First Definitive Treatment

First Definitive Treatment is the first CLINICAL INTERVENTION intended to manage a PATIENT's disease, condition or injury and avoid further CLINICAL INTERVENTIONS.

What constitutes First Definitive Treatment is a matter of clinical judgement in consultation with others, where appropriate, including the PATIENT.

Further guidance on ending REFERRAL TO TREATMENT PERIODS and first treatments.

Undertaking a procedure is not necessarily in itself the end of a REFERRAL TO TREATMENT PERIOD. For example, outpatient or day case diagnostic CARE ACTIVITIES prior to admission for treatment do not represent the end of the REFERRAL TO TREATMENT PERIOD and, in these cases, are part of the diagnostic process rather than the start of treatment.

Commencement of medication as an outpatient can be the end of a REFERRAL TO TREATMENT PERIOD, if it is intended as the First Definitive Treatment. However, CARE PROFESSIONALS often begin to manage a PATIENT's condition in advance of the first actual treatment taking place, for example by giving pain relief before a surgical procedure takes place. In these cases, the REFERRAL TO TREATMENT PERIOD END DATE is when the First Definitive Treatment (in this example, surgery) has started.

In NHS Allied Health Professional Services (Referral To Treatment Measurement), CLINICAL INTERVENTIONS  are often the First Definitive Treatment. However, it may be judged that other elements of PATIENT  care constitute First Definitive Treatment, for example the giving of advice. If there is any doubt, the key determining factors are

• what does the Allied Health Professional responsible for the PATIENT's care consider the start of treatment to be?

• when does the PATIENT  perceive their treatment to have started?

Other CARE ACTIVITIES that may end a REFERRAL TO TREATMENT PERIOD as First Definitive Treatment include the:

• fitting of a medical device where a CONSULTANT decides that treatment consists of fitting a medical device. This is the date of the actual fitting of the device rather than the point at which the PATIENT is measured for the device

• date of a therapeutic procedure where it is intended as diagnostic but the CARE PROFESSIONAL makes a decision to undertake a therapeutic procedure at the same time. In this example, it may count as a start of treatment and as such, the period will end

• date for less intensive treatment and medical management such as Palliative Care that may be attempted before moving on to invasive procedures and treatment or may be the only treatment. In such cases, the first treatment that is intended to manage a PATIENT's disease, condition or injury will end that particular REFERRAL TO TREATMENT PERIOD. Should the PATIENT at some later stage require more 'aggressive' treatment then the Decision To Treat would start a new REFERRAL TO TREATMENT PERIOD

• date  Active Monitoring  commenced.