Post on 11-Jul-2015
A time close to our heartsA time close to our hearts
Measurement of referral-to-treatment waiting timeMeasurement of referral-to-treatment waiting time
David AdlerDavid AdlerHead of Healthcare ImprovementHead of Healthcare Improvement
Beds & Herts SHABeds & Herts SHA
RTT MeasurementRTT Measurement
ContentsContents
ScopeScope
PracticalitiesPracticalities
Issues particularly relevant to Cardiology pathwaysIssues particularly relevant to Cardiology pathways
National and local actionNational and local action
MilestonesMilestones
Mar’06Mar’06 13 – 26 – 2613 – 26 – 26 (Theoretical max >1yr)(Theoretical max >1yr)
Mar’07Mar’07 11 – 13 – 2011 – 13 – 20 (Theoretical max 44 weeks)(Theoretical max 44 weeks)
Mar’08Mar’08 5 – 6 – 115 – 6 – 11 (Theoretical max 22 weeks)(Theoretical max 22 weeks)
Dec’08Dec’08 4 – 4 – 104 – 4 – 10 (Theoretical max 18 weeks)(Theoretical max 18 weeks)
Tolerance = ? %Tolerance = ? %
Scope of RTT measurementScope of RTT measurement
GP IP/STOP D OP
18 Weeks
GP Visit1st OutpatientAppointment
Decision to treat
Treatment
Referral Start of treatment
Prospective Retrospective
Key pathway pointsKey pathway points
ReferralReferral – record on PAS – record on PAS Opportunity to ‘tag’ the referral.Opportunity to ‘tag’ the referral.
Outpatient attendance(s)Outpatient attendance(s) - record on PAS - record on PAS Opportunity to record outcome(s).Opportunity to record outcome(s).
Decision to treatDecision to treat – record on clinic outcome slip &/or on – record on clinic outcome slip &/or on specially created PAS field.specially created PAS field.
Start of treatmentStart of treatment – record on PAS if date of admission for – record on PAS if date of admission for procedure; otherwise may have to be as for decision to treat.procedure; otherwise may have to be as for decision to treat.
Measurement ProcessMeasurement Process
Recording – how the data is collected and recordedRecording – how the data is collected and recorded
Extraction – how queries are constructedExtraction – how queries are constructed
Reporting – in what detail and format, by whom, whenReporting – in what detail and format, by whom, when
Action – otherwise there’s no point!Action – otherwise there’s no point!
Referral First Care plan Start of consultation agreed treatment
Patient waiting for first
consultation
Diagnostic phase &/or patient awaiting follow-up outpatient
attendance(s)
Patient waiting to start care plan
Patient tagged with I.D.
unique to the referral.
All events recorded on PAS must include the referral I.D.
(All 4 boundary events must be recorded for local management
purposes).
PAS query at any time will reveal patient progress
(waits and phases) to date.
Performance report
PAS query after start of treatment will reveal
actual historical data on waits.
Forecasts of total waiting time.
Feedback to Choose & Book
systems, to inform patients, clinicians and commissioners
Analysis and decisions on action to improve service. Also link to ISIP.
Recording
Extraction
Reporting
Action Choice, by patients and commissioners
Patient tagged with
I.D. unique to the referral.
All events recorded on PAS must include the referral I.D.
(All 4 boundary events must be recorded for local
management purposes).
Recording
PAS query at any time will reveal patient progress
(waits and phases) to date.
PAS query after start of treatment will reveal actual historical data
on waits.
Extraction
Forecasts of total waiting time.
Feedback to Choose & Book
systems, to inform patients, clinicians and commissioners
Reporting
Performance report
Analysis and decisions on action to improve service.
Also link to ISIP.
ActionChoice, by patients and commissioners
10
Current waiting time silosCurrent waiting time silos
GP written referral to first outpatient attendanceGP written referral to first outpatient attendance Outpatient wait, currently max 13wOutpatient wait, currently max 13w
Wait for diagnostic testWait for diagnostic test Only the time from request until the test itselfOnly the time from request until the test itself MR and CT, currently max 26wMR and CT, currently max 26w
Time on admission waiting listTime on admission waiting list Admission wait, currently max 26wAdmission wait, currently max 26w
Common issuesCommon issues
Definition of time and source of referralDefinition of time and source of referral
Definition of start of treatmentDefinition of start of treatment
Suspensions and deferralsSuspensions and deferrals
Cardiology ClinicsCardiology Clinics
Palpitation / arrhythmiaPalpitation / arrhythmia
CHD (mainly in RACPC rather than general clinics)CHD (mainly in RACPC rather than general clinics)
HypertensionHypertension
Heart failureHeart failure
Dizziness, syncopeDizziness, syncope
Cardiac pathology in pregnancyCardiac pathology in pregnancy
(Screening for) potentially inherited cardiac conditions(Screening for) potentially inherited cardiac conditions
Cardiology pathway issuesCardiology pathway issues
Long-term conditionsLong-term conditions
Which new spells of hospital consultant care are Which new spells of hospital consultant care are regarded as new referrals and which as continuity of regarded as new referrals and which as continuity of care plan treatment? And who checks / decides?care plan treatment? And who checks / decides?
Cardiology pathway issuesCardiology pathway issues
Hospital consultant-led outpatient work in community Hospital consultant-led outpatient work in community settingssettings
Ensure that any referral, consultation and procedure Ensure that any referral, consultation and procedure dates are recorded and reported alongside hospital dates are recorded and reported alongside hospital PAS data.PAS data.
Be clear about which work is and is not part of an Be clear about which work is and is not part of an 18w pathway.18w pathway.
Cardiology pathway issuesCardiology pathway issues
Tertiary careTertiary care
Ensure that key dates up to and including start of Ensure that key dates up to and including start of treatment are recorded and reported alongside treatment are recorded and reported alongside secondary care data; and…..secondary care data; and…..
Ensure completion of whole pathway records, to Ensure completion of whole pathway records, to help resolve issues listed under long-term conditions.help resolve issues listed under long-term conditions.
Define clearly what constitutes start of treatment.Define clearly what constitutes start of treatment.
Cardiology pathway issuesCardiology pathway issues
Defining, recording and reporting key pathway datesDefining, recording and reporting key pathway dates
ReferralReferral(Which ones are included and which excluded)?(Which ones are included and which excluded)?
First outpatient attendanceFirst outpatient attendance(How is this collected if at a one-stop shop or with a MDT)?(How is this collected if at a one-stop shop or with a MDT)?
Decision to treat / agreement on care planDecision to treat / agreement on care plan(Who defines it ; who records it and how)?(Who defines it ; who records it and how)?
Start of treatmentStart of treatment(Who defines it ; who records it and how)?(Who defines it ; who records it and how)?
5
2004/05 Total Waiting Time : General Surgical Procedures
0
5
10
15
20
25
30
35
40
Speci
alty
Inguin
al h
erni
a
Sigm
oidosc
opy
Lumpec
tom
y
Varic
ose v
eins
Chole
cyst
ecto
my
Colono
scopy
Haem
orrh
oids
Gastro
scopy
Excis
ion s
kin le
sion
Umbili
cal h
ernia
Mas
tect
omy
Anal f
istu
la
Circum
cisi
on
Excis
ion p
iloni
dal s
inus
Opns on a
nus
Inci
siona
l her
nia
Lymph
node
procs
.
Excis
ion re
ctum
Ventra
l her
nia
Hemic
olect
omy
Lesio
n of c
olon
We
ek
s WL Weeks
Diag Weeks
Out Pat Weeks
2004/05 Total Waiting Time : General Surgical Procedures
0
2
4
6
8
10
12
14
16
18
Speci
alty
Inguin
al h
erni
a
Sigm
oidosc
opy
Lumpec
tom
y
Varic
ose v
eins
Chole
cyst
ecto
my
Colono
scopy
Haem
orrh
oids
Gastro
scopy
Excis
ion s
kin le
sion
Umbili
cal h
ernia
Mas
tect
omy
Anal f
istu
la
Circum
cisi
on
Excis
ion p
iloni
dal s
inus
Opns on a
nus
Inci
siona
l her
nia
Lymph
node
procs
.
Excis
ion re
ctum
Ventra
l her
nia
Hemic
olect
omy
Lesio
n of c
olon
We
ek
s Out Pat Weeks
Diag Weeks
WL Weeks
GP referred patients - waits for first outpatient attendance and completion of outpatient treatment 2004/05
0
5
10
15
20
25
30
3510
0 G
en
era
l Sur
ger
y
101
Uro
log
y
11
0 O
rth
opa
edic
Su
rge
ry
120
Ea
r N
ose
And
Th
roa
t
130
Oph
tha
lmo
log
y
140
Ora
l Su
rge
ry
16
0 P
last
ic S
urg
ery
180
A &
E
191
Pai
n M
ana
gem
en
t
30
0 G
ene
ral M
edic
ine
301
Ga
stro
ent
ero
log
y
302
End
ocr
ino
log
y
303
Ha
em
atol
ogy
32
0 C
ard
iolo
gy
330
De
rma
tolo
gy
340
Th
ora
cic
Med
icin
e
40
0 N
euro
log
y
410
Rh
eum
atol
og
y
430
Ca
re O
f The
Eld
erl
y
501
Obs
tetr
ic
50
2 G
yna
ecol
ogy
510
Ob
stet
ric A
nte
Na
tal
800
Onc
olo
gy
Specialty
Ave
rag
e W
eek
s
First outpatient attendanceOutpatient treatment completeTreatment started 18 weeksDiagnosis complete 11 weeksAttend outpatients 5 weeks
ActionAction
NationalNational Pioneer sitesPioneer sites Tactical solution mid-2006Tactical solution mid-2006 Strategic solution by 2007?Strategic solution by 2007?
DH website DH website www.18weeks.nhs.ukwww.18weeks.nhs.uk
Local: Local: Find out and join in what’s happening on 18w.Find out and join in what’s happening on 18w. Ensure that solutions are developed that suit CardiologyEnsure that solutions are developed that suit Cardiology The local CHD network could help develop solutions. The local CHD network could help develop solutions.
3
Local actionLocal action
Get the right organisations and people involvedGet the right organisations and people involved
PCTPCT Acute TrustAcute Trust SHASHA
Chief execsChief execs – the leaders and watchers – the leaders and watchers 18w leads18w leads – the encouragers – the encouragers Information managersInformation managers – the measurers – the measurers Clinical championsClinical champions – the keen clinical leaders – the keen clinical leaders
The carrots:
intellectual challenge
+
opportunity to study what really happens to our patients
+
worthwhile objective
Local networking
RecommendationsRecommendations
Keep it simple with few ‘rules’Keep it simple with few ‘rules’
Start with key dates - referral and start of treatmentStart with key dates - referral and start of treatment(ignore suspensions, DNAs etc initially)(ignore suspensions, DNAs etc initially)
Start with retrospective data (it may take longer to establish real time tracking)Start with retrospective data (it may take longer to establish real time tracking)
Try to ‘tag’ patients from the start of their journeyTry to ‘tag’ patients from the start of their journey
PioneersPioneers
8 sites across England8 sites across England
Pioneers with CHD focus:Pioneers with CHD focus: East KentEast Kent GatesheadGateshead Royal Devon & ExeterRoyal Devon & Exeter South BedfordshireSouth Bedfordshire
Tactical RTT solution by June 2006Tactical RTT solution by June 2006 RetrospectiveRetrospective ProspectiveProspective
Other pioneer sites:
Huntingdonshire
Kings, London
North Nottinghamshire
Oldham