A time close to our hearts Measurement of referraltotreatment waiting time

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A time close to our heartsMeasurement of
referral-to-treatment waiting time

• David Adler
• Head of Healthcare Improvement
• Beds Herts SHA

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RTT MeasurementContents

• Scope
• Practicalities
• Issues particularly relevant to Cardiology
  pathways
• National and local action

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Milestones

• Mar06 13 26 26 (Theoretical max gt1yr)
• Mar07 11 13 20 (Theoretical max 44 weeks)
  
• Mar08 5 6 11 (Theoretical max 22 weeks)
• Dec08 4 4 10 (Theoretical max 18 weeks)
• Tolerance ?

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Scope of RTT measurement
18 Weeks
GP
IP/ST
OP
D
OP
1st OutpatientAppointment
Decision to treat
GP Visit
Treatment
Referral
Start of treatment
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Key pathway points

• Referral record on PAS
• Opportunity to tag the referral.
• Outpatient attendance(s) - record on PAS
• Opportunity to record outcome(s).
• Decision to treat record on clinic outcome slip
  /or on specially created PAS field.
• Start of treatment record on PAS if date of
  admission for procedure otherwise may have to be
  as for decision to treat.

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Measurement Process

• Recording how the data is collected and
  recorded
• Extraction how queries are constructed
• Reporting in what detail and format, by whom,
  when
• Action otherwise theres no point!

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Extraction
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.
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Reporting
Forecasts of total waiting time.
Feedback to Choose Book systems, to inform
patients, clinicians and commissioners
Performance report
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Action
Analysis and decisions on action to improve
service. Also link to ISIP.
Choice, by patients and commissioners
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Current waiting time silos

• GP written referral to first outpatient
  attendance
• Outpatient wait, currently max 13w
• Wait for diagnostic test
• Only the time from request until the test itself
• MR and CT, currently max 26w
• Time on admission waiting list
• Admission wait, currently max 26w

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Common issues

• Definition of time and source of referral
• Definition of start of treatment
• Suspensions and deferrals

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Cardiology Clinics

• Palpitation / arrhythmia
• CHD (mainly in RACPC rather than general
  clinics)
• Hypertension
• Heart failure
• Dizziness, syncope
• Cardiac pathology in pregnancy
• (Screening for) potentially inherited cardiac
  conditions

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Cardiology pathway issues

• Long-term conditions
• Which new spells of hospital consultant care are
  regarded as new referrals and which as continuity
  of care plan treatment? And who checks /
  decides?

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Cardiology pathway issues

• Hospital consultant-led outpatient work in
  community settings
• Ensure that any referral, consultation and
  procedure dates are recorded and reported
  alongside hospital PAS data.
• Be clear about which work is and is not part of
  an 18w pathway.

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Cardiology pathway issues

• Tertiary care
• Ensure that key dates up to and including start
  of treatment are recorded and reported alongside
  secondary care data and..
• Ensure completion of whole pathway records, to
  help resolve issues listed under long-term
  conditions.
• Define clearly what constitutes start of
  treatment.

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Cardiology pathway issues

• Defining, recording and reporting key pathway
  dates
• Referral(Which ones are included and which
  excluded)?
• First outpatient attendance(How is this
  collected if at a one-stop shop or with a MDT)?
• Decision to treat / agreement on care plan(Who
  defines it who records it and how)?
• Start of treatment(Who defines it who records
  it and how)?

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Action

• National
• Pioneer sites
• Tactical solution mid-2006
• Strategic solution by 2007?DH website
  www.18weeks.nhs.uk
• Local
• Find out and join in whats happening on 18w.
• Ensure that solutions are developed that suit
  Cardiology
• The local CHD network could help develop
  solutions.

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Local action
The carrots intellectual challenge opportunity
to study what really happens to our
patients worthwhile objective

• Get the right organisations and people involved
• PCT
• Acute Trust
• SHA
• Chief execs the leaders and watchers
• 18w leads the encouragers
• Information managers the measurers
• Clinical champions the keen clinical leaders

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Recommendations

• Keep it simple with few rules
• Start with key dates - referral and start of
  treatment
• (ignore suspensions, DNAs etc initially)
• Start with retrospective data (it may take longer
  to establish real time tracking)
• Try to tag patients from the start of their
  journey

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Pioneers

• 8 sites across England
• Pioneers with CHD focus
• East Kent
• Gateshead
• Royal Devon Exeter
• South Bedfordshire
• Tactical RTT solution by June 2006
• Retrospective
• Prospective

Other pioneer sites Huntingdonshire Kings,
London North Nottinghamshire Oldham