National Demand Optimisation Group (NDOG): demand optimisation in laboratory medicine - phase IV report

The National Demand Optimisation Group (NDOG) is a Scottish Government commissioned group. Its main objective is to reduce unwarranted variation in laboratory diagnostic testing, contributing to improved patient outcomes The group has recently completed its fourth phase of work.

4 Phase IV

4.1 Aims

An NDOG Phase IV Programme Initiation Document (PID) was developed in early 2020, expanding upon work undertaken in Phase III of the programme and was approved through agreed governance channels (see Annex C for original Phase IV PID).

As with all aspects of healthcare, the impact of the COVID-19 pandemic on the Demand Optimisation programme was significant. In response to the emerging pandemic, the suitability of the initial scope and objectives of the Phase IV Demand Optimisation programme were reconsidered by the Scottish Government and the NDOG and it was agreed that the Phase IV objectives and scope should be revised accordingly (see Annex D). This paper and the revised Phase IV Proposal document were supported and fully endorsed by the appropriate governance groups.

The new objectives resulted in a re-focused and dynamic programme of work responsive to the COVID-19 pandemic and changing landscape. It should be noted that work against many of the initial objectives of Phase IV were effectively paused.

The revised Phase IV objectives were as follows:

  • Source data and observations from all boards and networks on the changes in healthcare infrastructure and provision as a result of the COVID-19 pandemic.
  • Collect discipline specific laboratory activity data for the main sources where available – primary care, secondary care and outpatients.
  • Estimate the "gap" in testing for different areas and disciplines especially in relation to the response to the COVID-19 pandemic.
  • Histopathology – focus on identifying specific specimen workload reductions and the burden of workload in expected recovery phase.
  • Development of educational guidance, mainly via the networks, to roll out across healthcare settings with a focus on avoiding unnecessary samples as well as individual tests.
  • Atlas of Variation – re-focus of the Atlas to acknowledge and track the new post COVID-19 metrics, but also to allow peer comparison across boards, regions, clusters and nations. Such comparisons are likely to be pandemic focused rather than looking chronologically at what came before COVID-19. A post-COVID-19 dashboard will need developing that merges with prior Atlas aims and objectives around appropriate testing.
  • Focus on key areas such as cancer and diabetes where normal testing activity will likely have been impacted by the response to the COVID-19 pandemic.

4.2 Meeting Schedule

The NDOG Steering Group formally met five times throughout Phase IV. In addition, the NDOG core team led a data workshop in September 2020 to define the Phase IV blood science data request. A full list of Phase IV NDOG meetings is listed in Annex E.



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