Signs and symptoms
- Dysfunction of bladder, bowel or sexual function
- Sensory changes in saddle or peri-anal area
- Gait disturbance
Pain may be wholly absent; the patient may complain only of lack of bladder control and of saddle anaesthesia.
Welcome to the Right Decision Service (RDS) newsletter for August 2024.
Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.
We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.
I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.
2.National IV fluid prescribing calculator
This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.
Please do spread the word about this new calculator and get in touch with any questions.
The following toolkits are now live;
We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.
We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.
To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)
7 Evaluation projects
Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.
We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.
If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
The primary aim of the patient assessment and differential diagnosis is to exclude any serious pathology through screening for red flags.
It is important to bear in mind that red flags represent a list of clinical findings rather than a set of diagnostic labels. They raise an index of suspicion with regard to sinister pathology. It is only after clinically reasoning all assessment findings that a clinical diagnosis should be made. It is also important to retain a sense of perspective when examining patients as only 1% of examined patients are suspected of having a serious pathology. It is vital to look at the patient from a holistic perspective and consider the context of each finding in light of other findings.
NB: Index of suspicion only. Accumulation (cluster) of a number of red flags or increased frequency of main indicators increases that index of suspicion.
Red Flags: are essentially clinical prediction guides: they are not diagnostic tests and they are not necessarily predictors of diagnosis or prognosis. The main role of red flags is that when combined they help to raise the clinician’s index of suspicion. Red Flags II.
Age > 50 years + History of Cancer + Unexplained weight loss + Failure to improve after 1 month of conservative management. (SENSITIVITY 1.0 i.e. 100 %) Greenhalgh and Selfe (2006)
Where a patient is failing to respond to conservative management re-screening for red flags should be repeated.
If serious pathology is suspected discuss with senior colleague or clinical specialist for potential ONWARD REFERRAL referral as required.
Possible red flags that may indicate serious pathology are:
The Red Flag indicators of serious pathology include:
For guidance on the identification and onward referral for patients with suspected Serious Pathology, see the relevant sections below.
Signs and symptoms
Pain may be wholly absent; the patient may complain only of lack of bladder control and of saddle anaesthesia.
Signs and symptoms
Next steps
See West of Scotland guidelines for malignant spinal cord compression.
Signs and symptoms
Next steps
Onward referral for GP/Neuro.
Signs and symptoms
Next steps
Urgent referral to orthopaedics or GP
Signs and symptoms
Next steps
Refer to GP/Ortho.
Signs and symptoms
Next steps
Refer to Rheumatology.
Signs and symptoms
Next steps
Refer to ortho/A&E
Signs and symptoms
Next steps
Refer to surgical team/GP
Signs and symptoms
Next steps
Patient to contact NHS24 for advice.
Signs and symptoms
Next steps
Patient to contact NHS24 for advice.
Signs and symptoms
Next steps
Sign post to A&E or call 999.