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Robot-assisted surgery for hysterectomy or sacrocolpopexy

  Robot-assisted surgery (RAS) for hysterectomy or sacrocolpopexy should be limited to clinical research settings at present as it is unclear whether it is safer and more effective than conventional laparoscopic surgery (CLS). Ongoing trials are

Published November 2015

Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults

There is no good evidence that flushing central venous catheters (CVCs) with heparin is better than flushing with normal saline solution (sodium choride 0.9%). Heparin may cause undesirable side effects and gives no benefit over normal saline, which

Published September 2015

Operative procedures for anal fissure

  Anal fissure is an ulcer of the skin that lines the anus, causing pain on defecation. A number of procedures have been trialled for treatment of this condition, including manual anal stretch and sphincterotomy. Manual anal stretch has a

Published August 2015

Nystatin prophylaxis and treatment in severely immunodepressed patients

  This review suggests that although nystatin is effective prophylaxis and treatment for oral candidiasis in immunocompetent individuals, the effect of nystatin for prophylaxis or treatment of oral candidiasis in immunodepressed individuals is no

Published July 2015

Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews

  Complex regional pain syndrome (CPRS) is characterised by pain and a variety of other local symptoms that are disproportionate to the injury sustained. This comprehensive review identified a number of systematic reviews of clinical

Published July 2015

Stopping perioperative antibiotics for post-tonsillectomy morbidity

  NICE summary of Cochrane review conclusions The review suggests that antibiotics, although prescribed to reduce bacterial burden post tonsillectomy and hence reduce pain and bleeding, do not in fact reduce analgesic prescription, reported

Published March 2015

Ensuring appropriate use of monitored dosage systems: reducing unnecessary pharmacy workload

  This initiative aims to reduce the inappropriate use of monitored dosage systems by ensuring they are only issued on a case-by-case basis to address specific practical problems of medicines adherence. The inappropriate use of monitored dosage

Published January 2015

Pharmacist-led repeat prescription management: ensuring appropriate prescribing and reducing wastage

  Walsall Clinical Commissioning Group (CCG) implemented a pharmacist-led repeat prescription management service (RPMS). The service was aimed at reducing medicines wastage, minimising possible harm from medicines and improving the quality of

Published November 2014

A pharmacist-led ulcerative colitis review service: Improving medicines adherence in general practice

This case study describes a pharmacist-led ulcerative colitis review service which was commissioned by Bushloe End surgery in Leicester. The initiative was also rolled out to an additional 4 surgeries in the city of Leicester and 6 surgeries in

Published October 2014

Bed rest and posture for preventing post-dural puncture headache

Post-dural puncture headaches are a recognised complication of any procedure where the dura is punctured. The dural puncture may be intentional, with the use of a spinal needle, or unintentional, as a complication of epidural injections or

Published September 2014

Crisis response falls team: reducing admissions and repeat falls

Falls-related calls make up about 20% of all calls received by the East Midlands Ambulance Service (EMAS); approximately 90,000 calls per year. Reducing demand on hospitals and the potential negative outcomes associated with hospital admission

Published August 2014

Early epoetin for preventing red blood cell transfusion in premature infants

Use of epoetin (also known as EPO) may reduce the use of blood transfusions but not sufficiently to reduce donor exposure. Use of epoetin appears to lead to an increase in the incidence of retinopathy of prematurity (ROP). As such the Cochrane

Published July 2014

Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis

NICE summary of review conclusions Given the established effectiveness and safety of aminosalicylates (that is, mesalazine or sulfasalazine) for the maintenance of remission in ulcerative colitis, azathioprine and [6-] mercaptopurine cannot be

Published March 2011

Fragility fractures - acute care

In the USA orthogeriatricians have been used to improve the care of elderly patients with fragility fractures. This has improved quality by reducing both the time to surgery and post-operative complications. Productivity has been improved by reduced

Published November 2009

Surgery for obstructive sleep apnoea in adults

NICE summary of review conclusions A small number of trials have compared different surgical techniques with inactive and active control treatments for patients with obstructive sleep apnoea/hypopnoea syndrome. The studies do not provide

Published January 2011

Telemedicine for primary care ECG (electrocardiogram) interpretation

A telemedicine system was established that allowed ECGs undertaken in primary care to be sent for interpretation to a centre staffed by clinical specialists. Interpretations are returned within 30 minutes. Referrals to secondary care were reduced

Published November 2009

Enhanced recovery for elective surgery

Enhanced recovery programmes use evidence based interventions to improve pre-, intra-, and post-operative care. They have enabled early recovery, discharge from hospital, and more rapid return to normal activities. Quality is increased by reducing

Published November 2009

Heart Failure: Use of BNP/NTproBNP testing in primary care to facilitate early diagnosis

To assist the primary care organisations still to implement Serum Natriuretic Peptide (Serum NP: either BNP or NTproBNP) testing as part of the primary care diagnostic pathway for heart failure, through the spread of evidence, good practice and

Published June 2011

Adopting a US model for elective joint replacement service

Two NHS hospitals’ orthopaedic teams were trained and then adopted the US Glen Cove service model for elective orthopaedic care. This improved quality and productivity in the departments with lower prosthesis costs and increases in surgical

Published November 2009

Speech therapist led videofluoroscopy for swallowing assessments

Videofluoroscopy clinics were staffed by speech therapists and radiographers instead of consultant radiologists and speech therapists. This system was more time efficient and gave a more comprehensive assessment of swallowing dangers. Cost savings

Published November 2009

Text messaging in healthcare: to reduce non-attendance

To reduce "Did not attend" (DNA) rates leading to missed appointments. Portsmouth NHS Trust outpatients department has approximately 43,000 outpatients per month with an average of 3300 DNAs per month. This leads to missed appointments, lost

Published July 2011

The WHO Surgical Safety Checklist:to reduce harm by consistent use of best practice

To reduce harm during the perioperative period by encouraging theatre teams to consistently apply evidence-based practices and safety checks to all patients, and by improving teamwork and communication by following the Five Steps to Safer Surgery

Published August 2011

The productive operating theatre

This programme is designed to produce a long term cultural change in the performance of operating theatres. It is estimated to produce savings of £1.7 million for an average-sized trust per annum with an improvement in quality of care in multiple

Published November 2009

Thyroid Fine Needle Aspiration (FNA) Cytology: Implementation of a standardised and reproducible terminology system

This case study aims to improve the quality of terminology and the reporting of thyroid cytology diagnoses and thus improve the service quality for patients. This initiative demonstrates the effectiveness and clinical usefulness of The Royal College

Published June 2011

Patient self-care in podiatry

The programme educated patients in podiatric self-care. Quality and cost benefits have not been quantified, but more patients were seen per podiatrist following implementation.

Published November 2009

Cervical Cancer screening - improved efficiency

Efficiency in screening has been used in 13 regions to improve detection of cervical cancer. Quality is improved by the optimal treatment of patients with suspected cervical cancer, thereby reducing the risk of death. Productivity is increased by

Published May 2010

Early use of oral prednisolone for Bell's palsy

The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme concludes that the use of oral prednisolone within 72 hours of symptom onset improves outcomes in patients with Bell’s palsy. The use of prednisolone alone

Published November 2009

Rapid Response Services: intermediate tier, multi-disciplinary health and social care service

The approach recognises that crises for older people almost always have a health and a social care component. Therefore, the model described involves an integrated approach across health and social care and, in this example, is a partnership between

Published February 2011

Productive community services: releasing time to care

Observational research suggests that there is considerable scope for improving efficiency in community based services through teams completing a set of service modules. These aim to increase quality by increasing time with patients and adherence to

Published November 2009

Enhanced home-based palliative care for adults

Establishing a nurse-led palliative care service across the Bournemouth and Poole area has helped more people to die at home. This has led to an estimated saving of 16,404 bed days and further savings from avoiding A&E admissions. Feedback from

Published November 2009

Antiplatelet agents and anticoagulants for hypertension

NICE summary of review conclusions Aspirin cannot be recommended for the primary prevention of cardiovascular events in patients with hypertension because the benefit does not outweigh the harm. The size of the benefit is much greater for

Published February 2011

Transport service for dialysis patients:to improve quality

To improve the quality, efficiency and cost of dialysis transport services. As people receiving haemodialysis are high users of hospital transport services. This initiative addresses a more efficient approach to transport for people undergoing

Published July 2010

Transplant donation - training for A&E staff

A centrally-funded training programme for emergency medicine staff saw a 13-fold increase in organ donor referrals over a 4 year period in the North Thames area. Extrapolating the resulting increase in transplant surgery would produce savings

Published November 2009

Management of patients with Stroke: REDS (Reach Early Discharge Scheme)

The Stroke REDS team was developed from a fully functional community rehabilitation team, Camden REACH, with the commissioning of new posts integrating stroke-skilled staff into a new ESD pathway. Camden REACH provides stroke rehabilitation and

Published October 2012

Community Teams: Improving Patient Safety and Reducing Risk

To improve patient safety and reduce district nursing services through: • ensuring accountability of care at all levels of triage, treatment and outcome • having  a single point of contact for patients and referrers • moving from task

Published March 2011

Stroke pathway: delivering through improvement

The NHS Institute supported Chief Executives and senior leadership to champion change and improvement across NHS organisations in all areas of the stroke pathway. Quality was improved by reducing mortality, time in A&E, and delay in CT scanning.

Published November 2009

Improving medicines management: An effective approach to local decision-making

Organisations have come together across Mid Mersey (Halton, St Helens, Warrington, and Knowsley) to form the Mid Mersey Medicines Management Board (4MB). The Board covers four main areas of work: - formulary and guidelines: develop local

Published October 2011

Statins for the treatment of dementia

NICE summary of review conclusions At present, evidence to recommend statins for the treatment of dementia is insufficient. Analysis from the studies available, including one large randomised control trial indicate that statins have no clear

Published December 2010

Intra-amniotic surfactant for women at risk of preterm birth for preventing respiratory distress in newborns

NICE summary of review conclusions Intraamniotic instillation of surfactant for women at risk of preterm birth is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research

Published October 2011

Routine chest physiotherapy for pneumonia in adults

NICE summary of review conclusions Chest physiotherapy should not be recommended as a routine adjunctive treatment for pneumonia in adults as it is not supported by sufficient good quality evidence. Consideration could be given to using it only

Published October 2011

Emergency day surgery: Improving productivity and reducing bed days

This case study is about improving the management of patients with minor emergency surgical conditions (principally abscesses) by assessing them and admitting them if possible as emergency day cases the following day. This should save bed days and

Published January 2012

Avoiding unnecessary referral for glaucoma: use of a repeat measurement scheme

To reduce the number of unnecessary suspect glaucoma referrals to the hospital eye service in Bexley Care Trust, thereby improving quality of referral, generating savings and releasing capacity. A glaucoma repeat measurement scheme, in which the

Published December 2011

Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin

NICE summary of review conclusions Evidence shows that the harms of using low or medium intensity anticoagulation for the prevention of further vascular events after a transient ischaemic attack (TIA) or minor stroke of presumed arterial origin

Published December 2011

Miniport versus standard ports for laparoscopic cholecystectomy

NICE summary of review conclusions Use of miniport as opposed to standard ports for laparoscopic cholecystectomy is not currently supported by sufficient good quality evidence. Consideration could be given to using it only within the context of

Published October 2011

Prevention of inpatient falls: systematic risk assessment and reduction programme

This case study describes how a Trust is aiming to prevent inpatient falls by developing a stepwise approach underpinned by information from national sources. It is calculated that in an average 800-bed acute hospital trust, there will be about 24

Published December 2011

Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases

NICE summary of review conclusions Breathing training, walking aids, neuroelectrical muscle stimulation and chest wall vibration appear to be effective non-pharmacological interventions for relieving breathlessness in the advanced stages of some

Published December 2011

Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children

Evidence shows that biofeedback for treating functional faecal incontinence is not effective in children and should not be used. NICE has previously recommended against the use of biofeedback to treat functional constipation; but biofeedback also

Published May 2012

Corticosteroids for treating severe sepsis and septic shock

NICE summary of review conclusions Evidence shows that a course of low-dose corticosteroids lasting for 5 day or longer leads to better outcomes for patients with septic shock. However, shorter courses of high-dose corticosteroids are not

Published December 2011

Beta-lactam antibiotic monotherapy versus beta-lactam–aminoglycoside antibiotic combination therapy for sepsis

NICE summary of review conclusions Evidence shows that the harms of using a combination of aminoglycoside antibiotic together with narrow-spectrum beta-lactam antibiotic for the empirical treatment of sepsis may outweigh the benefits of using a

Published December 2011

Oral budesonide for induction of remission in ulcerative colitis

Evidence shows that oral budesonide is not an effective treatment for acute ulcerative colitis and should not be used. Oral mesalazine is significantly more effective at inducing remission in people with an acute exacerbation of ulcerative

Published May 2012