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Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 pm

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.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   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 Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

 

Estimated Due Date (EDD) Ultrasound Scan (501)

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

EDD should be calculated from the first scan ≥ 11+ 2 weeks gestational age (≥ 45mm).

If the initial scan is performed < 11+2 weeks gestation, the patient should have a return appointment at approximately 12-13 weeks gestation to perform optimal dating +/- NT measurements.
(Refer to Screening / Non-screening Pathways)

Upper and lower limbs must be assessed as well as cranial anatomy

Parameters to be Used for Calculation of EDD and Associated Downs Syndrome Screening Method

As adapted from Chudleigh, Loughna & Evans (2011) from BMUS.

Parameter 

Parameter used for establishing EDD

Down’s Syndrome Screening method

CRL < 45.0mm

Unable to date. Re-scan at 12-13 weeks gestation

N/A

CRL 45.0mm – 84.0mm

CRL

First Trimester CUBS 

CRL >84mm  and HC< 101.0mm

Unable to date.  Re-scan ≥ 14+2 weeks gestation

No screening until EDD confirmed

HC ≥ 101.0mm – 172.0mm

HC

Second Trimester Bloods only (AFP)

1st Trimester dating (CRL 45.0mm-84.0mm)

Recommended criteria for measurement of CRL for pregnancy dating (UKNSC, 2015):

CRL DETAIL TO BE DEMONSTRATED
MIDLINE SECTION
  • Sagittal section of the fetus with the head in line with the full length of the body
  • Echogenic tip of the nose
  • Rectangular shape of the palate
  • Translucent Diencephalon
  • CRL axis should be between 0-30 degrees to horizontal
  • Clearly defined crown and rump 
POSITION
  • Pocket of fluid, at least equivalent in size to the width of the palate, should be visible between the fetal chin and chest 
  • Fetal palate angle should be 30º to 60º relative to the horizontal 
  • Nasal tip should be level or above the anterior abdominal wall 
MAGNIFICATION
  • Entire CRL section should fill over 60% of the screen 
CALIPER PLACEMENT
  • Correct calliper placement on outer borders of crown and rump
  • Longest length of the fetus should be measured
IMAGE ARCHIVING
  • The CRL should be measured at least twice and the maximum measurement that meets the criteria should be recorded 
  • The image demonstrating the measured CRL which has been reported should be archived

2nd Trimester dating (HC ≥ 101.0mm – 172.0mm)

The HC should be calculated using the recommended values of Altman and Chitty as per BMUS recommendations.

Technique for calculation of HC:

A cross-sectional view of the fetal head at the level of the ventricles should be obtained. The image should have the midline echo lying as close as possible to the horizontal plane.

The following landmarks should be identified and the image frozen:

  • rugby ball shape;
  • centrally positioned, continuous midline echo broken at one third of its length by the cavum septum pellucidum;
  • anterior walls of the lateral ventricles centrally placed around the midline;
  • the choroid plexus should be visible within the posterior horn of the ventricle in the distal hemisphere.
  • Callipers should be placed on the outer border of the occipital and frontal bones as close as possible to the midline across the longest part of the skull.

If HC measurements cannot be made then EDD should be calculated using the femur length (FL)

Technique for calculation of FL:

The image should be obtained with the femur lying as close as possible to the horizontal plane. The full length of the bone should be visualised with soft tissue visible at both ends. Calipers should be placed at the centre of the ‘U’-shape at each end of the bone.

Third Trimester (Late Booker: HC > 232mm)

After 25 completed weeks the patient will be classed as ‘LATE BOOKER'.

All three measurement parameters [HC, AC and FL] should be obtained.

An EDD will be calculated from the HC measurement and entered on Badgernet. On the ultrasound report page type in comments ‘EDD based on HC >25 weeks GA’ and create a LATE BOOKER alert.

Multiple Pregnancy

If there is discrepancy in the sizes between the fetuses, the EDD should be calculated from the largest fetus, using the criteria above.

Establishing Gestational Age Prior to Visualisation of a Live Embryo

Gestational age may be assessed from measurements of the mean sac diameter (MSD). This is calculated from the maximal diameters of the gestation sac (in mm) in the longitudinal and transverse views on transvaginal scan. The Mean gestation sac volume should be calculated where a transvaginal examination is declined using the full bladder technique.

An EDD should only be generated once a live embryo or fetus has been identified measuring ≥ 45mm.

Ultrasound EDD/Screening Pathway – Singleton (patients who wish Downs syndrome screening)

Ultrasound: Establishing EDD/Screening pathway - Singleton (Patients who decline T21 screening)

Editorial Information

Last reviewed: 31/05/2022

Next review date: 31/05/2026

Author(s): Donna Maria Bean.

Version: 2

Approved By: Obstetrics Clinical Governance Group

Document Id: 501

References

Altman DG & Chitty LS (1997). New charts for ultrasound dating of pregnancy. Ultrasound Obstet Gynecol 10:174-91

Antenatal Care: Routine care for the pregnant healthy woman. National Institute of Clinical Excellence (NICE) Guildeline.

Chudleigh, T., Loughna, P and Evans, T. (2011). A practical solution to combining dating and screening for down’s syndrome. Education & Training 1:154-71

Fetal Anomaly Screening Programme Handbook for Ultrasound Practitioners. UKNSC  April 2015.

Fetal Size and Dating:Charts Recommended for Clinical Obstetric Practice. BMUS, Jan 2008

Guidelines for Professional Working Standards. Ultrasound Practice. United Kingdom Association of Sonographers. October 2008