Guidance producer: Royal College of Radiologists (RCR) Guidance product: Referral guidelines Date: 29 June 2010 Final Accreditation Report
Contents Introduction... 3 Accreditation recommendation... 3 Implementation... 5 Appendix A: NHS Evidence accreditation analysis... 6 Appendix B: Bibliography... 14 Appendix C: Advisory Committee members, external advisers and NHS Evidence accreditation team... 15
Introduction The NHS Evidence Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. Users of the accredited guidance can therefore have high confidence in the quality of the information. Organisations can publicly display a seal of approval called an Accreditation Mark for three years after their processes have been accredited. The process for accrediting producers of guidance and recommendations for practice is described in the process manual 1. Accreditation recommendation NHS Evidence has accredited the process used by the Royal College of Radiologists (RCR) to produce the referral guidelines. Accreditation is valid for three years from June 2010 and is retrospectively applicable to guidance produced using the processes described in the manual Making the best use of clinical radiology services: the process for the sixth edition 2003 2007 and the 2009 update. Background to the guidance producer The Royal College of Radiologists aims to advance the practice of radiology and oncology, improve public education, and promote study and research through setting professional standards of practice. To help achieve these aims, faculty publications are produced to provide members and Fellows with professional standards and guidance. The RCR produces the referral guidelines, Making the best use of clinical radiology services, for clinicians, radiologists, radiographers and other healthcare professionals to determine the most appropriate imaging investigations for a wide range of clinical 1 http://www.nice.org.uk/nhsevidence/aboutaccreditation/aboutaccreditation.jsp?domedia=1&mid= 27C232A0-19B9-E0B5-D4A11FA899F4C219
problems. The guidelines provide practical guidance based on the evidence, together with expert opinion where evidence is lacking or conflicting. Summary The Advisory Committee considered that the Royal College of Radiologists referral guidelines demonstrated compliance with 23 of the 25 criteria for accreditation. The processes used by the Royal College of Radiologists to produce the referral guidelines are clearly documented and robust. Processes are described in the manual Making the best use of clinical radiology services: the process for the sixth edition 2003 2007. The Royal College of Radiologists referral guidelines are clearly presented and up to date. A range of stakeholders, including patients, are involved in developing guidance and there is a comprehensive peer review process. Systematic methods are used to identify evidence for developing guidance. Suggestions to further strengthen the Royal College of Radiologists development processes for the referral guidelines are: showing how organisational barriers to guidance implementation are considered adding to the guidance estimated costs for each investigative technique making available on request evidence demonstrating the self funding model for the guidance. David Haslam Chair, Advisory Committee June 2010
Implementation Following accreditation, guidance from the accredited producer will be identified on NHS Evidence by the Accreditation Mark. The accredited guidance producer is also granted a royalty-free, worldwide licence to use the NHS Evidence Accreditation Mark in accordance with the Conditions and Terms of Use 2. Providing these conditions are met, a guidance producer's accreditation will last for three years from publication of approval on the NHS Evidence website. Accredited guidance producers must take reasonable steps to ensure the accredited processes are followed when generating the type of evidence for which they are accredited. Accredited guidance producers should have quality assurance mechanisms in place and must inform NHS Evidence of any significant change to a process within 30 days. Figure: The NHS Evidence Accreditation Mark 2 http://www.nice.org.uk/nhsevidence/?domedia=1&mid=5ae1d938-19b9-e0b5- D471CA81220F57DA
Appendix A: NHS Evidence accreditation analysis The Advisory Committee considered the following analysis of the guidance producer s compliance with NHS Evidence accreditation criteria, which covers six discrete domains. The full analysis leading to the accreditation decision is shown below. Domain Criterion Evidence for meeting the criterion Accreditation decision Does the guidance producer have a policy in place and adhered to that requires them to explicitly detail: Scope and purpose 1.1 Overall objective The overall objective is clearly defined and implemented in the referral 1.2 The clinical, healthcare or social questions covered guidelines b as described in the process manual a. In the referral guidelines b section 1 Introduction states the overall objective. The clinical questions are clearly defined and implemented in the referral guidelines b as described in the process manual a. In each of the 12 sections of the referral guidelines b a number of clinical / diagnostic problems are indicated.
Domain Criterion Evidence for meeting the criterion Accreditation decision 1.3 Population and/or target audience to whom the guidance applies The population and target audience is clearly defined and implemented in the referral guidelines b as described in the process manual a. The patient populations for each clinical situation are indicated within the body of the guidelines and the target audience is indicated in the Introduction section. 1.4 Guidance includes clear recommendations in reference to specific clinical, healthcare or social circumstances The recommendations are clearly linked to specific clinical circumstances in the referral guidelines b as described in the process manual a. The guidelines b are actually a collection of specific guidelines for specific clinical circumstances. Does the guidance producer have a policy in place and adhered to that means it includes: Stakeholder involvement 2.1 Individuals from all relevant stakeholder groups, including patient groups, in developing guidance The production of the referral guidelines b includes individuals from relevant stakeholder groups including patients as described in the process manual a. In the guidelines there is an Acknowledgements section which names both individuals and consultation groups involved in the guideline production process. 2.2 Patient and service user representatives and seeks patients views and preferences in developing guidance The production of the referral guidelines b includes patients views as described in the process manual a. Opinions of lay representatives are sought during the production of guidance.
Domain Criterion Evidence for meeting the criterion Accreditation decision 2.3 Representative intended users in developing guidance. Intended users are involved in the development of the referral guidelines b described in the process manual a. Does the guidance producer have a clear policy in place that: Rigour of development 3.1 Requires the guidance producer to use systematic methods to search for evidence and provide details of the search strategy 3.2 Requires the guidance producers to state the criteria and reasons for inclusion or exclusion of evidence identified by the evidence review 3.3 Describes the strengths and limitations of the body of evidence and acknowledges any areas of uncertainty Systematic methods are used to search for evidence on which the referral guidelines b is based and the search strategy detailed as described in the process manual a. Further information regarding the dates of searches can be found in the evidence tables of the electronic version of the guidelines. The inclusion and exclusion criteria are defined in the production of the referral guidelines b as described in the process manual a. The information for this process is found in section 6.2 of the process manual a. The strength and limitations of the evidence are defined in the production of the referral guidelines b as described in section 6.2 of the process manual a. The guidance producer describes an evidence grading system.
Domain Criterion Evidence for meeting the criterion Accreditation decision 3.4 Describes the method used to arrive at recommendations (for example, a voting system or formal consensus techniques like Delphi consensus) The method used to arrive at recommendations in the referral guidelines b are explained in the process manual a. The guidance producer s chosen methodology is the Delphi technique. 3.5 Requires the guidance producers to consider the health benefits against the side effects and risks in formulating recommendations The risks versus health benefits are considered in the production of the referral guidelines b as described in the process manual a. All of the directives noted in the guidelines effectively state that given the choice of two or more dose levels of radiation the lowest practicable should always be used. 3.6 Describes the processes of external peer review The peer review process used in the production of the referral guidelines b is clearly defined as described in section 6.5 of the process manual a. 3.7 Describes the process of updating guidance and maintaining and improving guidance quality The process of updating and maintaining guidance quality is observed in the referral guidelines b as described in the process manual a section 6.6.
Domain Criterion Evidence for meeting the criterion Accreditation decision Does the guidance producer ensure that: 4.1 Recommendations are specific, unambiguous and clearly identifiable All recommendations in the referral guidelines b are specific, unambiguous and clearly identifiable as described in the process manual a. The recommendation grading system is documented in section 2 of the process manual a. Clarity and 4.2 Different options for the management of the condition or options for intervention are clearly presented Different options for the management of radiological conditions are clearly presented in the referral guidelines b as described in the process manual a. Each specific condition has a number of different management options indicated where these are available and suitable. presentation 4.3 The date of search, the date of publication or last update and the proposed date for review are clearly stated 4.4 The content of the guidance is suitable for the specified target audience. If patients or service users are part of this audience, the language should be appropriate. All dates of search, update and proposed date for review are documented as described in the process manual a. The content of the referral guidelines b is suitable for its target audience as described in the process manual a. Some of the language within the guidelines is technical, particularly in the Comments section. However this is appropriate given the intended audience for these referral guidelines (clinicians, radiology practitioners and healthcare organisations).
Domain Criterion Evidence for meeting the criterion Accreditation decision Does the guidance producer routinely consider: 5.1 Publishing support tools to aid implementation of guidance Support tools are published to aid implementation of the referral guidelines b by the Royal College of Physicians. The electronic version of the guidelines and format of the print version assist in implementation because of their ease of use. Applicability 5.2 Discussion of potential organisational and financial barriers in applying its recommendations Other than an overall discussion in its submission that potential barriers to applying its recommendations should be considered, the guidance producer does not address the potential organisational barriers to implementation of its guidelines. Similarly, the guidance producer does not include information regarding the cost effectiveness of each investigation Not fully met for each diagnostic or imaging problem as it is not thought to be helpful. 5.3 That their guidance is current, with review criteria for monitoring and/or audit purposes within each product. The referral guidelines b is current and audit of the uptake and use of this guideline is undertaken. Local level audits are encouraged and users of the guidance engaged to monitor uptake and outcomes.
Domain Criterion Evidence for meeting the criterion Accreditation decision Does the guidance producer: 6.1 Ensure editorial independence from the funding body The referral guidelines b is editorially independent from the funding body. All groups involved in the guideline production are independent of the College and all work carried out by the Delphi panels, the guidelines working party and the Editorial Group is done on a voluntary basis. Editorial independence 6.2 Demonstrate transparency about the funding mechanisms for its guidance The process document and example guidance do not provide details of how the funding is achieved. The guidance producer indicates that the guidance is self funding, but this cannot be confirmed. Some uncertainty 6.3 Record and state any potential conflicts of interest of individuals involved in developing the recommendations 6.4 Take account of any potential for bias in the conclusions or recommendations of the guidance Conflicts of interest are stated and recorded as described in the process manual a. There is a conflicts of interest policy in place which can be found on the College s website. The referral guidelines b production minimises bias via a combination of the composition of the Guideline Development Groups, declaration of interests, stakeholder consultation and review, as described in the process manual a.
a Making the best use of clinical radiology services: the process for the sixth edition 2003 2007 (process manual). b Making best use of clinical radiology services, sixth edition. Referral guideline
Appendix B: Bibliography Appendix B lists the additional information taken into account in the analysis and considered by the Committee. Document name Description Location Making the best use of Process manual clinical radiology services: the process for the sixth edition 2003-2007 Making the best use of Guideline assessed as clinical radiology evidence services: referral guidelines (Sixth edition, 2007) Not publicly available. http://www.rcr.ac.uk/content.aspx? PageID=995
Appendix C: Advisory Committee members, external advisers and NHS Evidence accreditation team NHS Evidence Advisory Committee Members The NHS Evidence Advisory Committee operates as a standing advisory committee of the Board of the National Institute for Health and Clinical Excellence (NICE). The Committee provides advice to the Institute on a framework for accrediting sources of evidence that should be recognised as trusted sources of information for the NHS. The Chair of the Committee is appointed by the Institute s Board and the meetings are conducted by the Chair or in his/her absence the vice chair. The current Chair is David Haslam. A full list of the Advisory Committee membership is available on the NICE website 3. The members have been appointed for a period of 18 months. This may be extended by mutual agreement to a further term of 3 years and up to a maximum term of office of 10 years. The decisions of the Committee are arrived at by a consensus of those members present. The quorum is set at 50% of committee membership. The Committee submits its recommendations to the Institute s Guidance executive which acts under delegated powers of the Institute s Board in considering and approving its recommendations. Committee members are asked to declare any interests in the guidance producer to be accredited. If it is considered that there is a conflict of interest, the member(s) is excluded from participating further in the discussions. A list of the committee members who took part in the discussions for this accreditation decision appears below. [Page break] 3 http://www.nice.org.uk/nhsevidence/nhseac.jsp
Title Name Surname Role Organisation Ms Judy Birch Lay member Mr Richard Brownhill Clinical Development & Nurse practitioner Calderdale and Huddersfield NHS Trust and Kirklees PCT Ms Amanda Edwards Head of Knowledge Services Social Care Institute for Excellence (SCIE) Ms Joyce Epstein Lay member Dr Brian Fisher General Practitioner NHS Alliance (GP and national patient/public lead) Professor David Haslam National Clinical Advisor Care Quality Commission Dr Bobbie Jacobson Dr Monica Lakhanpaul Professor Stuart Logan Dr Donal O Donoghue Professor Sandy Oliver Dr Mahendra Patel Director of London Health Observatory, Vice Chair of Association of PH Observatories Senior Lecturer / Consultant Paediatrician / Clinical Director Professor of Paediatric Epidemiology National Clinical Director for Kidney Care and consultant renal physician Professor of Public Policy, Deputy Director, Social Science Research Unit Senior lecturer in pharmacy practice, school of applied sciences/consultant Pharmacist London Health Observatory Health Education Research and Development Unit (HERADU), Department of Medical Education and Social Care, University of Leicester Peninsula College of Medicine and Dentistry Salford Royal NHS Foundation Trust Cochrane Consumers and Communication Review Group, University of London University of Huddersfield
Mr Adrian Reyes- Hughes Associate Clinical Director NHS Direct Dr Karen Ritchie Ms Sasha Shepperd Dr Mark Strong Ms Gill Swash Lead Health Services Researcher Senior Research Scientist, Department of Public Health MRC Fellow, Section of Public Health Head of knowledge and Library Services NHS Quality Improvement Scotland University of Oxford School of Health and Related Research (ScHARR) University of Sheffield NHS Western Cheshire Dr Sara Twaddle Director Scottish Intercollegiate Guidelines Network Advisory Committee Deputies Title Name Surname Role Organisation Deputising for Ms Lynda Cox Head of Knowledge Sharing and Learning North East Strategic Health Authority Stephen Singleton External Advisers for Royal College of Radiologists referral guidelines accreditation application Cheryl Harding-Trestrail, Locality Commissioning Manager (West), NHS Southampton City, Southampton, UK Dr Frances Burnett, Associate Medical Director-Practice Governance, Consultant Adult Psychiatrist (Community), Hertfordshire Partnership Foundation Trust, St Albans, Hertfordshire, UK
NHS Evidence accreditation team for Royal College of Radiologists referral guidelines accreditation application Stephanie Birtles, Accreditation Technical Analyst, NHS Evidence, National Institute for Health and Clinical Excellence, Manchester, UK Dr Paul Chrisp, Associate Director Accreditation, NHS Evidence, National Institute for Health and Clinical Excellence, Manchester, UK