Local Practice Collection - examples of our guidance in practice

Our local practice collection has over 500 examples of quality improvement in health and social care services.
The collection consists of:
• Quality and productivity case studies: These are examples of quality improvement at a local level that also make cost savings.
• NICE Shared learning examples: These show how NICE guidance and standards have been put into practice by a range of health, local government and social care organisations.

Quality and productivity case studies

These case studies are written, edited and produced by NICE based on information provided by the submitter.

We evaluate each case study based on its impact on quality improvement and whether it has been cost saving or cost neutral to implement. As part of our quality assurance process all published case studies have undergone external peer review.
This year we have published case studies on topics such as:

• Mechanical thrombectomy for large vessel occlusion stroke: improving clinical outcomes and reducing cost
• Supply chain management and collaboration: cardiology device procurement
• BRAFV600E mutation testing for thyroid cancer: avoiding unnecessary surgery

NICE Shared Learning examples

Our shared learning examples show how NICE guidance and standards have been put into practice by a range of health, local government and social care organisations.

Each example outlines how our guidance and standards can be implemented, leading to improvements in patient and service user care.

Every year the best examples are recognised at the NICE Shared Learning Awards which are presented at our annual conference.

NICE approach to managing urinary incontinence in women wins 2015 Shared Learning Award

A scheme that led to the improved management of urinary incontinence in women, won the NICE Shared Learning Award in 2015.

Royal Cornwall Hospitals NHS Trust scooped the prize for improving treatment through greater compliance with NICE guidance, simplifying its pathway of care, and by introducing a multidisciplinary team.

Following an audit of care, the Trust found that the treatment it provided was irregular and inconsistent. In particular, it was not following advice from NICE’s quality standard on lifestyle changes, and it did not have a multidisciplinary team.

A secondary audit to assess compliance on referral to secondary care found that women who had not received conservative measures were being sent back to primary care. This added to waiting times, inconveniencing both patients and doctors.

Simpler referral pathway

Compliance with NICE guidance was hampered by the pressure to speed up the time in which patients are seen. Furthermore, the referral pathway was overly complex and difficult to follow.

Consequently the Trust developed an ‘Easy Step Guide’ for referral to simplify the pathway. It arranged teaching sessions with GPs every 6 months, and it conducted a rolling annual audit on compliance with NICE guidance.

A multidisciplinary team was also set up to ensure review before surgery or invasive treatment, in accordance with NICE advice.

Greater compliance leads to less unnecessary testing

After 6 months, the Trust carried another audit and found that compliance with NICE guidance had risen to 99 per cent.

This led to less unnecessary urodynamic testing before conservative management, which in turn reduced the likelihood of patients picking up urinary tract infections.

The reduction in testing also means that women were less likely to experience the physical and emotional stress that comes with such consultations.

Key learning points include keeping things simple – following an easy pathway makes it easier for referrers and for patients, increasing the likelihood of success. Regular education and training was also necessary to prevent returning to old routines.

Presenting the award to project leader Farah Lone, NICE Chair Professor David Haslam said: “Congratulations to Royal Cornwall Hospitals Trust for its truly remarkable work. All three finalists were absolutely fantastic, and they all truly deserved to win.”

Dorset County Hospital NHS Foundation Trust was commended for its work in improving care through complaints.

Guy’s and St Thomas’ Hospital was equally recognised for its work in caring for victims of domestic abuse.