Quality statement 4: Assessment

Quality statement

People who have imaging features suggestive of active pulmonary tuberculosis (TB) are assessed by the next working day.

Rationale

Assessing people by the next working day helps to ensure that case management and infection control procedures start promptly. Delayed diagnosis can delay the start of treatment, which may in turn lead to greater risks of morbidity (both long and short term) and mortality.

Quality measures

Structure

Evidence of TB services having local arrangements in place to ensure that people who have imaging features suggestive of active pulmonary TB are assessed by the next working day.

Data source: Local data collection.

Process

Proportion of people with imaging features suggestive of active pulmonary TB who are assessed by the next working day after their results are received.

Numerator – the number in the denominator who are assessed by the next working day after their results are received.

Denominator – the number of people with imaging features suggestive of active pulmonary TB.

Data source: Local data collection.

Outcome

a) Proportion of people with active pulmonary TB starting treatment within 2 months of symptom onset.

Data source: National and regional data on the proportion of pulmonary TB cases starting treatment within 2 months of symptom onset is collected in Public Health England's TB Strategy monitoring indicators.

b) Active pulmonary TB incidence.

Data source: Local data collection. National and regional data on TB incidence in England is collected in Public Health England's TB Strategy monitoring indicators.

What the quality statement means for different audiences

Service providers (secondary care services) have systems in place to ensure that people who have imaging features suggestive of active TB are assessed no later than the next working day after their results are received.

Health and social care practitioners (such as a respiratory physician or nurse) assess people who have imaging features suggestive of active TB no later than the next working day after they receive the results.

Commissioners (clinical commissioning groups) ensure that they commission services that have the capacity to assess people who have imaging features suggestive of active TB no later than the next working day after their results are received.

People who have a chest X-ray that suggests they have active TB have an assessment no later than the first working day after their results are received by a health or social care practitioner such as a respiratory doctor or a nurse.

Source guidance

Tuberculosis (2016) NICE guideline NG33, recommendation 1.8.9.8

Definitions of terms used in this quality statement

Imaging features suggestive of active TB

These include but are not limited to:

  • evidence of extensive consolidation or cavities

  • predominantly upper lobe involvement.

[NICE's guideline on tuberculosis, adapted from recommendation 1.8.9.8 and expert consensus]

Assessment

This type of assessment is done by a member of the TB service or the multidisciplinary team, or a person with expertise in respiratory medicine.

The assessment is to gather information about symptoms and general clinical information. Assessments are an ongoing process and should be reviewed and amended during the treatment period.

[Expert consensus]

Equality and diversity considerations

Healthcare professionals who are doing assessments on people who have imaging features suggestive of active TB should be aware that many of these people come from under-served groups. These groups may find it difficult to access TB services because of a lack of awareness of TB and its treatment and because of the stigma associated with a diagnosis of TB.