new ways of defining and measuring waiting times applying the scottish executive health department...
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New Ways of Defining and Measuring Waiting Times
Applying the Scottish Executive Health Department Guidance
‘New Ways’
Key changes that New Ways brings
Central SEHD guidance Changes in patient circumstances recorded Availability Status Codes abolished Focus on shared responsibility of patients and
GPs / referrers with hospital services
Four main elements
Did Not Attend - DNA Could Not Attend - CNA Medical and social unavailability Reasonable offer
Applies to all new outpatients, return outpatients
with a procedure, and all non-emergency inpatient
and day case admissions
Did Not Attend (D.N.A)
Guidance states that patient does not attend without prior notice they should be sent back to the original referrer - if clinically appropriate
If sent back to referrer, patient is taken off the waiting list
If the patient is to remain on the waiting list the clock is reset to zero from the ‘failed’ date
The expectation is the increased choice over dates will reduce DNA rates
Patient attends initial appointment
WT – Referral to Initially SeenClock reset to Zero when patient DNAs
Appointment offer
accepted by patient
Patient DNAs appointment
Appointment offer
accepted by patient
New appointment offer made to
patient
Patient referral received
Appt. offer
made to patient
Patient referral
sent
What to do next? local
clinical decisio
n
Patient returned to
referrer
Could Not Attend (C.N.A)
Guidance states that patient is allowed to cancel twice, but if cancels a third time, should be send back to the referrer - if clinically appropriate
Clock is reset to zero from the date the appointment or admission is cancelled, not the date of the appointment itself
Therefore it is in the patients best interest to cancel as early as possible
The expectation is the increased choice over dates will result in reduced cancellations
Patient attends initial appointment
WT – Referral to Initially SeenClock reset to Zero when patient notifies that CNA
Appointment offer
accepted by patient
Patient notifies cannot attend
Appointment offer
accepted by patient
New appointment offer made to
patient
Patient referral received
Appt. offer
made to patient
Patient referral
sent
Unavailability
‘Unavailability’ is a period of time when the patient is unavailable for treatment
As unavailability affects planning and scheduling of appointments, it is essential that periods of unavailability are identified and recorded
Patients who have no known end date should not be added to the waiting list
Guidance defines two types of unavailability Medical Social
Unavailability
Any periods of unavailability should be recorded with a start date and, where possible, a likely end date
ALL periods will be removed from the patient’s reported wait
Patients should be reviewed within thirteen weeks if no known end date to their unavailability
Repeated periods of unavailability should be discouraged - if patients are unavailable they should not be added to the waiting list
Patients should be made aware of what effect unavailability has on their waiting time
Appt made to
attend/admit for
treatment
Patient attends/ admitted
for treatment
Patient discharged
Waiting Time
Patient receives treatmen
t
Patient added to WL
Patient unavailable for treatment
Waiting Time
Patient becomes
unavailable
Patient reviewe
d
What to do next? local
clinical decisio
n
Patient returned to
referrer
available
not available
Reasonable Offer: Outline
Reasonable offer package Two dates 7 days or more in advance
Second date not required if first date accepted Short notice appointments can be offered Exceptions
Urgent appointments Infrequent services i.e. remote and rural
Patient referral received
Patient attends
appointment
Waiting Time (1) – Referral to Initially Seen‘Reasonable offer’
Appt. offer
made to patient
Appointment offer (1) rejected
by patient
Appt. offer (2) made to patient
Appointment offer (2)
accepted by patient
Patient referral
sent
Reasonable Offer: Declining
Patients must be given the opportunity to accept or decline appointment or admission dates
If declining a first date within a reasonable offer a further date must be offered
If declining a short notice offer, two dates must still be offered
If patient refuses the reasonable offer ‘package’ they may be sent back to the original referrer
Clock is reset to zero from the date second offer is declined
Reasonable Offer: Communication
Patients should be given clear instructions on how and when to contact the hospital to either accept or decline appointments and admission dates
Where treatment may occur outside the health board area make this clear to the patient at the outset of the process
Patients should be given clear information on the consequences of not responding quickly and the impact on their waiting time
Reasonable Offer and PFB
Dialogue between service and patient is central to success of reasonable offers
Patient Focused Booking (PFB) takes this approach already
PFB is recognised as the best approach to making a reasonable offer
Waiting Time
Patient ‘unavailable’
No contact within 7
days
Reminder sent
Patient referral received
Patient asked to
make contact
Patient referral
sent
Patient attends initial appt.
Appt. offer made to patient
Appointment offer accepted by
patient
Waiting Time
No contact within7
days
Reminder sent
Patient returned to
referrer
Patient referral received
Patient asked to
make contact
Patient referral
sent
No contact within
another 7 days
What to do next? local
clinical decisio
n
• 18 week RTT pathway becomes operational standard for NHSScotland (December 2011).
• The clock starts for a RTT period on the date of receipt of referral to:
• - a consultant-led service• - a referral management centre, or• - a direct access service for audiology• This does not include mental health services, homoeopathy,
obstetrics and assisted conception services which have never been the subject of national waiting times standards. Other work is ongoing within NHSScotland which will address access issues to mental health services in particular.
Treatments and care activities that may end a referral to treatment period include:
a. Treatment as an inpatient or daycaseb. Treatment as an outpatient including surgical, medical and non-consultant led activityc. Fitting of a medical deviced. No treatment requirede. Active monitoringf. Patient declines treatment
Treatment stopping the 18 weeks RTT clock
NEW DATA ITEMS
• Unique Care Pathway Number (UCPN)
• Outcome Codes (Ensure correct management of the Patient wait)
• Sub-Specialty/Clinic codes – For Local Use only
Clinical Outcome Sheet• Clinician input• Required for ALL OP
appointments• Needs updated after
every appointment• Efficient turnaround
required to capture changes to wait
In summary
New Ways started 1 January 2008 Covers all patients waiting at that time, not just new referrals Reasonable offer and unavailability introduced ASCs abolished SMR3 and OPWL ends New data items recorded More frequent data extraction New national data warehouse
And then the 18 week waiting times target comes into
force….
To support you
Applying Guidance publication Desktop Guide Website
Frequently Asked Questions Downloadable presentations
Newsletter Definitions manual Leaflets for staff Patient leaflets and posters
Thank You!
You can get more information:
Online www.newways.scot.nhs.uk
www.18weeks.scot.nhs.uk
EmailCAMHS Inbox - [email protected] Ways - [email protected]
18 Weeks RTT - [email protected]