TEALE FENNING

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:28 pm Post subject: The 18 Week Clock for Treatment

I thought you should all be aware of the new Governement Guideline for the collection of Treatment Status to support 18 Week Wait. The 18 week target, which was set by the DOH, has to be enforced by 31/3/2008.

Here are the Treatment Statuses Definitions & Impact on the 18 Week Clock
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:29 pm Post subject:

1. First definitive treatment given or completed

First definitive treatment is defined as an intervention intended to manage a patient’s disease, condition or injury and avoid further intervention. (Treatment will often continue beyond the first definitive treatment and after the clock has stopped).

First definitive treatment can be:

a. Inpatient or day-case treatment; the clock stops on the date of admission

b. Diagnostic tests turned into therapeutic procedures during the investigation; for example, a colonoscopy which reveals a polyp that can be removed there and then

c. The fitting of a medical device, with the clock stopping on the date on which definitive fitting or trial fitting begins, and with no undue delay in subsequent fitting sessions thereafter

d. Outpatient treatment (or medical or surgical consultant-led treatment irrespective of setting) if no subsequent inpatient or day-case admission is expected, with the clock stopping on the date of attendance

e. First-line treatment – less intensive treatments or medical management attempted with the intention of avoiding more invasive procedures or treatment, with a new clock starting if a decision is later taken to provide more aggressive treatment; for example intra uterine insemination could constitute first definitive infertility treatment and clock-stop, with consultant referral for IVF at a later date starting a new clock subject to communication with primary care and possible primary care veto

f. Receipt of first definitive advice from a consultant geneticist may reasonably stop the clock if treatment by the genetics service (e.g. counselling) is not required and if the original referral was direct to the consultant geneticist; however, this rule will be kept under review as genetics services and treatments develop

g. Therapy (for example physiotherapy, speech and language therapy, podiatry, counselling) or healthcare science interventions (e.g. hearing-aid fitting) if that is what the medical or surgical consultant-led service decides is the intervention intended to manage the patient’s disease, condition or injury and avoid further intervention

NB: Administration of pain relief before a surgical procedure takes place, or other steps to manage a patient’s condition in advance of definitive treatment does not stop the clock. In these instances, this treatment status should not be selected.

Effect on clock

clock stopped

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:31 pm Post subject:

2. Decision not to treat

A decision has been made not to treat after an outpatient attendance or after diagnostic testing, with no further action in secondary care at this time. The clock stops when the decision is communicated to the patient.

Effect on clock

clock stopped

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:31 pm Post subject:

3. Start/Continuation of Watchful Waiting (Active Monitoring)

Watchful Waiting (Active monitoring) is when there is a period during the patient pathway where a decision is made (and agreed with the patient) that the patient will not receive any specific treatment but will be observed.

The clock stops when a diagnosis (please note that “no definitive diagnosis” is also a valid diagnosis) has been reached, and a clinical decision is made that a period of active monitoring will begin.

If a patient subsequently requires further treatment this decision would start a new 18 week clock

Effect on clock

clock stopped

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:32 pm Post subject:

4. Decision to treat following a period of Watchful Waiting (active monitoring)

If a patient subsequently requires further treatment following a period of watchful waiting (active monitoring), this decision would initiate the start of a new 18 week clock. The clock will start on the date when the appointment is made for the first outpatient attendance /assessment on the new RTT pathway.

Effect on clock

clock start
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:32 pm Post subject:

5. Treatment arranged for future admission or outpatient appointment

A Diagnosis has been made, and the patient will be treated either in an outpatient setting or as an admission. The clock remains ongoing until the patient has been treated.

Effect on clock

clock ongoing

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:33 pm Post subject:

6. Decision to treat pending (e.g. awaiting results)

Patient continues to attend an Outpatient Clinic prior to diagnosis – awaiting results to tests etc.

Effect on clock

clock ongoing

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:33 pm Post subject:

7. Treatment given in previous outpatient appointment or admission

Patient has received treatment in a previous outpatient appointment or admission - has attended this appointment for review, and has subsequently been discharged.

Effect on clock

clock stopped

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:34 pm Post subject:

8. Decision to return patient to primary care / RMC (Referral Management Centre)

The patient returns to primary care either after outpatient attendance or after diagnostic testing. There has been a decision not to treat and no further action in secondary care is undertaken at this time. The date on which this decision is communicated to the patient should be used as the clock stop date.

Effect on clock

clock stopped

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:38 pm Post subject:

9. Refer to other Consultant for different condition (where patient will not be seen in this clinic again)

The patient will not be seen in this clinic again, and is being referred onto another consultant for a condition other than that for which the patient was originally referred.

Where the patient will continue to be seen in this clinic please select another treatment status. If a consultant has identified a condition other than that for which the patient was original referred, this will start a new patient pathway with a new RTT pathway clock. As the patient is still being seen for the original condition the original referral pathway also continues with its own 18 week pathway.

Clock Stop

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:39 pm Post subject:

10. Refer to other Consultant for same condition

The patient is referred from consultant-to-consultant, where the underlying condition remains unchanged. The original clock start date is carried forward to the new clinic.

Clock Ongoing

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:39 pm Post subject:

11. Refer to other Provider for same condition

The patient is referred from this provider to another provider for the same condition. In these cases the new provider will take on the original RTT clock start date.

Clock Ongoing

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:39 pm Post subject:

12. Patient declined treatment

The consultant decides that treatment is appropriate but the patient declines treatment. The date the patient declines treatment should be used as the clock stop date.

Clock Stop

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:40 pm Post subject:

13. Add patient to transplant list

Where a decision is taken to add a patient to a transplant list, the 18 week clock stops
Clock Stop

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:41 pm Post subject:

14. None/Unknown

This option should only be used where none of the other treatment statues apply, or the treatment status is unknown.

Clock Ongoing

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:41 pm Post subject:

15. Admit Direct – Diagnostic

Patient admitted directly to a ward following a visit to an outpatient clinic, for a diagnostic procedure

Clock Ongoing

Nick Raine-Fenning · Posted: Thu May 24, 2007 4:41 pm Post subject:

16. Admit Direct – 1st Definitive Treatment

Patient admitted directly to a ward following a visit to an outpatient clinic, for 1st definitive treatment.

Clock Stop

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

i wonder how this is going to work. our out patients now has a new form monitoring the above points. it's going to be our index audit.

what i don't understand is----- say for e.g. a chr pelvic pain pt may not respond and has the potential to stay on the books for years. we in gyn are prone to getting chronic-ers ( not as much as palliative / elderley care though) how then do we stand with the clock business?

i see us breaching the 18week deadline quite often.

any views?

r
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Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region