Nhs England
Purpose
The main aim of DQASS is to monitor and support the quality and effectiveness of Downs syndrome (T21), Edwards syndrome (T18) and Pataus syndrome (T13) screening in England.
DQASS provides feedback and support to laboratories, sonographers, the Screening Quality Assurance Service (SQAS) and to the NHS fetal anomaly screening programme (NHS FASP). The analyses provided by DQASS are used to improve the performance of the screening programme through feedback on all aspects of the test to laboratories, ultrasound departments and commercial suppliers.
Software used by screening laboratories must adhere to the specification for the chance result(s) calculation.
How DQASS works
DQASSworks on a rolling audit of screening test data on a 6-monthly cycle. The statistical analyses monitor various components of the screening process such as the overall standardised screen positive rate (SPR) and specific adjustments for ethnicity, smoking and other factors applied to individual biochemical markers. Through meta-analyses,DQASSprovides information on effects of factors such as smoking that is used to improve screening performance.
The NHS FASP service specification requires all screening laboratories providing NHS screening to participate in DQASS. The service is provided to screening laboratories and individual ultrasound practitioners across England.
The screening support sonographer
The NHS FASP recommends the provider has a screening support sonographer (SSS) and a deputy SSS with administrative support. These roles oversee the implementation, delivery and monitoring of the ultrasound aspects of the service. The SSS and deputy must actively participate in the DQASS process including submission of a minimum of 25 paired measurements on a 6-monthly basis.
The SSS should:
- follow NHS FASP requirements as specified in the NHS FASP handbook and by DQASS
- attend provider and commissioner led antenatal and newborn (ANNB) screening programme boards to represent the ultrasound service, and take the DQASS laboratory and ultrasound summary reports to these meetings
- put in place an on-going education and training programme for ultrasound practitioners
- undertake departmental review of ultrasound images including a log of dates that the image review was performed (this is required as evidence for SQAS)
- keep an accurate and up-to-date database of ultrasound practitioners and associated identity codes and inform DQASS:
- and the screening laboratory when a new ultrasound practitioner starts, or existing practitioners leave the provider and if known, their new place of work
- if any of their ultrasound practitioners work at other sites
- of new trainees to generate a unique DQASS identity code
- of the accuracy of DQASS/Fetal Medicine Foundation (FMF) identity codes and of any changes before the 6-monthly data submission
- of any omissions or errors in the DQASS reports (detailed ultrasound report for each individual ultrasound practitioner or ultrasound department summary report for each ultrasound provider) so an updated report can be issued if appropriate
- if there are any changes to their service that could impact their DQASS reports, for example new ultrasound machines
- monitor throughput for each ultrasound practitioner and put in place a locally agreed action plan to enable them to meet the minimum throughput
- send and provide feedback on DQASS detailed ultrasound reports for each individual ultrasound practitioner
- implement and monitor any supportive red flag action plans; in cases where the ultrasound practitioner works at more than one site, the SSS should work together with the other sites SSS and the ultrasound practitioner to develop the supportive action plan
- review the SSS resource every 2 years; all new SSS and deputy SSS should review the SSS resource when they start in the role
The SSS should also have a local documented process for the above actions.
DQASS identity codes
Ultrasound practitioners must have a unique identity code matched to the ultrasound department(s) where they work to participate in DQASS.
Trainee ultrasound practitioners
A trainee will need a unique DQASS identity code once they are able to achieve nuchal translucency (NT) and crown rump length (CRL) measurements with minimal guidance from the supervising practitioner.
A DQASS identity code is different from a FMF identity code.
The SSS should email DQASS at dqass@plymouth.ac.uk with the practitioners name and their associated hospital/unit(s) to obtain a DQASS identity code for the trainee.
DQASS will issue an identity code with the suffix T to indicate a practitioner in training (for example, 123456T).
The training process should take no longer than 6 months. The training code T will remain valid for this time. If training is not completed within 6 months, the SSS should document the reasons and contact DQASS.
The trainees should follow the 2-part training process as outlined in education and training for ultrasound practitioners in the NHS FASP handbook.