3rd Feb 2009
The Trust has an ongoing challenge in managing waiting lists to meet eighteen week targets.
The management of waiting lists is a complex process that can be easily derailed if information is incorrectly recorded, reported, or managed.
Our new patient administration system will offer many opportunities to improve the quality of the registration, booking, scheduling, admission, discharge, and transfer information that we gather. The system will make it relatively simple to merge double registrations when these are found; and it will enable staff to define useful fields for searching, hence reducing the creation of duplicate records.
However the new system is less helpful than the current one if incorrect information is entered into it to update 18 week pathways. This means that we, as an organisation must make a special effort to ensure that the information that is to be entered is correct before it is entered.
What will happen if we don’t meet our 18 week targets?
Put simply, if the Trust fails to meet 18 week pathway management targets then it does not get paid for the service it has provided. The obvious flow on from this is that there is less money for Directorates in following years and less money for the Trust to invest in improved infrastructure and resourcing.
Why would we not hit our targets?
Our Trust is a top-performer. If we record accurately the details of the services we provide we are unlikely to miss our targets with regard to 18 week waiting lists. If, however, our data collection is inaccurate it is quite likely that we will miss targets.
How can we all help to achieve targets?
We know that sometimes the information that is available to be entered into the computer system following assignment of a patient category by our doctors and others is incorrect. As a result managers need to identify how anyone who is responsible for assigning categories on the pathway might be helped to improve the accuracy of that assignment.
Some ideas that are being explored are presented here:
1) Engagement of clerical and nursing staff to ensure that all outpatient 18 weeks forms are properly processed (existing status correctly identified and non-relevant patient categories scored through), returned, and entered into the computer system in a timely (same day) manner.
2) Increased focus on training and support of staff to check patient categories for accuracy and validity before they are entered into computer systems. Further development of support tools for people entering patient categories into computer systems.
3) Standardising our 18 week pathway data collection processes across all departments with well understood Key Performance Indicators to measure enable ongoing monitoring and review by a dedicated 18 week pathway coordinator.
4) Completion of the 24 hour admission, discharge and transfer project and incorporation of real time 18 week data entry into this process.
5) It is possible to eliminate non input of non-sequential patient categories (excluding typographic mistakes and wilful errors) by printing individualised 18 weeks sheets according to simple rules that offer the doctor only the logical choices.
By doing this, with no extraneous information the appearance of the sheets will improve, there will be more space to explain better what the fewer choices mean, the sheets would be more acceptable to the doctors with the possibility of fewer sequential but incorrect inputs. There should be no non-sequential inputs except through typographic mistakes.
Note: Ensuring the sequentiality of the data recorded is critical to the process of managing the 18 week pathway and to achieving compliance with waiting list targets.
6) Development of a short on-line tutorial for doctors regarding how to effectively code outpatient appointments. Making this available to doctors via the Intranet so that they can review it in their own time and revise at any time.
7) Identification and development of reports that will enable managers to identify sequential errors and manage process changes.
If you need further information about how you can be involved in helping us to improve our 18 week compliance please contact XXXXX.