Referral to Treatment Clock Stop Administrative Event

DSCN 18/2006 published in December 2006, defined essential new data items required to support the measurement of 18 week REFERRAL TO TREATMENT PERIODS (monitoring of DH PSA target 13 - "By 2008, no one will have to wait longer than 18 weeks from GP referral to hospital treatment").

In particular, DSCN 18/2006 introduced the following new data items.

• PATIENT PATHWAY IDENTIFIER
• REFERRAL TO TREATMENT PERIOD START DATE
• REFERRAL TO TREATMENT PERIOD END DATE

Strategic reporting of 18 weeks will be undertaken by the Secondary Uses Service using data obtained via the Commissioning Data Sets. The data items defined in  DSCN 18/2006  are enabled to flow in Commissioning Data Set.

However, an event which results in an update to the REFERRAL TO TREATMENT PERIOD STATUS may occur outside the events that are defined in the Commissioning Data Sets (typically Outpatient or Inpatient encounters) and will therefore not flow to the Secondary Uses Service. These types of events have been termed as "administrative events". They can be defined as any communication event between the Health Care Provider and the  PATIENT that occurs outside of an outpatient attendance or inpatient admission and that results in the PATIENT's REFERRAL TO TREATMENT PERIOD STATUS being changed to stop the 18 week clock. These events are not face to face consultations and do not necessarily involve clinical staff.

These Referral To Treatment Clock Stop Administrative Events may be carried using the Commissioning Data Set Type 020 Outpatient record type. They are differentiated from PATIENT contact ACTIVITY by the FIRST ATTENDANCE value carried within them. FIRST ATTENDANCE national code 5 "Referral to treatment clock stop administrative event" signifies that an ACTIVITY has taken place which has ended the REFERRAL TO TREATMENT PERIOD and changed the REFERRAL TO TREATMENT PERIOD STATUS to one of the following:

• 30 Start of First Definitive Treatment

• 31 Start of Active Monitoring initiated by the PATIENT

• 32 Start of Active Monitoring initiated by the CARE PROFESSIONAL

• 34 Decision not to treat - decision not to treat made or no further contact required

• 35 PATIENT declined offered treatment

• 36 PATIENT died before treatment

When to Use Referral To Treatment Clock Stop Administrative Events

These events may happen because:

• The ACTIVITY ending the event does not qualify as a "patient contact" between a clinician and PATIENT, or

• The ACTIVITY occurred in a setting where IT systems cannot produce REFERRAL TO TREATMENT PERIOD data items, or

• The ACTIVITY would be carried in a Commissioning Data Set record type not currently processed by the Secondary Uses Service

Secondary Uses Service Processing

The Secondary Uses Service currently processes the following Commissioning Data Set record types in order to build Referral To Treatment pathways.

• CDS V6-2 Type 020 - Outpatient Commissioning Data Set

  / CDS V6-3 Type 020 - Outpatient Commissioning Data Set

• CDS V6-2 Type 130 - Admitted Patient Care - Finished General Episode Commissioning Data Set

  / CDS V6-3 Type 130 - Admitted Patient Care - Finished General Episode Commissioning Data Set

• CDS V6-2 Type 190 - Admitted Patient Care - Unfinished General Episode Commissioning Data Set

  / CDS V6-3 Type 190 - Admitted Patient Care - Unfinished General Episode Commissioning Data Set

All other types are not currently processed and so if they carry the REFERRAL TO TREATMENT PERIOD END DATE  for a REFERRAL TO TREATMENT PERIOD, a Referral To Treatment Clock Stop Administrative Event  must also be sent in order to inform the Secondary Uses Service of the clock stop.

CDS V6-2 Type 120 - Admitted Patient Care - Finished Birth Episode Commissioning Data Set

• CDS V6-2 Type 140 - Admitted Patient Care - Finished Delivery Episode Commissioning Data Set
• CDS V6-2 Type 150 - Admitted Patient Care - Other Birth Event Commissioning Data Set
• CDS V6-2 Type 160 - Admitted Patient Care - Other Delivery Event Commissioning Data Set
• CDS V6-2 Type 180 - Admitted Patient Care - Unfinished Birth Episode Commissioning Data Set
• CDS V6-2 Type 200 - Admitted Patient Care - Unfinished Delivery Episode Commissioning Data Set

This is because a Referral To Treatment Clock Stop Administrative Event  occurring in the scenarios where these record types are generated, would be rare. However this will be reviewed as part of the ongoing maintenance of the Referral To Treatment Clock Stop Administrative Event, and the requirements for the Secondary Uses Service.

When NOT to Use a Referral To Treatment Clock Stop Administrative Event

The Referral To Treatment Clock Stop Administrative Event  should NOT be used to correct previously submitted records where a REFERRAL TO TREATMENT PERIOD END DATE was submitted incorrectly to the Secondary Uses Service.

For example, if an Out-Patient Appointment  took place where  First Definitive Treatment  was started, but the REFERRAL TO TREATMENT PERIOD END DATE  was not sent in the corresponding CDS V6-2 Type 020 - Outpatient Commissioning Data Set/ CDS V6-3 Type 020 - Outpatient Commissioning Data Set record as it was not entered on the Patient Administration System until later; then the CDS V6-2 Type 020 - Outpatient Commissioning Data Set/ CDS V6-3 Type 020 - Outpatient Commissioning Data Set record should be resubmitted with the correct data. A Referral To Treatment Clock Stop Administrative Event  should NOT be used.

Where an ORGANISATION's Patient Administration System supports the submission of cancelled and Did Not Attend appointments in the CDS V6-2 Type 020 - Outpatient Commissioning Data Set/ CDS V6-3 Type 020 - Outpatient Commissioning Data Set, the Referral To Treatment Clock Stop Administrative Event  should NOT be used when a PATIENT has a booked Out-Patient Appointment, which is then cancelled because, for example, the PATIENT dies. In these cases the  CDS V6-2 Type 020 - Outpatient Commissioning Data Set/ CDS V6-3 Type 020 - Outpatient Commissioning Data Set  can carry the details of a cancelled CARE ACTIVITY, including the REFERRAL TO TREATMENT PERIOD END DATE  and update to the REFERRAL TO TREATMENT PERIOD STATUS. (Note - not all Patient Administration Systems provide functionality to create and submit Commissioning Data Set records for cancellations/Did Not Attend's as this is not yet mandated - you should contact your Patient Administration System support team to ascertain whether your Patient Administration System supports this. If not, then it is permissible to send a Referral To Treatment Clock Stop Administrative Event in order to stop the clock in the Secondary Uses Service  instead).

Referral To Treatment Clock Stop Administrative Events only require a sub-set of the data elements contained in the  CDS V6-2 Type 020 - Outpatient Commissioning Data Set/ CDS V6-3 Type 020 - Outpatient Commissioning Data Set record, to be submitted to the Secondary Uses Service. All other data elements not listed should be omitted from the XML submission of the CDS V6-2 Type 020 - Outpatient Commissioning Data Set/ CDS V6-3 Type 020 - Outpatient Commissioning Data Set record to the Secondary Uses Service. The submission of a Referral To Treatment Clock Stop Administrative Event  is not reliant on the use of the Net Change Commissioning Data Set Submission Protocol to the Secondary Uses Service

The required data elements making up a Referral To Treatment Clock Stop Administrative Event are: