Clinical notices

When there is a clinical notice, information about it will appear here.

 

Barts Health Radiology Update

27 April 2020

To reduce the incidence of COVID-19 contacts and pragmatically manage imaging capacity, Barts Health radiology service is undertaking a radiologist-led review of all imaging ordered to date.  Decisions will be taken based on the clinical details provided in the request and in accordance with radiology guidelines. 

Urgent and 2 week wait scans will continue to be booked and appointments offered to patients.

Non-urgent radiology requests from GPs and hospital colleagues will either be cancelled or rescheduled. 

In the case of rescheduled imaging, patients will be offered an appointment from June onwards. This may be subject to change given developments with COVID-19. Patients will be informed via text message or letter.

For cancelled requests, patients will be contacted directly through a letter or text message.  Clinicians will be informed via Emis results workflow and via an email to the practice workflow address (with a list of cancelled requests).

If you consider a scan to be urgent you can re order this with further clinical details in the request. 

If you wish to discuss a request clinically with a radiologist please use the following email address for advice:

Newham: Radiology.gpsupport@nhs.net

Tower Hamlets: BartsHealth.imagingadviceandsupportrlh@nhs.net ‚Äč

Waltham Forest: bhnt.wxh.imagingctandmri@nhs.net

Emails should be answered within 5 days.

GPs will be informed of patients whose scan has been booked and offered but the patient has declined to attend. Currently this is happening with approximately 50% of scans being offered.

New imaging requests will also be clinically triaged and any rejections sent back to the practice workflow email address.  Further discussions can be had with radiology colleagues on the email addresses above. 

Urgent walk-in xray/suspected fracture access is continuing during normal hospital hour. Please note however Mile End x-ray is currently still closed. Any patients being referred should be screened for COVID-19 and the department notified of any symptoms.  tQuest orders are electronic and patients can attend the department without a form giving 3 identifiers (name/DOB/address/NHS no).  However you can also attach a tQuest Radiology form as an Accurx message for the patient to show at the front door of the walk-in department.

Should you have any further queries about this information please contact lesley.perkins3@nhs.net or harpreet.shergill1@nhs.net

Dermatology service at The Royal London Hospital

26 April 2020

As a response to COVID-19 the Dermatology service at Royal London will require patients who meet the criteria for suspected skin cancer to bereferred through the two-week wait pathway. Further guidance is below. 

Update to GPs regarding telederm appointments [docx] 16KB

Further telederm guidance - Tower Hamlets [pptx] 418KB

 

Changes to swabbing guidance

22 April 2020

The microbiology swabs required for MRSA screening and routine use are now both pink. Please help to protect our staff from COVID-19 by following the new instructions and only leave the white swab inside.

Resources 

 

Postponed Outpatient appointments: contact details for GPs with urgent queries 

20 April 2020

Advice and Guidance on eRS should be used for clinical queries. The numbers in the document below should only be used where advice guidance is not available or where the query needs to be escalated.

Service contact numbers for urgent queries.docx [docx] 381KB

 

Barts Health Outpatients Phlebotomy Covid 19 process for GPs update

18 April 2020

The below flyer for outpatients community blood tests has been updated:

Outpatients community blood test patient flyer [pptx] 42KB

 

Barts Health diagnostics and therapies status update 

14 April 2020

Barts Health provision of diagnostics and therapies which now includes details of changes to radiology services.

Diagnostics and therapies services status update [docx] 31KB

 

Barts Health Covid 19 Outpatients Updates

3 April 2020

In line with national guidance, and where it is clinically safe to do so, Barts Health is postponing all routine outpatient activity that was due to take place after today. We attach frequently asked questions for GPs about these changes. We also attach FAQs for patients which we are sending to those affected by these changes, and have uploaded to our website. An updated version of the Diagnostics and Therapies Status Update is also attached. The Outpatients Referrals Covid Guidance is attached again for reference; the title has been amended for clarity, but there are no changes to the content.

Resources 

 

30 March 2020

As the numbers of people who require hospital treatment for Covid 19 increase, Barts Health needs to make as many staff as possible available to provide intensive and acute care in its hospitals.

This means from 3 April all routine outpatient appointments and diagnostics will be cancelled.

Barts Health is confirming with each service their arrangements to keep patients well, avoid admissions and manage the provision of urgent advice over the next period. This information will follow over the next few days.

Diagnostics

A status update on diagnostics provision is attached and will be updated as additional information becomes available.

For direct access imaging, where management of the patient would not change based on the imaging finding, requests should not be made. GPs are asked to restrict referrals to where there is an immediate and urgent need for imaging (especially ultrasound) and consider whether referring a patient to attend for a diagnostic would increase risk to patient. Direct access imaging availability will be variable by site according to staff availability. Where possible please discuss the imaging need with a specialty consultant and include their name on the request.

Information for patients, the public and GPs

Barts Health is contacting patients about changes to their upcoming appointments by telephone and letter.

Update information about changes and FAQs will be posted on the Barts Health website and social media channels.

Updates for GPs will continue to be shared with the WEL and NEL CCG communications hub and posted on: https://www.bartshealth.nhs.uk/clinical-notices

Helping to keep patients away from hospitals where possible

Virtual clinics will continue for urgent appointments. A process is in place for the supply of medicines to patients who attend virtual appointments and arrangements have been made for Barts Health patients to get blood tests in community clinics.

Attachments

 

Barts Health Outpatients Phlebotomy Covid 19 process for GPs

27 March 2020

The attached process has been agreed between Barts Health and local CCGs to enable patients to get essential blood tests following an outpatients consultation without needing to visit a hospital. Barts Health clinicians will send blood test labels in the post along with the attached patient flyer which explains how to access community phlebotomy clinics.

 

Barts Health outpatient changes in response to Covid 19

23 March 2020

Referrals

Guidance was uploaded to the GP intranet on Friday evening (20 March 2020). This sets out arrangements agreed between WEL CCGs and Barts Health to reduce the numbers of patients referred into Barts Health. 

To support this we are making some changes to eRS which will mean that there will be no directly bookable routine appointments available within the next 16 weeks. 

If you need to refer a patient, you should continue to make the referral on eRS as normal, and you will be prompted to select ‘defer to provider’ The referral will be received by the hospital as normal, and our clinicians will triage the referral to decide whether the consultation should be conducted face to face or over the phone.

Outpatient COVID guidance for GPs [ppt] 124KB

Outpatient appointments

Most Barts Health outpatients appointments have changed to telephone consultations. Patients should not go to hospital for appointments . Hospital bookings teams are contacting patients to let them know about the new arrangements for their appointment. In most cases, this is a telephone consultation at the same time as the patient’s appointment was booked for. 

Where clinical need for a face-to-face appointment outweighs the risk of bringing a patient to a hospital, the clinician will arrange this with the patient. Changes to appointment timetabling and clinic cleaning are in place to reduce transmission risk in outpatients clinics.  Information for the public is being shared on the Barts Health website and social media. 

Endoscopy changes

The British Society of Gastroenterologists has made recommendations for responding to the pandemic, so like all NHS organisations, we are making changes to our endoscopy services. This means that some procedures will continue as planned, some will be postponed, and others will be cancelled. Our team is contacting patients to let them know what this means for their individual situation. 

Changes to Endoscopy services  [docx] 12KB

Diagnostics, including cardiology

Routine diagnostics are being postponed. Barts Health is contacting patients to let them know and will notify referrers. This applies to  ultrasound, Xray, CT, MRI, echocardiography and heart monitoring. Urgent diagnostics will continue and patients will be called by Barts Health to confirm their appointment. Patients should  not attend any diagnostics appointment unless they have been contacted by Barts Health and asked to come in. 

Changes to Cardiology services during coronavirus pandemic [docx] 11KB

 

Referrals to the Barts Health Centre (Inherited Arrhythmia Service)

6 August 2019

The Inherited Arrhythmia service at St Bartholomew’s Hospital  looks after patients who have signs or a family history of various heart conditions (including Brugada syndrome, long QT syndrome, catecholaminergic polymorphic VT), as well as people who have lost a relative from sudden arrhythmia death or people who have survived a cardiac arrest and no cause was found (idiopathic VF).

These conditions are usually dominantly inherited so we recommend first-degree relatives are screened in the first instance.  Our specialist clinics offer a one-stop-shop for the bulk of the tests which range from ECGs, echocardiograms, exercise tests and holters.  If you are suspicious that a patient has one of these conditions or has a first-degree relative with one, please refer them to the service via the electronic referral system. 

We can be found under Cardiology Genetics > Inherited Arrhythmia Service (RAS).  Alternatively, if you would like to discuss a referral first please call the specialist nurses on 0203 76 58644.  If you have a patient with a cardiomyopathy, they will need to be seen in the Inherited Cardiovascular Diseases clinic.

 

Change in the criteria which determines if urines are cultured

9 May 2019

Urine microscopy is a quick and effective way of ruling-out infection and ensures that resources are used to culture urine samples from patients most likely to have a urinary tract infection.

At present, for most samples, if microscopy detects ?30 WBC/?l OR ?750 bacteria/?l, the urine will be cultured.

Urine samples from some patients, children   and pregnant women for example, undergo culture irrespective of the microscopy result.

What is changing?

From 27th May 2019 only urine samples with both ?30 WBC/?l AND ?750 bacteria/?l, will be cultured. Therefore, you may notice a reduction in the proportion of urine samples with culture results.

Urine samples from children and pregnant women will continue to undergo culture irrespective of the microscopy result

What is the reason for the change

An internal study was conducted which found that using the ‘OR’ criteria resulted in a significant number of false-positive culture results, which in turn may have led to unnecessary antibiotic therapy. Using the ‘AND’ criteria retains a good level of sensitivity and, when negative, accurately rules-out infection in 80% of cases.

Urine containers

We still require urines to be sent in the kima tubes (see picture). This assists the laboratory hugely, allowing for rapid automated testing and reduces the risk of errors.

Further information

Contact microbiology (details are available via MicroGuide App or Barts Health switchboard)