Definitions: General Guidance and Scope
•Health boards in Wales to provide information. Accountability for reporting follows Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf) unless otherwise indicated. This is as follows:
o The Welsh health board with clinical responsibility for the patient at the reporting census date is responsible for reporting the Open Pathways metrics.
o The Welsh health board with clinical responsibility for the patient at any clock stop event is responsible for reporting the Clock Stop metrics.
o When NHS activity is commissioned from an independent sector provider, the Welsh health board commissioning the pathway is responsible for reporting the respective metrics.
o When a referral is made to an English provider, for the purposes of this data collection, this will be treated as a clock stop event and be reported as such by the Welsh health board with clinical responsibility at that reporting point.
•When patient care transfers between organisations the clock does not stop, and it is the responsibility of the transferring organisation to provide the correct pathway start date. Detailed guidance for reporting and clock stop events is given in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
•Health boards are required to report on the 20th working day of the month following the last day of the previous month (dates provided on the Guidance - General sheet of the pro forma).
•The information required relates to all new cardiac and cardiology referrals for actual and relative pathways for adults and paediatric patients (i.e., Main Specialties 170 - Cardiothoracic Surgery, 320 - Cardiology, 321 - Paediatric Cardiology) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/mainspecialtyconsultant.htm). It excludes rehabilitation (i.e., Treatment Function Code 327 - Cardiac Rehabilitation).
o Actual refers to the 'real' patient wait for the respective component with no amendments to any dates due to e.g., resets from CNAs / DNAs, adjustments due to patients being unavailable etc.
o Relative refers to the wait for the respective component taking into account any amendments to dates, irrespective of the reason as to why the amendment has been made e.g., resets from CNAs, DNAs, adjustments (both patient and health board related) etc.
•All sources of referral should be included.
•Both face to face and virtual appointments should be included.
•Component 2 treatment figures are defined as elective admitted treatments only (i.e. Admission Method 11 - Waiting List, 12 - Booked, 13 - Planned) (see www.datadictionary.wales.nhs.uk/#!WordDocuments/admissionmethod.htm). Types of treatment include (this is not an exhaustive list):
o Revascularisation (Angioplasty (Percutaneous Coronary Intervention); CABG (Coronary artery bypass surgery))
o Valve Surgery (Aortic; Mitral; Combined Aortic & Mitral)
o Other Cardiac Surgery (Adult congenital cardiac surgery; Tumours; Other surgical procedures e.g. removal of pericardium)
o Device and other procedural therapy (Pacemakers for heart block; Implantable defibrillators for arrhythmias; Biventricular pacemakers for heart failure; DC cardioversion for atrial fibrillation; Ablation)
•It is acknowledged that operational processes and systems differ across health boards and that information may be pulled from a variety of fields. With that in mind, to ensure consistency of approach, Component Start and Component Stop Points include reference to standards as proxies where available. In some scenarios, the Component Start may differ according to whether the health board is the original recipient of a referral or whether it has clinical responsibility because the patient was transferred. Where the Component Starts are different this will be reflected in the guidance for the respective metric.
Definitions: Metrics
Definitions for the component metrics are given below, but the pathway can be summarised as follows:
|
Open Pathways – Relative | ||
|
Metric |
Definition | |
|
Component 1 |
Referral to Decision to Treat |
The number of patient pathways that are waiting for a decision to treat, following a referral into secondary care. The decision to treat is the date that the consultation between the patient and the clinician takes place and a planned treatment is agreed.
Component Start Point Outpatient Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
The WLD will initially be the same as the Clinical Referral Date (CRD) i.e., the date the referral is received into Secondary Care. However, there are a number of situations where the WLD will change if, for example, a patient has been offered and agreed an appointment but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Outpatient Waiting List Date (WLD) to reflect any changes to the original Pathway Start Date (PSD).
Component Stop Point N/A (as this is an open pathway) |
|
Component 2 |
Decision to Treat to Elective Admitted Treatment Undertaken |
The number of patient pathways that are waiting for an elective admitted treatment, following a decision to treat.
Component Start Point Admitted Patient Care Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
There are a number of situations where the WLD will change if, for example, a patient has been offered and agreed a treatment date but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
Component Stop Point N/A (as this is an open pathway) |
|
Open Pathways – Actual | ||
|
Metric |
Definition | |
|
Component 1 |
Referral to Decision to Treat |
The number of patient pathways that are waiting for a decision to treat, following a referral into secondary care. The decision to treat is the date that the consultation between the patient and the clinician takes place and a planned treatment is agreed.
Component Start Point Outpatient Clinical Referral Date (CRD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/clinicalreferraldate.htm) i.e., the date the referral is received into Secondary Care.
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Clinical Referral Date (CRD) i.e., the Pathway Start Date (PSD) of the original referral to the transferring organisation
Component Stop Point N/A (as this is an open pathway)
|
|
Component 2 |
Decision to Treat to Elective Admitted Treatment Undertaken |
The number of patient pathways that are waiting for an elective admitted treatment, following a decision to treat.
Component Start Point Decision to Admit Date (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/decisiontoadmitdate.htm). Component Stop Point N/A (as this is an open pathway) |
|
Clock Stop - Relative | ||
|
Metric |
Definition | |
|
Component 1 |
Referral to Decision to Treat
|
The number of Component 1 patient pathways that ended during the month with a decision to treat point. The decision to treat is the date that the consultation between the patient and the clinician takes place and a planned treatment is agreed.
Component Start Point Outpatient Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
The WLD will initially be the same as the Clinical Referral Date (CRD) i.e., the date the referral is received into Secondary Care. However, there are a number of situations where the WLD will change if, for example, a patient has been offered and agreed an appointment but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Outpatient Waiting List Date (WLD) to reflect any changes to the original Pathway Start Date (PSD).
Component Stop Point Admitted Patient Care Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm). |
|
Component 1 |
Referral to Death of Patient
|
The number of Component 1 patient pathways that ended during the month with a patient death.
Component Start Point Outpatient Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
The WLD will initially be the same as the Clinical Referral Date (CRD) i.e., the date the referral is received into Secondary Care. However, there are a number of situations where the WLD will change if, for example, a patient has been offered and agreed an appointment but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Outpatient Waiting List Date (WLD) to reflect any changes to the original Pathway Start Date (PSD).
Component Stop Point The date of the patient's death |
|
Component 1 |
Referral to Any Other Clock Stop Event
|
The number of Component 1 patient pathways that ended during the month with a clock stop event other than decision to treat or death of patient.
Component Start Point Outpatient Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
The WLD will initially be the same as the Clinical Referral Date (CRD) i.e., the date the referral is received into Secondary Care. However, there are a number of situations where the WLD will change if, for example, a patient has been offered and agreed an appointment but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Outpatient Waiting List Date (WLD) to reflect any changes to the original Pathway Start Date (PSD).
Component Stop Point The date of any other clock stop event during the month other than decision to treat or death of patient e.g., decision not to treat, active monitoring, patients elect to have private care etc. For WelshPAS users see (Cardiac and Cardiology Component Waits - Supporting Guidance) for a list of possible outcome codes. |
|
Component 2 |
Decision to Treat to Elective Admitted Treatment Undertaken |
The number of Component 2 patient pathways that ended during the month with the patients having received elective admitted treatment.
Component Start Point Admitted Patient Care Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
There are a number of situations where the WLD will change if, for example, a patient has been offered and agreed a treatment date but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
Component Stop Point Start Date of Provider Spell (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/startdateofproviderspell.htm).
Note: The Start Date of Provider spell may not be the same as the date the patient actually received treatment. |
|
Component 2 |
Decision to Treat to Death of Patient
|
The number of Component 2 patient pathways that ended during the month with a patient death.
Component Start Point Admitted Patient Care Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
There are a number of situations where the WLD will change if, for example, a patient has been offered and agreed a treatment date but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
Component Stop Point The date of the patient's death. |
|
Component 2 |
Decision to Treat to Any Other Clock Stop Event
|
The number of Component 2 patient pathways that ended during the month with a clock stop event other than elective admitted treatment undertaken or death of patient.
Component Start Point Admitted Patient Care Waiting List Date (WLD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/waitinglistdatewld.htm).
There are a number of situations where the WLD will change if, for example, a patient has been offered and agreed a treatment date but then subsequently cancels or DNAs. The circumstances where the WLD may change can be found in the Consolidated Rules for Managing Cardiac Referral To Treatment Waiting Times – March 2018 (see http://howis.wales.nhs.uk/doclib/Welsh%20Health%20Circular%202018%20018%20Consolidated%20Rules%20for%20Managing%20Cardiac%20Referral%20Traetment%20Waiting%20Times%20-%20March%202018%20(English).pdf).
Component Stop Point The date of any other clock stop event during the month other than elective admitted treatment undertaken or death of patient e.g., emergency treatment, patients elect to have private care etc. For WelshPAS users see (Cardiac and Cardiology Component Waits - Supporting Guidance) for a list of possible outcome codes. |
|
Clock Stop - Actual | ||
|
Metric |
Definition | |
|
Component 1 |
Referral to Decision to Treat
|
The number of Component 1 patient pathways that ended during the month with a decision to treat point. The decision to treat is the date that the consultation between the patient and the clinician takes place and a planned treatment is agreed.
Component Start Point Outpatient Clinical Referral Date (CRD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/clinicalreferraldate.htm) i.e., the date the referral is received into Secondary Care.
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Clinical Referral Date (CRD) i.e., the Pathway Start Date (PSD) of the original referral to the transferring organisation
Component Stop Point Decision to Admit Date (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/decisiontoadmitdate.htm) |
|
Component 1 |
Referral to Death of Patient
|
The number of Component 1 patient pathways that ended during the month with a patient death.
Component Start Point Outpatient Clinical Referral Date (CRD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/clinicalreferraldate.htm) i.e., the date the referral is received into Secondary Care.
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Clinical Referral Date (CRD) i.e., the Pathway Start Date (PSD) of the original referral to the transferring organisation
Component Stop Point The date of the patient's death. |
|
Component 1 |
Referral to Any Other Clock Stop Event
|
The number of Component 1 patient pathways that ended during the month with a clock stop event other than decision to treat or death of patient.
Component Start Point Outpatient Clinical Referral Date (CRD) (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/clinicalreferraldate.htm) i.e., the date the referral is received into Secondary Care.
In cases where patients were transferred to another health board within this component of the pathway, the Component Start Point will also be the Clinical Referral Date (CRD) i.e., the Pathway Start Date (PSD) of the original referral to the transferring organisation
Component Stop Point The date of any other clock stop event during the month other than decision to treat or death of patient e.g., decision not to treat, active monitoring, patients elect to have private care etc. For WelshPAS users see (Cardiac and Cardiology Component Waits - Supporting Guidance) for a list of possible outcome codes. |
|
Component 2 |
Decision to Treat to Elective Admitted Treatment Undertaken |
The number of Component 2 patient pathways that ended during the month with the patients having received elective admitted treatment.
Component Start Point Decision to Admit Date (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/decisiontoadmitdate.htm
Component Stop Point Start Date of Provider Spell (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/startdateofproviderspell.htm.
Note: The Start Date of Provider spell may not be the same as the date the patient actually received treatment |
|
Component 2 |
Decision to Treat to Death of Patient
|
The number of Component 2 patient pathways that ended during the month with a patient death.
Component Start Point Decision to Admit Date (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/decisiontoadmitdate.htm).
Component Stop Point The date of the patient's death. |
|
Component 2 |
Decision to Treat to Any Other Clock Stop Event
|
The number of Component 2 patient pathways that ended during the month with a clock stop event other than elective admitted treatment undertaken or death of patient.
Component Start Point Decision to Admit Date (see http://www.datadictionary.wales.nhs.uk/#!WordDocuments/decisiontoadmitdate.htm).
Component Stop Point The date of any other clock stop event during the month other than elective admitted treatment undertaken or death of patient e.g., emergency treatment, patients elect to have private care etc. For WelshPAS users see (Cardiac and Cardiology Component Waits - Supporting Guidance) for a list of possible outcome codes. |