Acutely Painful testes

Transcription

1 2.0 FINAL Guideline adopted from the Bedside Clinical Guideline Partnership EQUALITY IMPACT The Trust strives to ensure equality of opportunity for all both as a major employer and as a provider of health care. This policy has therefore been equality impact assessed by the authorising body to ensure fairness and consistency for all those covered by it regardless of their individual differences, and the results are shown in Appendix 1. Version: 2.0 Final Authorised by: Surgery DMT Date authorised: April 2013 Next review date: April 2015 Document author: Mr C Pratap

2 VERSION CONTROL SCHEDULE Acutely painful testes Version : 1.0 Final Version Number Issue Date Revisions from previous issue 1.0 (final) May 2010 ne 2.0 (Final) April 2013 ne

3 INDEX/ TABLE OF CONTENTS EQUALITY IMPACT... 1 INTRODUCTION... 4 PURPOSE... 4 SCOPE... 4 DEFINITIONS... 4 DUTIES... 4 GUIDELINE STATEMENT... 5 GUIDELINE DEVELOPMENT AND REVIEW... 7 IMPLEMENTATION... 5 MONITORING... 5 REVIEW... 5 REFERENCES AND BIBLIOGRAPHY... 6 THE GUIDELINE... 6 EQUALITY IMPACT ASSESSMENT TOOL... 8

4 INTRODUCTION This clinical guidance document produced by the Bedside Clinical Guidance Partnership has been amended and adopted for local use by Tameside Hospital NHS Foundation Trust. PURPOSE This clinical guideline is a systematically developed statement designed to assist practitioners in deciding appropriate health care for specific clinical circumstances. The guideline is intended to provide guidance for staff in the diagnosis and management of a particular condition, and provides indication of the best choices for the clinical management of the patient. SCOPE This guideline is to be used by staff or professional groups involved in the diagnosis management of the condition to which to the document relates in all areas within Tameside Hospital NHS Trust. DEFINITIONS The definitions of key words, terms and concepts used in the policy document will be clearly defined within the body of the guideline where necessary. DUTIES Chief Executive The Chief Executive is responsible and accountable for ensuring that clinical guidelines are in place and that implementation of the guidelines is undertaken and monitored. Medical Director The Medical Director is responsible for overseeing that minated Divisional Leads implement guidelines according to the Bedside Clinical Guideline Policy and for ensuring that specifics of this guideline are implemented and monitored as appropriate. minated Divisional Leads for Clinical Guidelines Will ensure that guidelines adopted by their specialty or Division are appropriately scrutinised and amended where applicable and that they are subject to adoption and ratification by the Division at the Divisonal DMT meeting or other appropriate Committee as specified in the Trusts Controlled Documents Policy. Clinical Risk Officer for General CNST and Elective Services Is responsible for facilitating the implementation of clinical guidelines by liaison with minated Divisonal Leads. The Clinical Risk Offcier is also responsible for the review of the overarching Bedside Clinical Guidelines policy and guideline template and for producing monitoring reports for the Medical Director on

5 progress of the implementation, review and monitoring of clinical guidelines adopted from the Bedside Partnership. These monitoring reports will be on an annual basis. Local Implementation Author The person submitting the ratified guideline for publishing on the Intranet is considered the local implementation author and will be responsible for any subsequent review process and for ensuring that guidelines are implemented and monitored where appropriate, e.g. through their inclusion in the annual Clinical Audit Plan for the Division. All staff All staff have a duty to follow this guideline unless there are sound clinical reasons for not doing so which can be supported by evidence. Junior Staff should discuss any proposed deviation with their senior colleagues, and gain their approval prior to implementation. Junior doctors should document the discussion with the Consultant and reasons for deviation in the Health records. Where consultants choose to deviate from agreed practice stated in the guideline this should also be documented. GUIDELINE STATEMENT The guideline is presented using set headings in the body of the guideline which provide structure to the guideline and a methodical order The guideline subheadings will differ dependening on the topic of the guideline but will given structured guidance to staff on treatment and management of the specific clinical condition or procedure. GUIDELINE DEVELOPMENT & CONSULTATION This guideline has been developed by the Bedside Guidelines Partnership and has been amended to reflect local implementation processes by a consultative process within the division responsible for delivering care. Where appropriate consultation with other stakeholders within the Trust was appropriate this has taken place before final ratification at the Divisional DMT or other approved Committee or Group stated on the cover page table. IMPLEMENTATION This guideline has been distributed to main stakeholders and members of the ratifying Committee for dissemination and uploaded to the Trust s intranet in the clinical guidelines section MONITORING Monitoring of this guideline will be undertaken by the Surgical Division.

6 REVIEW This guideline will be formally reviewed at a minimum of every 2 years. The date of review is stated on the title page. The guideline may be reviewed earlier depending on the results of monitoring, recommendations from recognised bodies or as a result of incident complaint or claim review REFERENCES AND BIBLIOGRAPHY Extensive reference material and evidence base is provided by the Bedside Clinical Guidelines Partnership for each individual guideline and is accessible on the TIS site, under the section Policies and Procedures entitled Bedside Clinical Guidelines Reference section.

7 THE GUIDELINE THE ACUTELY PAINFUL TESTIS DIFFERENTIAL DIAGNOSIS Testicular torsion Epididymo-orchitis Strangulated inguino-scrotal hernia Haematocoele Hydrocoele Testicular cancer Idiopathic scrotal oedema Torsion of appendix testis TESTICULAR TORSION Can occur at any age but more common in adolescence Symptoms Pain of acute onset chronic testicular pain is not an emergency Swelling or high-riding testis, onset usually <24 hr Signs Testicular tenderness Testicular swelling Scrotal erythema (occasionally) Fever suggests acute epididymo-orchitis, as it occurs only as a late manifestation of torsion Investigations Consider isotope scan (available only) high uptake in infection and no uptake in torsion but do not delay surgical exploration while waiting for this investigation MANAGEMENT Immediate surgical exploration an acutely painful swollen testis in an adolescent is the result of torsion until proved otherwise. If in doubt, explore Even if pain has been present for >6 hr, immediate surgery can still rescue 25% of torted testes Acute Painful Testis is now managed by Urologists at Stepping Hill Hospital and every effort should be made to expedite transfer of these patients without any delay.

8 EQUALITY IMPACT ASSESSMENT TOOL. Yes/ Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? n/a 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? n/a n/a