Procedure Criteria (Link to PLCV policy: Patient Leaflet Information

Transcription

1 PLCV Policy Summary (Explore having it as a screensaver on desktops) Procedure Criteria (Link to PLCV policy: Patient Leaflet Information Hernias Gastroscopy for Dyspepsia Tonsillectomy & Adenoidectomy Refer overt or suspected symptomatic inguinal hernia Refer all femoral hernias. Urgently refer - irreducible and partially reducible inguinal hernias - groin hernias in women - suspected strangulated or obstructed inguinal hernia (EMERGENCY) Diagnostic imaging should not be requested at primary care level Urgently refer (within 2 weeks) for direct access upper GI endoscopy - Chronic gastrointestinal bleeding - Progressive unintentional weight loss - Progressive dysphagia OR aged 55 and over with weight loss and any of the following: upper abdominal pain, reflux, dyspepsia Non-urgent upper gastrointestinal endoscopy - pts > 55 years with unexplained and persistent recent onset dyspepsia or - upper abdominal pain with low haemoglobin levels or - raised platelet count with (one of): - nausea, vomiting, weightless, reflux, dyspepsia, upper abdo pain or - nausea or vomiting with (any one of) :- weight loss, reflux, upper abdominal pain Refer (any one of) - suspected malignancy - more than one episode of peri-tonsillar abscess (quinsy) - acute upper airways obstruction OR - Recurrent sore throat caused by tonsillitis, with significant and documented impact on quality of life e.g. absence from school/work. AND i. 7 or more eligible episodes in the last year or ii. 5 or more eligible episodes in each of the last 2 years or iii. 3 or more eligible episodes in each of the last 3 years. hernia-leaflet. dyspepsia-indigestion. tonsils-and-adenoids. tonsillitis-leaflet.

2 Children only Varicose veins Cholecystectomy Grommets (any one of) - Failure to thrive due to difficulty eating solid foods or - strong clinical history suggestive of sleep apnoea, or - significant impact on quality of life e.g. ability to exercise, unreasonably slow eating/ difficulty eating solids, loud and persistent noisy / mouth breathing leading to social difficulties. One or more of the following indications are present: - - significant venous eczema, venous ulcer or lipdermatoslerosis - superficial thrombophlebitis likely due to venous incompetence - major bleeding episode from the varicosity AND Referral for weight management advice if BMI >25kg/m2 and smoking cessation made where applicable (or pt is a non-smoker). Pt needs to have confirmed smoking abstinence for a minimum of 6 weeks before surgery. Refer pts with symptomatic gallbladder stones: - - clinically significant symptomatic gallstones (epigastric/ RUQ pain, lasting several minutes to hours, frequently nocturnal) Removal of asymptomatic gallbladder stones is not funded, unless resident in the common bile duct. Refer children aged 2 and above with bilateral otitis media with effusion (where auto-inflation with a nose balloon has not been tolerated/ successful and minimum of three months watchful waiting from index presentation) with one of: - - at least 5 occurrences of acute otitis media needing medical assessment and/or treatment in the last 12 months. - hearing loss of at least 25-30dB in the better ear - evidence of developmental delay (speech, education, behavioural problems) attributed to the hearing loss or a significant second disability that may itself lead to developmental problems, eg Down s syndrome, Turner s syndrome, cleft palate Refer adults with at least one of the following criteria: - - Three months watchful waiting, refractory to auto-inflation and significant negative middle ear pressure has been measured on two sequential appointments. Hearing aids offered. - 3 episodes of acute otitis media in 6 months OR 4 episodes in 12 months AND refractory to continuous antibiotic therapy AND impairs speech and/or hearing - Barotrauma with pain caused by changes in pressure, eg scuba diving/ flying - Unilateral middle ear effusion where a biopsy and/or examination of the post nasal space required to exclude malignancy varicose-veins-leaflet. gallstones. gallstones-diet-sheet. glue-ear-leaflet. Page 2 of 5

3 Surgical Haemorrhoidectomy Refer either: - Recurrent and persistent systematic haemorrhoids unresponsive to conservative measures (eg topical treatment, increased fluid and fibre intake) OR Haemorrhoids that cannot be successfully reduced and where banding is not appropriate (or available in primary care) haemorrhoids. Surgical treatment of sleep apnoea Hysterectomy for Menorrhagia Bunions Hyperhidrosis Patients need to have been referred to a weight management service if the patient is overweight or obese. (additional criteria will need to be met by secondary care prior to surgery eg no improvement with 6/12 CPAP, sleep studies) NB: Presence of pelvic pain/ pressure would warrant investigation with ultrasound before pharmacological treatment. - unsuccessful trial of at least 6 month s duration of a levonorgestrel intrauterine system (eg Mirena), unless contraindicated or inappropriate AND at least two of the following treatments have not improved symptoms (or are not appropriate or contraindicated) Non-steroidal anti-inflammatory drugs, eg naproxen Tranexamic acid Oral hormones, eg cyclical oral prosterone, combined oral contraceptives AND There is evidence of severe impact on quality of life Urgently refer: - impending or non-healing skin ulcer at bunion site Symptomatic bunions will be removed where: - - Persistent symptoms despite minimum 3 months of conservative treatment AND - Presence of severe deformity causing significant functional impairment* (eg overriding toes) OR - Severe pain causing significant functional impairment* OR - Pain under ball of the affected foot *examples of significant functional impairment: preventing work duties, physical activity, domestic/ carer activities Refer to secondary care for further management where all of the following interventions have proven unsuccessful: - Lifestyle advice modification has been given - Investigation and treatment of any underlying conditions has been addressed - Over the counter topical aluminium chloride - Oral anticholinergics if AlCl 3 has not improved symptoms after 1 month (eg propantheline 15mg BD) obstructive sleep apnoea. Hysterectomy update -v2. Bunions- v2. Hyperhidrosis summary. Page 3 of 5

4 Microsuction for removal of ear wax Spinal Cord Stimulation for chronic neuropathic pain Meibomian (chalazion) cyst removal Refer if one or more of the following contraindications to ear irrigation is present: - - There is a history of a middle ear infection in the last six weeks - The patient has undergone ANY form of ear surgery (apart from grommets that have extruded at least 18 months previously and the patient has been discharged from the ENT Department). - The patient has a tympanic membrane perforation or there is a history of a mucous discharge in the last year. - The patient has a cleft palate (repaired or not). - In the presence of acute otitis externa with pain and tenderness of the pinna. - The patient has hearing loss of one ear, and the remaining functional ear is the one to be treated (could result in permanent deafness) or - The patient has experienced complications following ear irrigation or - Ear irrigation has been unsuccessful on two successive occasions despite appropriate pretreatment with wax softeners All of the following need to apply: - - The patient has chronic pain for at least 6 months (measuring at least 50mm on a 0 100mm visual analogue scale) - The pain is neuropathic in origin - All medical and surgical measures are not appropriate OR have not resolved pain - The patient has had a good response (at least 50% reduction in pain intensity from baseline) to a spinal cord stimulator trial - The benefits of the procedure are deemed to outweigh the risks - The specialist team are experienced in assessing and managing patient response to treatment from spinal cord stimulation At least TWO of the following criteria must apply: - - The cyst(s) has/ have been present for more than six months - The cyst(s) has/have been managed conservatively with warm compresses, lid cleaning and massage for at least FOUR weeks - Vision is significantly impaired - Lid closure is affected, thereby compromising eye protection - The cyst(s) is/ are a source of infection, creating an abscess - The cyst(s) has/ have been a source of infection requiring medical attention on two or more occasions in the last 12 months Refer to ophthalmology if the cyst presents with a red eye, to rule out blepharokeratoconjunctivitis (BKC) OR if malignancy is suspected Microsuction of ear wax. Spinal cord stimulation. Chalazion patient uk. Page 4 of 5

5 Imaging in management of trochanteric bursitis (not routinely commissioned) Imaging in Morton s Neuroma (not routinely commissioned) Knee arthroscopy and management of suspected meniscal tears in patients with degenerative knee arthritis 90% of cases settle with conservative measures. Requesting ultrasound or other imaging is not required as it will unlikely alter management of the condition. Refer patients who are not responding to conservative measures (outlined in the policy) to MSK-CATS Refer patients not responding to conservative measures (outlined in the policy) to MSK-CATS Requesting ultrasounds or MRIs does not alter clinical management of Morton s Neuroma and should not be requested. Radiofrequency ablation (NICE IPG 539) lacks evidence for efficacy, and is not funded by the CCG. This policy excludes conditions such as diagnostic arthroscopy, trauma, urgent cases (eg septic joint). Refer patients with degenerative knee symptoms to ortho (see flow chart in policy) if all of the following apply: - all appropriate analgesia has been trialled AND - Structured physio (such as via MSK-CATS) has been undertaken for a minimum of 12 months AND - Symptoms are impacting on quality of life Trochanteric bursitis. Morton's Neuroma. meniscal tear. Page 5 of 5