Guidance

Pathway standards, risk management and quality assurance

Updated 1 October 2024

Pathway standards, risk management and quality assurance

All screening programme services are required to monitor performance against the pathway standards for the NHS AAA Screening programme. All surgeons treating patients identified through NAAASP will be expected to submit data to the NVR.

NAAASP pathway standards are a core set of objectives, criteria, minimum standards and targets that have been developed to measure the processes or intervention of AAA screening

Both quality assurance (QA) between units and quality control within a unit are important. Involvement of radiologists, sonographers, screening technicians and medical physicists is required.

1. National pathway standards

The NHS AAA Screening Programme has developed pathway standards.

2. Programme risk management and failsafe procedures

The NHS AAA Screening Programme has developed a failsafe document and care map.

2.1 Serious incidents

The UK NSC has developed guidance on how serious incidents should be managed in national screening programmes.

3. Quality assurance (QA)

Quality assurance should be carried out on the following elements of the programme.

3.1 Local service

A quality assurance framework has been developed as part of education and training. Details of the quality assurance requirements for screening technicians are available.

A QA module has been developed as part of the SMaRT system and is used to generate subject details in line with the QA process. Local quality assurance should be performed by the lead radiology clinician or the nominated CST.

As part of the QA process, if the screener fails to meet any of the standards in 3 or more assessments then remedial action should be taken, such as:

• close mentoring and supervision
• retraining
• continuing review of images from random clinic selection
• review of past images and possible recall of men. Local programmes should work with QA and local commissioners and notify the national programme if a recall is required and should work with them to plan the process
• suspension from screening in the situation of a serious incident, pending investigation as per local Trust policy

3.2 Ultrasound equipment

Information regarding quality assurance of ultrasound machines](https://www.gov.uk/government/publications/abdominal-aortic-aneurysm-screening-ultrasound-equipment-guidance) is available.

3.3 Referral to vascular unit

Monitor time from referral to outpatient consultation (see failsafe for limits).

3.4 Vascular unit

Monitor time from referral to surgery.

3.5 Surgical procedure

Vascular Society of Great Britain and Ireland monitors outcomes.

3.6 AAA mortality

Monitor deaths from ruptured AAA through information supplied by the Office for National Statistics (ONS) and linked to gender, age group and screening category.

3.7 Reporting

As the NHS AAA Screening Programme uses a national call and recall screening management system, it has responsibility for providing programmes with regular activity reports as well as KPIs and pathway standards reports. The activity reports are to inform the local programme and commissioners of monthly activity while the KPIs are related to the performance of programmes.

3.8 Other

There should also be quality assurance of:

• service provision
• questionnaires sent periodically to a sample of randomly selected service users (doctors, practice managers/staff, patients, vascular surgeons) to ask whether any problems arose as a result of the screening programme
• any procedural changes that could improve the delivery of the screening programme

4. Clinic room requirements and site survey

4.1 Minimum requirements

Two rooms ensuring patient privacy, plus a small waiting area. Ground floor or with lift access so they are accessible for infirm men.

4.2 Room 1

This room is used by the screener to explain procedures, answer queries, check personal details (such as address, date of birth, registered GP).

Minimum requirements are 2 chairs, small table and power point.

If you are using 2 screening technicians, you should use the specifications for room 2 for both rooms and ignore this specification.

4.3 Room 2

To take sonographic measurements, give results verbally, offer further information, advice and counselling if required.

Minimum requirements are full-length height adjustable examination couch, power points x2; small desk, subdued lighting, curtains/blinds.

Ideally there would be access to a computer connected to N3 to allow live access to the IT system.

4.4 Waiting area

This requires seating for up to 6 people, close to the above rooms.

4.5 Site survey

To ensure the smooth running of the screening programme, it is essential that the programme co-ordinator views potential clinic rooms and available facilities are determined. A suggested site survey form is available to download. (INSERT LINK)

*[DH}: Department of Health *[DICOM]: Digital Imaging and Communications in Medicine *[DVLA]: Driver and Vehicle Licensing Agency *[ECDL]: European Computer Driving Licence *[HSCIC]: Health and Social Care Information Centre *[IT]: Information technology *[KPI]: Key performance indicators *[NAAASP]: National AAA screening programme *[NHSEI]: National Health Service England/Improvement *[NICE]: National Institute for Health and Clinical Excellence *[NIGB]: National Information Governance Board for Health and Social Care *[NVR]: National vascular registry *[ONS]: Office for National Statistics *[PHE]: Public Health England *[QA]: quality assurance *[SMaRT]: Screening management and referral tracker system (Northgate) *[SOP]: Standard operating procedures *[SVT]: Society of Vascular Technology *[UKNSC]: United Kingdom national screening committee *[VSGBI]: Vascular Society of Great Britain and Ireland *[WTE]: Whole time equivalent