NICE guidance on elective surgery in the wake of COVID-19

NICE has published a guideline on the arrangements the NHS should put in place for patients needing elective surgery and other planned treatments and procedures (including diagnostics and imaging) during the COVID-19 pandemic.

The latest in its series of COVID-19 rapid guidelines, the guideline makes recommendations about how these services should be organised in order to balance the risks associated with COVID-19 with the potential harms that can arise from delays in elective treatment and diagnostic procedures. It promotes a flexible approach based on individual circumstances and the type of procedure and aims to support the prompt recovery of elective care, while advocating shared decision-making, balancing the risks and benefits.

The guideline emphasises the need to discuss with people having planned care factors such as older age, sex and whether they are from a black, Asian or other minority ethnic group, or have any underlying conditions that could increase their risk of getting COVID-19 and of having a severe illness, because these may influence their decision to go ahead with their planned care. In order to minimise the risk of COVID-19 transmission to other patients and healthcare workers, the guideline says that people having planned care involving any form of anaesthesia or sedation should follow comprehensive social-distancing and hand-hygiene measures for 14 days before admission. They should also be advised to have a test for SARS CoV 2 within three days before admission and self-isolate from the day of the test until the day of admission. For all other planned procedures, including diagnostic tests and imaging, people should be advised to follow comprehensive social distancing and hand

Moving hospital appointments online could save £500 million

One in three routine outpatient hospital attendances could be moved online, saving nearly half a billion pounds per year in lost economic activity and wasted NHS time. Analysis by digital healthcare platform

hygiene measures for 14 days before having planned care. For people who are at greater risk of getting COVID-19, or having a poorer outcome from it, the guideline says they should be advised that some types of surgery, for example cardiac, carry additional risks for people with COVID-19, and that they should consider self-isolating for 14 days before a planned procedure. The guideline says that people should be informed that their planned care is likely to be postponed if they test positive, have symptoms of COVID-19, are not clinically well enough or need to self-isolate after contact with someone with COVID-19 (for example, as identified by the NHS Test and Trace system). People having inpatient surgery who stay in hospital for more than five days should be tested for SARS-Cov-2 between five and seven days after admission, in line with current NHS England and Improvement advice. The guideline also recommends that all people going from hospital to other care settings are tested before they are discharged. To view the guideline, visit:

provider Visiba Care reveals that 25.8 million NHS outpatient consultations in England annually could be delivered using digital technology, allowing patients to get help and advice from their consultant without the need for a hospital visit. The findings also reveal that more than half of all hospital outpatient attendances (54%) last year were made by people aged 16-64 and show that the wider use of digital consultations would mean nearly one million days off work for NHS consultations could be avoided, pouring an estimated £231.3m back into the British economy. There would be further savings to the NHS from moving consultations online totalling £265.7m, from a combination of more efficient use of clinicians’ time – digital consultations are typically quicker to complete than face-to-face ones – and fewer missed appointments known as DNAs (‘did not attend’). Scaled across England, digital consultations could save nearly five million hours of clinical time. Taking avoidable lost economic output and NHS efficiency savings together, wider use of digital consultations would release a cautious estimate of £497m per year. Moving appointments online could help towards meeting the Government’s goal to reduce face-to-face outpatient appointments by a third by 2023-24.

Plaster cast ‘effective as surgery’ for common wrist fracture The research found that patients who had

The SWIFFT trial, led by researchers at University Hospitals of Leicester NHS Trust found that for a fracture of the scaphoid bone (one of eight small bones in the wrist), a plaster cast provides as good healing as surgery. Fracture of the scaphoid bone is common in young, active people, caused by a fall on the hand or the hand being suddenly forced backward. The research suggests that by opting for a plaster cast, patients can avoid the risk of surgery, while hospitals can keep service delivery simple and cost effective, without compromising patient outcomes.

surgery had more complications following treatment (12%) than the plaster cast group (2%). In addition, the cost of surgery to the NHS was significantly higher at £2,350, compared with the cost of plaster cast treatment, which was £727 for each patient. Professor Joseph Dias, orthopaedic surgeon at the University Hospitals of Leicester NHS Trust and Chief Investigator for the SWIFFT trial, said: “This study confirms that putting a wrist with a broken scaphoid in a plaster cast provides as good healing as surgery, so long


as the few that do not re-join are identified and fixed by the medical team. Fixing the scaphoid by surgery does not speed up healing and the time taken to return to work is the same as when a cast is used. “With our research, patients and medical practitioners can be confident that we can treat patients with this fracture safely and effectively in a cast, resorting to surgery only when the bone doesn’t heal.” The study was funded by the NIHR

Health Technology Assessment Programme and the findings were published in the Lancet.


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