The COVID-19 pandemic has resulted in increased demand and delays to diagnostic services. Community diagnostic centres (which are generally referred to as Regional Diagnostic Hubs in Wales) aim to reduce this backlog and the waiting times for patients by providing a broad range of elective diagnostic services in the community, away from acute hospital facilities. As diagnostic services account for over 85% of clinical pathways and cost the National Health Service (NHS) over six billion pounds a year (NHS 2022), community diagnostic centres across a broader range of diagnostic services may be an effective, efficient, and cost-effective introduction to the UK health sector. This Rapid Evidence Map aimed to identify, describe, and map the available evidence on the effectiveness of diagnostic centres. 50 primary studies were identified. Studies were published between 1995 and 2021: A wide range of study designs were used, and studies were conducted in a range of countries including the UK. 30 studies were specific to cancer diagnosis, whilst the remaining 20 studies focused on diagnosis associated with: anaemia, autism, cerebral palsy, intellectual disability, multiple sclerosis, respiratory conditions, shoulder pain, and unexplained fever Eleven studies reported information on multi-condition diagnostic centres, rather than a specific condition. The majority of studies were conducted within hospital settings. Two studies evaluated diagnostic centres within a community setting. The diagnostic centres offered a wide range of diagnostic tests and incorporated different staff and facilities. Participants were mainly referred by GPs, primary care centres and emergency departments. However, referrals were also made from outpatient clinics located within the same hospital as the diagnostic centre. Over 100 different outcomes were reported covering: patient data and referral outcomes, clinical outcomes, performance outcomes, economic outcomes, and patient and physician-reported outcomes. The findings of this rapid evidence map were used to select a substantive focus for a subsequent rapid review on community diagnostic centres that can be accessed by primary care teams.
Surgical waiting times have reached a record high, in particular with elective and non-emergency treatments being suspended or delayed during the COVID-19 pandemic. Prolonged waits for surgery can impact negatively on patients who may experience worse health outcomes, poor mental health, disease progression, or even death. Time spent waiting for surgery may be better utilised in preparing patients for surgery. This rapid review sought to identify innovations to support patients on surgical waiting lists to inform policy and strategy to address the elective surgical backlog in Wales. The review is based on the findings of existing reviews with priority given to robust evidence synthesis using minimum standards (systematic search, study selection, quality assessment, and appropriate synthesis). The search dates for prioritised reviews ranged from 2014-2021. Forty-eight systematic reviews were included. Most available evidence is derived from orthopaedic surgery reviews which may limit generalisability. The findings show benefits of exercise, education, smoking cessation, and psychological interventions for patients awaiting elective surgery. Policymakers, educators, and clinicians should consider recommending such interventions to be covered in curricula for health professionals. Further research is required to understand how various patient subgroups respond to preoperative interventions, including those from underserved and minority ethnic groups, more deprived groups and those with lower educational attainments. Further research is also needed on social prescribing or other community-centred approaches. It is unclear what impact the pandemic (and any associated restrictions) could have on the conduct or effectiveness of these interventions.
The COVID-19 pandemic further exacerbated disruptions to elective care services in the UK, leading to longer waits for treatment and a growing elective surgery backlog. There have been growing calls for the creation of surgical hubs to help reduce this backlog. Surgical hubs aim to increase surgical capacity by providing quicker access to procedures, as well as facilitate infection control by segregating patients and staff from emergency care. This rapid review aimed to assess the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity, to inform the implementation of these hubs in Wales. The review identified evidence available up until January 2023. Twelve primary studies were included, eight of which used comparative methods. Most of the studies were conducted during the COVID-19 pandemic and described surgical hubs designed mainly to mitigate the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Outcome measures reported included clinical, performance, economic, and patient reported outcomes across a variety of different surgical disciplines. Most of the studies did not describe surgical hubs based on their structure, i.e., standalone, integrated, or ring-fenced hubs. The evidence relating to the impact of surgical hubs on clinical outcomes appeared to be heterogenous and limited. Included studies did not appear to control for the impact of the COVID-19 pandemic on outcomes. Evidence of the impact of surgical hubs on performance outcomes such as efficiency, utilisation/usage, volume of surgeries/treatments, performance, cancellations, and time from diagnosis to treatment is limited. Evidence relating to the economic impact of surgical hubs is also limited, however there is evidence to suggest that total average costs are lower in surgical hubs when compared to general hospitals. Evidence relating to the impact of surgical hubs on patient reported outcomes is limited but indicates there may be a positive effect on patient satisfaction and compliance. Considerable variation in the types of surgical hubs reviewed, surgical disciplines, along with the small number of comparative studies, as well as methodological limitations across included studies, could limit the applicability of these findings.
The COVID-19 pandemic directly impacted diagnostic services in the UK and globally. This exacerbated the rapid rise in demand for diagnostics that existed before the pandemic, resulting in significant numbers of patients requiring various diagnostic services and increased waiting times for diagnostics and treatment. In 2021, community diagnostic centres were launched in England. As diagnostic services account for over 85% of clinical pathways within the NHS and cost over six billion pounds per year, diagnostic centres across a broader range of diagnostic services may be effective, efficient, and cost-effective in the UK health sector. This rapid review aimed to identify and examine the evidence on the effectiveness of community diagnostic centres. A prior Research Evidence Map was used, along with the stakeholder input, to select a substantive focus for the rapid review. Comparative studies examining community diagnostic centres that accept referrals from primary care as a minimum were included. Prioritised outcomes included those relating to impact on capacity and pressure on secondary care, ensuring equity in uptake or access, and economic outcomes. The review included evidence available up until August 2022. Twenty primary studies were included. Twelve individual diagnostic centres were evaluated across the 20 studies. Most studies evaluated diagnostic centres located within hospital settings. One study evaluated a mobile diagnostic ultrasound service. Most studies were specific to cancer diagnoses. Six studies covered multiple health conditions, which will have also included cancer. Other conditions reported included: severe anaemia, fever of uncertain nature, and multiple sclerosis. A range of outcomes was identified. 11 studies conducted in Spain evaluated the same type of clinic i.e. Quick Diagnostic Unit and seven studies evaluated the same centre at different time intervals. No evidence relating to equity of access was identified. The evidence relating to effectiveness appeared mixed. There is evidence to suggest that diagnostic centres can reduce various waiting times, including time to surgical consultation, time from consultation to treatment, time from cancer suspicion to treatment, time from diagnosis to specialist consultation and time from diagnosis to treatment. Diagnostic centres could help reduce pressure on secondary care by avoiding hospitalisations in stable patients. Cost-effectiveness may depend on whether the diagnostic centre is running at full capacity. Factors that could determine the costs incurred by a centre include the diagnostic and clinical complexity of patients, and the characteristics of the unit including the number of staff and contribution of staff time.
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