Quality standard

Quality statement 4: Hallpike manoeuvre for adults

Quality statement 4: Hallpike manoeuvre for adults

Quality statement

Adults with transient rotational vertigo on head movement are assessed using the Hallpike manoeuvre.

Rationale

The Hallpike manoeuvre can be used to check for benign paroxysmal positional vertigo (BPPV) in adults with vertigo on head movement. If BPPV is confirmed, treatment to relieve it using a canalith repositioning manoeuvre can be given. Use of the Hallpike manoeuvre can reduce unnecessary referrals for specialist assessment.

Quality measures

Structure

Evidence of written clinical protocols to ensure that adults presenting with symptoms of transient rotational vertigo on head movement are assessed for BPPV using the Hallpike manoeuvre.

Data source: Local data collection, for example clinical pathways.

Process

Proportion of adults presenting with transient rotational vertigo on head movement who are assessed using the Hallpike manoeuvre.

Numerator – The number in the denominator who are assessed using the Hallpike manoeuvre.

Denominator – The number of adults presenting with transient rotational vertigo on head movement.

Data source: Local data collection, for example local audit of patient records.

Outcome

a) Proportion of adults presenting with transient rotational vertigo on head movement referred to ear, nose and throat services who were assessed using the Hallpike manoeuvre.

Numerator – The number in the denominator who were assessed using the Hallpike manoeuvre.

Denominator – The number of adults presenting with transient rotational vertigo on head movement who are referred to ear, nose and throat services.

Data source: Local data collection, for example local audit of patient records.

b) Patient satisfaction with investigation of transient rotational vertigo on head movement.

Data source: Local data collection, for example patient satisfaction surveys.

What the quality statement means for different audiences

Service providers (such as primary care services, secondary care services, physiotherapy services and neurology departments) ensure that systems are in place for adults with transient rotational vertigo on head movement to have the Hallpike manoeuvre performed by a healthcare professional trained in its use, to assess for BPPV. If there is not a trained healthcare professional available locally within primary care, then systems should be in place to refer adults for the Hallpike manoeuvre in accordance with local pathways.

Healthcare professionals (such as GPs, neurology specialists, nurses and physiotherapists) know when to use the Hallpike manoeuvre to assess for BPPV in adults with transient rotational vertigo on head movement. They are aware of staff in their healthcare setting who are trained in use of the Hallpike manoeuvre and local pathways for referral if there are no trained staff available.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which adults with transient rotational vertigo on head movement have the Hallpike manoeuvre performed to assess for BPPV. They agree local pathways for referral between service providers where services do not have access to a healthcare professional trained in performing the manoeuvre.

Adults who experience vertigo (the feeling that they or everything around them is spinning) when they move their head have a test done to check whether this is being caused by a condition called benign paroxysmal positional vertigo (BPPV). In the test they are asked to move their head in certain ways. If BPPV is diagnosed it can be treated to relieve the vertigo.