National Institiue for Health and Clinical Excellence

Annual Review - 2009/2010

NICE is supporting the current drive to reduce ineffective practice and cut costs in the NHS

Protecting patient safety

The NICE Interventional Procedures Programme looks at whether certain procedures for diagnosing and treating patients are safe enough, and work well enough, for their routine use in the NHS.

The programme focuses on tests, treatments or surgeries that involve a cut or puncture of the skin, or equipment such as endoscopes to look inside the body, or energy sources such as X-rays, heat or ultrasound.

During 2009/10 NICE assessed and issued guidance on 42 interventional procedures, and in May 2009 published the 300th piece of interventional procedures guidance since the programme began in 2002.

No interventional procedures are totally risk-free, but NICE’s guidance gauges the extent of the risks and uncertainties, based on the evidence, clinical opinion and patient experience, and helps patients understand new procedures and the risks and side effects associated with them. Each piece of guidance makes recommendations on how a procedure should be used in the NHS; should not be used because it is unsafe or clinically ineffective; or may only be used with special consent or in medical research.

Procedures often fall into this final category not because they don’t offer patients any benefits but simply because there is not enough evidence available to fully support whether they work (particularly in the long-term) or how safe they are. As the chair of the Interventional Procedures Advisory Committee, Professor Bruce Campbell, explains: “In simple terms, what we’re saying to clinicians wanting to use these procedures, is: ‘Tell your hospital, tell your patients, and audit your results well.’ We’re supporting the use of a procedure, so long as it is used in a responsible and well-monitored way.”

In 2009/10 NICE issued guidance recommending that 11 interventional procedures were safe and worked well enough to be routinely used in the NHS. These included guidance on replacing worn discs in the lower spine with artificial discs to treat the severe back pain caused by degenerative disc disease.

However, two interventional procedures assessed in 2009/10 were given ‘do not use’ recommendations by NICE. These were two different procedures for treating angina with laser devices. NICE found that there was evidence that the procedures did not work, and that both may pose unacceptable risks to patients’ health.

Ben Doak, Project Manager in NICE’s interventional procedures team, explains: “The evidence showed that both of these invasive treatments did not improve patients’ angina and caused significant risks including heart attacks and irregular heartbeats. In issuing guidance recommending that these procedures are not safe to use, NICE is supporting the current drive to reduce ineffective practice and cut costs in the NHS.”

All of the interventional procedure guidance issued by NICE, including patient-friendly versions, can be downloaded on the NICE website.

Reviewing management of the open abdomen

In January 2010 NICE’s Interventional Procedures Programme launched a national review of how all critical care units in the UK look after patients whose abdomens are left open after surgery or injury. This can happen if the patient needs more treatment inside the abdomen, or to allow infection to clear.

NICE set up the audit in response to concerns from one specialist unit that there may be a link between one of the treatments currently used, called negative pressure wound therapy, and patients developing intestinal fistulae, a potentially serious condition that can cause infection and bowel leaking.

To find out whether there is link between negative pressure wound therapy and intestinal fistulae, NICE has asked all intensive care and high-dependency units in the UK to submit information on all patients with open abdomens between 1 January 2010 and 30 June 2011. NICE has developed an audit tool to help clinical staff gather this information.

Professor Bruce Campbell, Chair of the Interventional Procedures Advisory Committee, said: “We have encouraged all critical care units in the UK to participate in the national audit so that the safety of this procedure and other alternative treatments can be reviewed.”