “Frequently Asked Questions”

ervices/pacs/learn

Interventional radiology: Improving Quality and Outcomes for Patients Department of Health November 2009

This report has been produced to inform and stimulate discussion about how interventional radiology services can support the QIPP (Quality, Innovation, Productivity and Prevention).


Procurement of CT and MRI technologies for stroke imaging services Department of Health January 2009

The Centre for Evidence based Purchasing developed this document in response to the national stroke diagnosis initiatives, realising that the sudden influx of new guidance for stroke imaging services needed analysing and collating into more manageable sources to help business case development and cost‐effective procurement of new CT and MRI technologies. The aim is to inform imaging providers considering procurement of either new systems, or upgrading with neuro‐imaging software packages.


PACS and Voice Recognition NHS CFH PACS Programme Team, 2009

This describes the work the national PACS Programme did to support Acute Trusts to implement Voice Recognition software, including a case study carried out by Leeds Teaching Hospitals NHS Trust.

http://www.connectingforhealth.nhs.uk/systemsandservices/pacs/projects/pacsvr/index_html

Implementing the National stroke strategy ‐ An imaging guide Department of Health May 2008

This guide provides further detail on the recommendations set out in the National Stroke Strategy regarding imaging for transient ischaemic attack (TIA) and stroke. It sets out best practice and provides guidance on how imaging services may develop to provide gold standard TIA and stroke care.


Image and Report Sharing NHS CFH PACS Programme Team, 2008

This sets out the advantages of sharing electronic images and summarises various approaches undertaken to achieve this as a series of side projects to the core national PACS programme.

http://www.connectingforhealth.nhs.uk/systemsandservices/pacs/projects/imagesharing/index_html

National Stroke Strategy Department of Health December 2007

This national strategy is intended to provide a quality framework to secure improvements to stroke services, to provide guidance and support to commissioners and strategic health authorities and social care, and inform the expectations of patients and their families by providing a guide to high quality health and social care services.


Using the OPCS‐4 mapping table from the National

To generate healthcare resource groupings for payment by results. http://www.improvement.nhs.uk/diagnostics/RadiologyKeyResources/DHpublications.aspx

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Interim Clinical Imaging Procedure Codes Department of Health

Towards best practice in Interventional Radiology NHS Improvement June 2012

This document draws together best practice in Interventional Radiology (IR), highlighting the findings from visits to IR services at the 24 proposed major trauma centres in England during 2011/12. This record of their major findings provides a definitive read for trust chief executives and commissioners to help better inform IR service redesign. It contains a collection of case studies for clinical teams in trauma and non trauma services to adopt and adapt to deliver safe and effective services for patients.

http://www.improvement.nhs.uk/documents/IR_Guide.pdf

Interventional radiology: How to implement best practice in stroke and TIA imaging Synergy News November 2011

This follow‐up article looks more closely at the three Accelerated Stroke Improvement (ASI) measures that relate directly to radiology. It outlines examples of best practice introduced by Trusts across England to meet these targets and provides patients with the best possible outcomes.

'How to implement best practice in stroke and TIA imaging'

Interventional radiology: The Challenge for Radiology Imaging for Stroke and TIA’s Synergy News September 2011

The article describes the improvement approaches to supporting Stroke Imaging. Strokes are the third biggest cause of death and the leading cause of disability in the UK, with more than 110,000 people per annum suffering an initial stroke. Three key themes are highlighted: 1. Why do we have to image 50% within an hour? 2. What is the role of perfusion imaging? 3. Why urgently undertake carotid imaging if surgery is not happening in a timely manner?

'The Challenge for Radiology Imaging for Stroke and TIA’s'

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A Guide to achieving changes in imaging services to support new stroke pathways NHS Improvement May 2011

This guide is a follow up to the document ‘Why treat stroke and TIAs as emergencies?’ It has been produced to highlight how changes in imaging services have been achieved by Trusts across the country to deliver improvements in services to stroke patients and to support improved outcomes and patient experiences. It contains a number of case studies for clinical teams to adopt and adapt to their local services.

http://www.improvement.nhs.uk/diagnostics/RadiologyKeyResources/tabid/63/Default.aspx

The role of teleradiology in supporting the delivery of diagnostic imaging services Department of Health April 2011

This document describes how teleradiology can address variations in local reporting capacity whilst providing patient centred and locally driven services.


Why treat stroke and transient ischaemic attacks (TIAs) as emergencies? NHS Improvement June 2010

This publication highlights why treating strokes and Transient Ischemic Attacks (TIAs) as emergencies can reduce mortality; reduce length of stay; improve functional recovery and minimise residual disability, thus increasing the chance of a return to independent living.

http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=TGB0QZ9zZ4A%3d&tabid=56

Radiology Reporting Times Best Practice Guidance NHS Improvement September 2008

This best practice guidance has been developed and endorsed by the National Imaging Board to define best practice for the reporting of images. It is based on the practical experience of some imaging departments in delivering high quality and effective patient‐centred services. It outlines the key role played by imaging services supporting the whole patient pathway by providing the reporting of images in a timely manner. This timely delivery is also key to the delivery of the NHS priorities for Cancer, Heart and Stroke Management.

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=e8lkz6rOyzY%3d&tabid=63

Service Improvement for Radiologists

NHS Improvement

November 2007

This signposting document aims summarising service improvement knowledge and experience for UK Radiologists. This document includes descriptions of underlying principles with specific examples. Endorsed by the British Institute of Radiology, it contains specific appendices of Radiology Success factors for each of the key imaging modalities. See below

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=bVz9WgBaan4%3d&tabid=63

Radiology Success Factors

NHS Improvement

This appendix supports the Service Improvement for Radiologist document. Generic Success Factors are described which contribute to improving radiology data; administrative; clinical working practices; skill

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=T3f6CZ%2fMIig%3d&tabid=63

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November 2007 mix; support services. PACS – Service improvement and benefits realisation NHS Modernisation agency May 2005

PACS has a very pivotal and extensive role to play in the delivery of imaging services. It lies at the heart of modernisation of the NHS IT infrastructure, and is linked to service improvement, advancing technology and a changing and developing workforce. This document demonstrates the impact that PACS supported by process redesign can have across the wider healthcare community. It describes the potential for non imaging digital images (such as ECG, endoscopy and dermatology) to use the infrastructure of the PACS architecture. The benefits of linking all digital images for the patient record will inevitably increase the efficiency of the healthcare system as a whole.

http://www.improvement.nhs.uk/diagnostics/LinkClick.aspx?fileticket=n3CfL6XrWCY%3d&tabid=63

Radiology service improvement toolkit – guide to redesign NHS modernisation Agency June 2003

The appendices included with this toolkit are designed to give teams a basic template to support data collection. They are designed to assist teams in reducing the set up time to start on such a project. However, you may wish to adapt the documentation to suit your local circumstances.

http://www.improvement.nhs.uk/diagnostics/RadiologyKeyResources/Archive.aspx

7 day working: a seven day service for the assessment and treatment of transient ischaemic attack NHS Improvement September 2011

Case study: University Hospitals of Leicester NHS Trust http://www.improvement.nhs.uk/SevenDayWorking/SevenDayWorkingCaseStudies/tabid/219/Default.aspx

7 day consultant radiology service NHS Improvement September 2011

Case study: Gloucester Hospitals NHS Trust

http://www.improvement.nhs.uk/SevenDayWorking/SevenDayWorkingCaseStudies/tabid/219/Default.aspx

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7 day radiology service NHS Improvement September 2011

Case study: Salisbury NHS Foundation http://www.improvement.nhs.uk/SevenDayWorking/SevenDayWorkingCaseStudies/tabid/219/Default.aspx

CT case studies NHS Improvement 2011 and 2009

Direct pathway from ambulance to CT scan: ‐ Royal Bournemouth Hospital ( 2011) Training radiographers to perform CT heads: ‐ The Great Western Hospital NHS Foundation Trust (2011) 24 hour CT imaging for patients suspected of having a minor stroke: ‐ Countess of Chester Hospital NHS Foundation Trust (2009) Providing a comprehensive stroke imaging service: ‐ Salford Royal Hospital NHS Foundation Trust Improving access for patients ‐ 24 hours a day, 7 days a week CT service: ‐ Hull and East Yorkshire Hospitals NHS Trust 24 hour CT imaging for suspected stroke patients: ‐ Chesterfield Royal Hospital Implementation of radiographer for CT head reporting for stroke: ‐ Kingston Hospital NHS Trust Introducing a radiology access unit: ‐ Portsmouth Hospitals NHS Trust Reducing waiting times and improving booking: ‐ Portsmouth Hospitals NHS Trust Providing immediate access to CT head scans for stroke patients: ‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay Providing a 24/7 service to support stroke and emergency care patients: ‐ St Helens and Knowsley Teaching Hospital NHS Trust

http://www.improvement.nhs.uk/diagnostics/RadiologyCaseStudies.aspx

CT & MRI case studies NHS Improvement 2011 and 2009

MRI training plan to support seven day working : ‐ Blackpool Victoria Hospital (2011) Improving scanner utilisation in MRI by 25%: ‐ North Staffordshire NHS Foundation Trust (2011) Streamlining paediatric sedation process: ‐ Great Ormond Street Hospital for Children NHS Trust (2009) Implementing NICE stroke guidelines: ‐ Central Manchester Foundation NHS Trust (2009)


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All Modalities case studies NHS Improvement 2009

Reducing reporting turnaround times: ‐ Barts and The London NHS Trust Reducing waiting times for outpatients: ‐ Hinchingbrooke Hospital NHS Trust Implementing a 3 session day: ‐ Mayday Healthcare NHS Trust Improving access and booking to reduce waiting times: ‐ Worcestershire Acute Hospitals NHS Trust Improving inpatient turnaround times: ‐ South Devon Healthcare NHS Foundation Trust ‐Torbay Implementing a 7 day service: ‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay Improving reporting turnaround times: ‐ St Helen's and Knowsley Teaching Hospitals NHS Trust


Booking case studies NHS Improvement 2009

Introducing direct booking: ‐ Portsmouth Hospitals NHS Trust Implementing direct booking in CT and Ultrasound: ‐ Bromley Hospital NHS Trust Implementing booking using a call centre: ‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay


Fluoroscopy case studies NHS Improvement 2009

Improving access to the hysterosalpingogram service: ‐ University Hospitals of Leicester NHS Trust Reduction in waiting times for hysterosalpingograms: ‐ Princess Alexandra NHS Trust


Interventional case studies NHS Improvement, 2009

Improving patient safety: ‐ Luton and Dunstable NHS Foundation Trust


Nuclear medicine case studies NHS Improvement, 2009

Redesigning the department and improving patient flow: ‐ Calderdale and Huddersfield NHS Foundation Trust


Plain film case studies NHS Improvement, 2009

Improving the flow for orthopaedics patients: ‐ Bolton Hospital NHS Trust


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Reporting case studies NHS Improvement 2009

Improving reporting turnaround times: ‐ St Helens and Knowsley Teaching Hospitals NHS Trust Improving reporting turnaround times: ‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay


Theatres case studies NHS Improvement 2009

Training theatre staff to screen during spinal surgery: ‐ Dorset County Hospital NHS Foundation Trust


Ultrasound case studies NHS Improvement 2009

Creating a one stop haematuria clinic: ‐ Blackpool Fylde and Wyre NHS Foundation Trust Expansion of ultrasound in primary care: ‐ Blackpool Fylde and Wyre Hospitals Foundation Trust Rapid access to carotid doppler imaging for TIAs: ‐ University Hospitals of Leicester NHS Trust Improving the urology patient pathway: ‐ Luton and Dunstable NHS Foundation Trust Reducing waiting times and improving quality: ‐ Blackpool Fylde & Wyre Hospitals Foundation Trust Reducing waiting times for musculoskeletal patients: ‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay


Other case studies NHS Improvement 2009

Maintaining zero infection rates: ‐ Princess Alexandra NHS Trust Achieving 18 weeks target: ‐ Queen Marys Hospital ‐ Sidcup


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CANCER


Description Link

National Awareness and Early Diagnosis Initiative (NAEDI)

The National Awareness and Early Diagnosis Initiative (NAEDI), arising from the Cancer Reform Strategy, aims to achieve improved outcomes for people with cancer through earlier diagnosis. The website contains information and resources for health professionals.Website: www.naedi.org.uk

http://www.cancerresearchuk.org/cancer‐info/spotcancerearly/naedi/

National Cancer Intelligence Network: Routes to Diagnosis NCIN

The National Cancer Intelligence Network website contains information and resources for health professionals. The NCIN is a UK‐wide initiative, working to drive improvements in standards of cancer care and clinical outcomes by improving and using the information collected about cancer patients for analysis, publication and research. Website: www.ncin.org.uk

http://www.ncin.org.uk/publications/data_briefings/routes_to_diagnosis.aspx

PCT Profiles for Cancer 2011/12; 2012/13 NCIN

The PCT Profiles for Cancer have been produced by the National Cancer Intelligence Network and give information about 26 key indicators relating to cancer services for every Primary Care Trust in England. These profiles provide comparative information for benchmarking and reviewing variations at a PCT level. They are intended to help Primary Care Trusts think about clinical practice and service delivery in cancer and, in particular, early detection and diagnosis. They are not for the purpose of performance management and there are no 'right or wrong' answers. Website: www.ncin.org.uk

http://www.ncin.org.uk/cancer_information_tools/profiles/pctprofiles.aspx

General Practice Profiles for Cancer NCIN July 2012

The General Practice Profiles for Cancer have been produced by the National Cancer Intelligence Network (NCIN) and give information about key indicators relating to cancer services for most GP practices in England. They are intended to help GP practices think about the services they offer to their patients, in particular those services related to recognising symptoms and diagnosing cancer earlier. Website: www.ncin.org.uk

http://www.ncin.org.uk/cancer_information_tools/profiles/gp_profiles.aspx

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Direct access to diagnostic tests for cancer: Best Practice Guide for General Practitioners Department of Health April 2012

A best practice referral pathways document for GPs for direct access to diagnostic tests for cancer. The four pathways focus on non‐obstetric ultrasound to support the diagnosis of ovarian cancer; chest x‐ray to support the diagnosis of lung cancer; flexible sigmoidoscopy to support the diagnosis of colorectal cancer; and brain MRI to support the diagnosis of brain cancer.


The Characteristics of an effective MDT National Cancer Action Team February 2010

This document sets out the characteristics of an effective MDT as identified by the responses of over 2000 MDT members to a survey in early 2009 about MDT working. It also takes into account additional views expressed at six workshops held in May 2009 and the outputs from ad hoc meetings with stakeholders. These characteristics will form the foundation on which the National Cancer Action Team’s (NCAT) MDT development work programme will build and may evolve over time. Website: www.ncin.org.uk


Best practice diagnostic guidelines for patients presenting with breast symptoms November 2010

These guidelines define, and bring together in one place, the key clinical and process markers of quality for the multidisciplinary diagnostic team to promote both quality and efficiency. They will be vital in ensuring that all breast cancer patients receive high quality, joined up care. They are as vital a guide for the GP practice as they are for the hospital specialist.

http://www.associationofbreastsurgery.org.uk/media/4585/best_practice_diagnostic_guidelines_for_patients_presenting_with_breast_symptoms.pdf

Supporting direct access to diagnostic imaging for cancer November 2012

Best practice pathways for diagnostic imaging teams. This guide covers the ‘best practice’ process for direct referral by GP’s to 3 specific diagnostic imaging tests where ovarian, lung or brain cancer may be suspected but urgent GP referral (2 week wait) is not applicable.

http://www.improvement.nhs.uk/documents/Diagnostic_Imaging_Cancer.pdf

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PHYSIOLOGICAL DIAGNOSTICS


Description Link

IQIPS Improving Quality in Physiological Diagnostics Services. The IQIPS programme is professionally led and aims to improve service quality, care and safety for patients undergoing physiological diagnostics investigations and treatments. The process of self assessment, improvement and accreditation gives national recognition to the service with a badge of quality.

www.rcplondon.ac.uk/projects/iqips

What is Physiological Measurement? Department of Health May 2007

A guide to the tests and procedures conducted by physiological diagnostics services including audiology, cardiac physiology, GI physiology, neurophysiology, ophthalmic and vision science, respiratory and sleep physiology, urodynamics and vascular science.

http://www.improvement.nhs.uk/physiologydiagnostics/documents/WhatisPhysiologicalMeasurement.pdf

Audiology Provision of Adult Balance Services – a Good Practice Guide Department of Health January 2009

This good practice guide provides practical evidence based advice on how to improve people’s access to, and experience of, balance services. It suggests how to reduce waste and unnecessary steps in care so people with balance problems receive high quality specialist services as quickly as possible.


Provision of Services for Adults with Tinnitus – a Good Practice Guide Department of Health January 2009

This good practice guide provides practical evidence based advice on how to improve people’s access to, and experience of, tinnitus services. It suggests how to reduce waste and unnecessary steps in care so people with tinnitus problems receive high quality specialist services as quickly as possible.


Transforming Services for Children with Hearing Difficulty and their Families Department of Health December 2008

This good practice guide aims to support local services in ensuring that children with hearing difficulty have improved access to high quality hearing services delivered as close to the child’s home as possible with rapid access to more specialist expertise when needed. The early detection, assessment and management of


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hearing problems in children is key to their personal, educational and social achievement.

Transforming Adult Hearing Services for Patients with Hearing Difficulty Department of Health June 2007

Improving access and reducing waits in adult hearing services requires those services to be transformed applying all the tools and techniques in service improvement and redesign. This good practice guide provides practical evidence based advice to provide quicker access to assessment and treatment and to improve the patient experience of hearing services.

http://www.thebsa.org.uk/index.php?option=com_content&view=article&id=100&Itemid=71

Shaping the future: Strengthening the evidence to transform audiology services NHS Improvement March 2011

This guide shows how applying Lean principles can improve service quality and patient experience while increasing service productivity in audiology. The principles outlined can be adapted to inform service redesign in local environments.

http://www.improvement.nhs.uk/audiology/documents/Shaping_the_Future.pdf

Pushing the boundaries: Evidence to support the delivery of good practice guide NHS Improvement July 2010

This guide outlines a range of practical examples to support clinical teams to deliver improvements in quality and the productivity of audiology services. The examples outlined cover a range of clinical audiology pathways which include tinnitus, balance, and children’s hearing as well as age related hearing loss.

http://www.improvement.nhs.uk/LinkClick.aspx?fileticket=zRsxjLXTeCw%3d&tabid=56

Cardiac Physiology Transforming Cardiac Diagnostic Services to Deliver 18 weeks – a Good Practice Guide Department of Health June 2007

This good practice guide provides practical evidence based advice on how to improve people’s access to, and experience of, cardiac services. It suggests how to reduce waste and unnecessary steps in care so people with cardiac problems receive high quality specialist services as quickly as possible.

http://www.nwlcn.co.uk/18weeks/cardiologygoodpractice060718weeksjune07.pdf

18 Week ‐ Focus on Cardiac Diagnostics NHS Improvement 2008

Focus on cardiac diagnostics is a project of the Heart Improvement Programme which focused on reducing the waiting times for all non‐invasive cardiac diagnostics. This document draws together information on good practice, advice on commissioning, workforce requirements, technology and innovation and service improvements in cardiac diagnostics

http://www.improvement.nhs.uk/physiologydiagnostics/documents/Cardiac_Diagnostics_Summary.pdf

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services. Neurophysiology Transforming Clinical Neurophysiology Diagnostic Services to Deliver 18 weeks – a Good Practice Guide Department of Health August 2007

This good practice guide provides practical evidence based advice on how to improve people’s access to, and experience of, neurophysiology services. It suggests how to reduce waste and unnecessary steps in care so people with neurophysiology problems receive high quality specialist services as quickly as possible.

http://www.improvement.nhs.uk/physiologydiagnostics/documents/Neurophysiology%20good%20practice_260907.pdf

Respiratory and Sleep Physiology

The NHS Atlas of Variation in Healthcare for Respiratory Disease Right Care September 2012

This Atlas outlines the extent of the variation in clinical activity and outcomes in respiratory services. It demonstrates the scope clinicians and commissioners have to improve outcomes by ensuring that all patients receive the quality of care that is delivered in the best performing localities.

http://www.rightcare.nhs.uk/index.php/atlas/respiratorydisease/

COPD Commissioning Tool Kit Department of Health August 2012

The Chronic Obstructive Pulmonary Disease (COPD) Commissioning Toolkit aims to make it easier to commission better outcomes for people with COPD by bringing together information about the clinical, financial and commercial aspects of commissioning.

http://www.dh.gov.uk/health/2012/08/copd‐toolkit/

Transforming Respiratory and Sleep Diagnostic Services – a Good Practice Guide Department of Health February 2009

This good practice guide provides practical evidence based advice on how to improve people’s access to, and experience of, respiratory and sleep services. It suggests how to reduce waste and unnecessary steps in care so people with respiratory and sleep problems receive high quality specialist services as quickly as possible.

http://www.improvement.nhs.uk/physiologydiagnostics/documents/RespiratoryGoodPractice_060209.pdf

Pulmonary Rehabilitation Service for Patients with COPD Commissioning Guide NICE December 2006

This guide provides support for the local implementation of NICE clinical guidelines through commissioning, and is a resource to help health professionals in England to commission an effective pulmonary rehabilitation service for patients with chronic obstructive pulmonary disease (COPD). This guide should be read in conjunction with the following NICE quality

http://www.nice.org.uk/media/63F/4D/PulmonaryRehabCommissioningGuide.pdf

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standard: http://publications.nice.org.uk/chronic‐obstructive‐pulmonary‐disease‐quality‐standard‐qs10

Vascular Science The Provision for Services for Patients with Vascular Disease 2012 The Vascular Society February 2012

This good practice guide provides practical evidence based advice on how to improve people’s access to, and experience of, vascular services. It suggests how to reduce waste and unnecessary steps in care so people with vascular problems receive high quality specialist services as quickly as possible.

www.vascularsociety.org.uk/library/vascular‐society‐publications.html

Service specifications The Society for Vascular Technology of Great Britain and Ireland August 2010

Evidence based service specifications, produced by the SVT Professional Standards Committee and are intended to be a source of guidance to anyone running, setting up or commissioning a vascular ultrasound service.

http://www.svtgbi.org.uk/resources/service‐specifications/

Lesley Wright NHS Improvement Director Email: [email protected] Fiona Thow NHS Improvement Director Email: [email protected] 21 March 2013

NHS Improvement3rd Floor | St John’s House | East Street | Leicester | LE1 6NBTelephone: 0116 222 5184 | Fax: 0116 222 5101

www.improvement.nhs.uk

NHS ImprovementNHS Improvement’s strength and expertise lies in practical service improvement. It has over a decade ofexperience in clinical patient pathway redesign in cancer, diagnostics, heart, lung and stroke anddemonstrates some of the most leading edge improvement work in England which supports improvedpatient experience and outcomes.

Working closely with the Department of Health, trusts, clinical networks, other health sector partners,

professional bodies and charities, over the past year it has tested, implemented, sustained and spread

quantifiable improvements with over 250 sites across the country as well as providing an improvement

tool to over 2,400 GP practices.

Delivering tomorrow’simprovement agenda for the NHS

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Directory of Diagnostic Services for Commissioning Organisations

Health & Medicine

Transcript of Directory of Diagnostic Services for Commissioning Organisations