Applying audiology referral to treatment clock rules

1
Applying audiology referral to treatment clock
rules

• 18 Weeks Intensive Support Team
• Department of Health

2
Context and links with 18 weeks

• Risk that delivery of 18 weeks will be undermined
  by long waits remaining in audiology
• 2008/9 HCC ratings ...an assessment of
  performance on direct access to audiology as
  published in the 2008/09 operating framework.
• HCC ratings to include a data completeness element

3
Audiology data collections

• Covers all direct access referrals to audiology
  services
• Weekly direct access audiology PTL
• A prospective view of performance
• A list of patients to be seen by a given date
• Shows clearly when patients are nearing breach
  date
• Monthly direct access RTT report
• A retrospective view of performance
• Measures how long a patient has waited from
  referral to first definitive treatment, e.g.
  hearing aid fitting

4
Data completeness

• There is a data completeness measure based on
  the following assumptions
• 90 of all audiology assessment waiting list
  activity reported in the diagnostic monthly
  return (DM01) are direct access pathways - i.e.
  the patient has been referred to a non medical or
  surgical consultant led service
• 10 of all audiology assessment waiting list
  activity reported in DM01 are 18 week RTT
  pathways i.e. where the patient is on a
  medical/surgical consultant led pathway

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Worked example Provider A Assesses and Treats
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What to do if your data is not complete

• Double check the analysis of the proportion of
  audiology assessment waiting list activity that
  are direct access pathways
• Check volumes of referrals received from ENT or
  other consultant led services
• Ensure pathways have accurate clock starts
• Capture all clock stops (record outcomes)
• Check you are interpreting the rules correctly
• Understand the relationship between the DM01 and
  audiology activity
• Check to see if you need to adjust your DM01
  return downwards to reflect patients waiting for
  more than one test on the same pathway

7
Direct access audiology clock rules summary (1)

• Audiology clock rules provide guidance around
  when the clock starts and stops.
• Consistent with 18 week clock rules, but specific
  to the direct-access audiology collection.
• The audiology collection covers all direct access
  referrals to audiology services, including
• patients who have a newly diagnosed hearing loss
• patients returning for reassessment and the
  provision of an upgraded aid.
• Not included
• patients on an 18 week pathway that are referred
  to audiology services from any consultant-led
  service
• hearing aid repairs and replacement aids seen in
  repair services.

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Direct access audiology clock rules summary (2)
clock starts

• The clock starts upon referral into the direct
  access service, including
• referrals for a first assessment or subsequent
  reassessment
• referrals from a GP or professional permitted by
  the primary care trust to make such referrals
• referrals from a hospital consultant to a direct
  access audiology service (where the patient is
  not on an 18 week pathway or where the referral
  to direct-access audiology has stopped the 18
  week clock)
• self-referral for reassessment and/or an upgraded
  hearing aid, where that has been locally agreed
  by commissioners and providers.
• Clock starts on the date the referral is received
  by the audiology service

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Direct access audiology clock rules summary (3)
clock stops

• The clock stops upon commencement of treatment,
  including
• the fitting of a medical device, e.g. hearing
  aid, with the clock stopping on the date on which
  definitive fitting or trial fitting begins
• hearing aid reprogramming (for patients whose
  hearing has deteriorated but who do not need
  another hearing aid)
• The clock may also stop where no treatment has
  occurred where
• a clinical decision is made to embark on a period
  of active monitoring
• a patient declines treatment having been offered
  it
• a clinical decision is made not to treat
• a clinical decision has been made to refer the
  patient from a direct access audiology service to
  a consultant-led service thus starting an 18 week
  clock, which starts on the date the referral is
  received in the consultant-led service.

10
Interaction between 18 weeks and audiology RTT
pathways

• A patient should not have both an 18 weeks and an
  audiology clock running at the same time for the
  same RTT pathway.
• where a patient on a consultant led 18 week
  pathway is referred on for non-consultant-led
  audiology treatment in secondary care (or at an
  interface service), their 18 week clock should
  continue until their first definitive treatment
  starts. No direct access audiology clock would
  start.
• where a patient on a consultant led 18 week
  pathway is referred on for non-consultant-led
  audiology treatment in primary or community care,
  their existing 18 week clock should stop. A
  direct access clock should start on the date that
  the onward referral is received by the
  primary/community care provider.

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Interaction between 18 weeks and audiology RTT
pathways
Direct access clock stop
Direct access audiology hospital setting
Treatment
18 Week clock stop
18 Week clock ticks
Direct access clock stop 18 weeks clock start
18 Week clock stop
Referral
ENT (consultant led)
Treatment
18 Week clock start
18 Week clock stop direct access clock start
Direct access clock stop 18 weeks clock start
Direct access clock start
Direct access audiology primary/community
setting
Treatment
Direct access clock stop
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Further clarification on reporting

• Analogue to digital hearing aid replacements
• Assess and fit services and the 6 week
  diagnostic milestone
• Paediatric audiology services
• Multi provider audiology pathways

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Sources of help/further information

• 18 Weeks website www.18weeks.nhs.uk/Content.aspx?
  path/achieve-and-sustain/Diagnostics/Audiology
• Audiology data/PTL queries dataaudiology_at_dh.gsi.g
  ov.uk
• SHA re data completeness issues
• matthew.baker_at_london.nhs.uk