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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

Fetal Gender Determination and Disclosure (Ultrasound) (670)

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

There is no requirement to determine fetal gender within the Fetal Anomaly Screening programme; however disclosure of fetal sex upon request respects a woman’s rightful autonomy over personal health information.

If the Sonographer is able to determine fetal sex with certainty and the patient wishes this information to be divulged to her, the Sonographer should advise the patient of their findings and document the gender in the ultrasound report.

Consent

The Sonographer should establish at the start of the examination whether the patient wishes to know the sex of the baby. If the patient indicates that they do wish to know – verbal consent should be obtained and recorded on the ultrasound report.

The Sonographer should advise the patient that it is not always possible to determine the sex of the baby, that it is not always 100% accurate and that the examination will not be extended to determine this.

There are occasions where the woman may not want to know the sex of the baby but Obstetric and Neonatal Medical Staff require this information for future management. In these circumstances the gender should be recorded on the ultrasound report and clearly stated that the patient does not want to be informed of the gender.

The Ultrasound examination

During the ultrasound examination, fetal gender should be ascertained under direct observation; views including transverse, sagittal and tangential sections of the fetal perineum should be examined.

The male gender should be determined by the clear visualisation of the penis and scrotum. Female gender should be determined by identification of the two or four parallel echogenic lines representing the labia folds.

An ultrasound image demonstrating the fetal genitalia should be recorded and retained in the patient's notes. The Sonographer should document the gender in the ultrasound report.

If clear visualisation of the genitalia is not possible with the prescribed time limits, the examination should not be prolonged or repeated to determine the fetal gender. The Sonographer should document in the notes that they were unable to determine the fetal sex.

Informing the Patient

The Sonographer should either verbally advise the patient of their findings or if requested, complete the 'Gender determination at 20 week Fetal Anomaly Scan' consent form.

The patient is required to sign and date this form. The Sonographer will then complete the tear off slip by circling the gender. The tear off slip will then be folded and handed to the patient. No envelopes will be provided. The signed portion of the consent form will be stored with the ultrasound images within the case notes.

This information should not be shared with the patient’s friends or relatives.

Appendix: Gender determination at 20 week Fetal Anomaly Scan Form

Gender determination at 20 week Fetal Anomaly Scan form (pdf)

Editorial Information

Last reviewed: 30/11/2022

Next review date: 04/11/2027

Author(s): Donna-Maria Bean.

Version: 2

Approved By: Obstetrics Clinical Governance Group

Document Id: 670

References

Harrington, K, Armstrong, V, Freeman, J, Aquilina, J and Campbell, S. (1996), Fetal sexing by ultrasound in the second trimester; maternal preferences and professional ability. Ultrasound in Obstetrics and Gynaecology, (8), p318-321.

Fetal Anomaly and Down’s Syndrome Screening National protocols, Version 2.0 NHS Scotland Screening Programmes – Pregnancy and Newborn Screening, (2011).

Sale of images, determination of Fetal Gender and commercial aspects related to NHS Obstetric Ultrasound examinations. The Society and College of Radiographers, (2011).