Part 2

To follow on with my previous missive explaining 18 weeks, I’d like to elucidate. I’d like to expound. Let’s face it, I’d like to have a damn good whinge (after all no-one uses the ‘net to praise anything).

18 weeks is a laudible target, and perfectly timed to be flaunted at the next general election (but we don’t go there).

So why do I have a problem? (Bearing in mind I can only speak about the radiology aspect, which is included in, but not the sole component of, the diagnostic element (4 weeks remember)).
As a whole our radiology department is doing well. In the majority of areas we are hitting next March’s targets now and have taken action to deal with the problem area. Furthermore unlike most other areas (such as A&E targets) where figures are fudged and corners cut, we’ve done it all by sheer bloody hard work.
An example – we have reduced a 2 year wait for barium enemas to 3-4 weeks.

I digress. So what is my problem?
(At this point you may like to refer to my previous post to have a brief recap of the ‘rules’.)

1) The starting time for the process is the date the request is written.
Seems fair enough; the doctor has expressed a need for a particular test: the patient is waiting for it.
What if the post takes several days to arrive from the GP?
What if the patient goes to Australia for 3 weeks then remembers the form on her return?
What if it gets put under a pile of discharge notes and is not seen again for 2 months?

Postal problem. Patient’s fault [1]. Requester error – It still is down on the system as a radiology delay.

2) There has been no joined up thinking between the part of the DoH responsible for CfH and the part responsible for the targets.
We have been given computer systems which are unable to cope with the information required. At the moment it is not possible to extract the data electronically from the computer system. So, on the first day of every month, one, possibly two members of staff spend all day counting patients statistics to send to the DoH for their monthly returns. Even if we were able to extract information electronically there is a limit to what can be done. Yes we could retrieve the date of request, the source, the type on investigation, the date recieved, the postcode (to identify the patient’s PCT) etc but the systems are totally inadequate with dealing with patients going ‘on hold’ while waiting.

So next time your are kept waiting for your x-ray or scan, have a look at the date. If it’s the first of the the month ‘your’ radiographer is probably in some dark room somewhere counting patients for the DoH.

3) Patient’s just do not want to be contacted.
We send out letters asking them to ring in to make appointments [2]. We ring them during the day. Out of hours staff try to call them at home. Short of sitting outside the house and canvassing all comers there’s little else we could do… And still the clock is ticking.

Incidentally isn’t it funny how audiology, an area with the biggest wait, with the least chance of ever meeting the 18 week target has been excluded from the diagnostic targets? [3]
[1] No such this as the customer patient is always right in radiology!

[2] Patient choice (‘partial bookings’ and ‘full bookings’ are the terms used) mean it is no longer the done thing to send out a letter saying “your appointment is on X date – please come with a full bladder and stop all recreational drug use”. We now have to negotiate a mutually agreable date – which of course needs bipartite involvement.

[3] Apparently at it not necessarily a consultant led service it doesn’t have to be included.

(Image c/o Friar Street Chisholms)
Part 1

The DoH have an on-going program imaginatively titled ‘18 weeks’ which has the target of (wait for it) 18 weeks from initial consultation to treatment by the end of December 2008.
One of the major elements of the 18 weeks is the time limit for diagnostic tests. This is to be set as 4 weeks for all diagnostic tests from this date. This is not the waiting time for an invstigation, this is the window in which all diagnostic tests prior to treatment must be completed within.
There is no big-bang approach; interim diagnostic targets are already in operation. We are currently working to 20 weeks. This will drop to 13 weeks next April and 6 weeks by the April after that.

Another initiative, ‘Choice of Scan’ (another name from the Stating the bleeding obvious section of the DoH) means that if we stray outside this time frame we have to offer the patient the choice of having their test[1] at a site of their choice [2] at our expense (well the Trust, not out of my own pocket (yet)).

We have to present the DoH with waiting list figures at the end of the month every month and have to present exception reports for every patient waiting over 6 weeks.
To clarify the situation we have been given guidelines.

• The waiting time can be viewed as a ticking clock.
• The waiting time starts from the date the request for the examination is written.
• If an appointment is made for a patient who subsequently contacts us to change their appointment date then they time they have been waiting changes to this date.
• If a patient DNAs then the clock stops until the patient is contacted and a new date agreed, at which point it restarts.
• If they DNA a second time then the request form is returned to the requesting doctor with a note saying what has happened and the patient is removed from the waiting list
• If a patient contacts the department to say they are unfit to come for an investigation the clock stops until they contact us again to say they are now well enough to attend.
• This is repeated if they become ill once more
• If we cancel their appointment then the clock continues ticking.
• Any patient for who asks for an appointment on or after a particular date is an advance booking and is no longer waiting until this date arrives.

Got that?

I’ll write more later.

[1] It could actually be a barium enema not a scan so ‘Choice of Scan’ is actally a misnomer. However ‘Choice of having some sort of Test, but only if you’ve waited too long’ doesn’t sound so good.

[2] From a somewhat limited list, so not much choice – no chance of a scan in an open MRI unit in Florida or some other pleasant location. Incidentally have you seen the open MRI ads that run incessantly over there (well they did last time I was there)?