Change History

DSCN 2009 / 09

NHS Reforms: NHS Wales Data Definition Update

DSCN (2008) 09 (W)

Access to Core Sexual Health Services

DSCN (2006) 01 (W)

To introduce Independent Nurse Activity in the Outpatient ds + QS1

DSCN 11/01 (W)

Subject: Changes to the definitions of Day Case, Bed, Out Patient Attendance, Out Patient Discharge and Date Decided to Admit

DSCN 04/01 (W)

Data Standards: Minor Changes and Corrections

a)

An attendance at a hospital outpatient department clinic for the purpose of consultation, examination or treatment by a doctor or independent nurse

b)

A visit to the home of a patient made at the insistence of the Local Health Board/Trust for either of the following:

i. To review the urgency of a proposed admission to hospital.

ii. To continue to supervise treatment initiated or prescribed at a hospital or clinic.

c)

Attendances that occur off hospital premises – those which are hospital consultant led clinics either in the community or at a GP surgery.

d)

Attendance by a patient at a ward (where the use of a bed is not made) for the purpose of examination or treatment by a doctor or independent nurse.

a)

Any visit made to the home of the patient for which a fee is payable under paragraph 140 of the terms and conditions of service.

b)

Any attendance at a hospital ward where a non-independent nurse (see WARD ATTENDERS) undertakes the examination, treatment or care.

c)

Any consultations, which occur during an inpatient consultant episode (hospital provider) with the consultant or independent nurse responsible for the patient’s, care i.e. Ward Rounds. See CONSULTANT EPISODE (HOSPITAL PROVIDER)

d)

Any attendance where the patient does not see a doctor or independent nurse. Other clinic attendances may count as contacts with a paramedical service or community nurses.

1

Each attendance is counted in a series of attendances provided that the consultant, locum, GP acting as a consultant or independent nurse a member of a medical team sees the patient.

2

An appointment cannot be counted unless the patient actually attends.

3

A person attending clinics run by different consultants (or independent nurse) (whether for the same or different condition) would have two separate series of attendance.

4

If a second consultant or independent nurse is consulted for advice or specialist treatment a separate attendance (new series) is counted only if a separate appointment is made to see the second consultant or independent nurse.

5

Where a patient is seen at one clinic and then seen by the same consultant or independent nurse at a different location the subsequent attendance is a follow up unless it does not relate to the original referral.

6

An attendance is counted as a follow up attendance if it follows an inpatient or day case hospital spell with the same consultant who treated the patient during the hospital spell.

7

Post-natal outpatient attendances are counted as follow ups if the mother sees the same consultant who provided the antenatal care.

8

If a consultant or independent nurse sees more than one person during a consultation e.g. a family, then each attendance is counted only if there is an identifiable individual record maintained for each of the attendees.

9

If a consultant or independent nurse sees a member of the patients family for a consultation regarding the treatment or care for that patient and a record is kept in the patients case notes and a specific appointment has been made.

10

A count should be made of each subsequent attendance by the patient who having seen the consultant or independent nurse at the clinic returns for treatment or surgical dressings unless:

i. The non-independent nurse's attention is in effect the completion of the attendance with the consultant or independent nurse.

ii. The patient is sent to another department before returning for the completion of the consultation.

11

A count of each attendance should be made for an inpatient attending an outpatients department for any treatment by another consultant or doctor or independent nurse e.g. dental or optical treatment.

12

Count any treatment carried out during a pre-arranged visit to the hospital by a consultant or independent nurse not responsible for the care owing to immobility of the patient or lack of outpatient facilities.

13

A count can be made for all attendances made by the patient where the clinical care and physiotherapy is given during the same or subsequent visit but only when such care is supervised by the consultant or independent nurse.

a)

Following an emergency inpatient hospital spell under the care of the consultant or independent nurse in charge of the clinic.

b)

Following a non-emergency inpatient hospital spell (elective or maternity) under the care of the consultant or independent nurse in charge of the clinic.

c)

Following an A/E attendance to an A/E clinic for the continuation of treatment.

d)

An earlier attendance at a clinic run by the same consultant or independent nurse in any Local Health Board/Trust, community or GP surgery.

e)

Following return of the patient within the timescale agreed by the consultant or independent nurse in charge of the clinic for the same condition or effects resulting from same condition.

a)

referral from a GP

b)

referral from an A/E Consultant within the same or different hospital provider to different consultant or independent nurse

c)

a different Consultant or independent nurse to the one receiving the referral either from  the same hospital provider or a different hospital provider

d)

self referral by the patient

e)

other referral from a prosthetist, dentist or optician

f)

Referral from a domiciliary visits by the consultant or independent nurse in charge of the clinic

g)

A referral from a private consultation with a Consultant or independent nurse in charge of the clinic

a)

The patient is not given a further appointment by the consultant or member of his medical team or independent nurse and is not expected to return within twelve months for the same complaint as the reason for referral or effect resulting from the same complaint.

b)

The patient was given an invitation to return to the clinic should his or her original condition worsen and has not done so by the timescale originally agreed with the consultant or independent nurse at the time of the last attendance.

c)

Six months has passed since the patient failed to attend their last offered appointment and no further requests for an appointment have been made.