Download Delay Code Reporting Guidance - Nationwide Service Framework

Faster Cancer Treatment:
Delay code reporting guidance
Date:
December 2016
Version:
2.0
Ministry of Health
Cancer Services
FINAL
Owner:
Status
Faster cancer treatment health target
85 percent of patients receive their first cancer treatment (or other management) within 62 days of
being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016,
increasing to 90 percent by June 2017.
The Faster cancer treatment health target builds on the significant improvements that have been made
in the quality of cancer services over recent years. It provides a lens across the whole cancer pathway
to ensure people have prompt access to excellent cancer services.
Background
To support achievement of the Faster cancer treatment (FCT) health target, from 1 January 2017
the reporting of a delay code for records that do not achieve the 62-day timeframe will be
mandatory.
The delay code reported should relate to the reason that contributed to the longest delay, or if
there are two delays of equal length, the first delay that occurred.
Purpose of this document
The Faster Cancer Treatment Indicators: Business Rules and Data Definitions1 specify three delay
code reporting values2:
Value
Meaning
1
Patient reason (chosen to delay)
2
Clinical consideration (co-morbidities)
3
Capacity constraint (resulting from lack of resources (theatre, equipment, facilities
or workforce) or process constraint including administrative errors)
With the introduction of mandatory reporting, this document is intended to provide further
clarification on the interpretation and use of these categories to support consistent and fair
reporting of delay codes within FCT.
1
Version 3.1, March 2014. Available on the Nationwide Service Framework Library:
http://nsfl.health.govt.nz/accountability/performance-and-monitoring/business-rules-and-templatesreporting/faster-cancer
2
It is understood that some DHBs and/or Regional Cancer Networks are capturing more detailed delay code
information than specified in the Faster Cancer Treatment Indicators: Business Rules and Data Definitions. This is
supported, so long as DHBs/RCNs ensure that for reporting to the national FCT collection this information is
aggregated into the three values specified in the Faster Cancer Treatment Indicators: Business Rules and Data
Definitions.
Rationale and use of reporting delay codes
Experience in the United Kingdom on shorter cancer waits3 shows that capturing and analysis of
breach reasons (delay codes) allows for identification of trends and highlighting of systematic
problems, which can be corrected or improved to positively impact patient experience and
achievement of targets.
Gaining visibility of breach numbers, locations and reasons is a critical component for DHBs to
understand where they are in the process of delivering on the FCT health target. Good breach
tracking and analysis will allow DHBs to develop local responses that reflect the complexities of
their own organisations, and can assist with:
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how to assess, understand and prioritise areas of greatest need within cancer pathways
assessing tumour streams and identifying key priorities for improvement
establishing baseline position and planning for improvements needed to achieve targets.
Delays to treatment can be categorised as either ‘avoidable breaches’ or ‘unavoidable breaches’.
Having clear visibility of the difference, and the volumes and locations of each type, is an
invaluable tool in the improvement cycle.


Unavoidable = legitimate patient choice, an unusually complex diagnostic pathway, or the
delay was a clinical exception and in the best clinical interest of the patient.
Avoidable = breaches resulting from administrative or capacity issues.
Good practice points on undertaking breach reviews include:

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3
all breaches should be reviewed in detail to identify learnings, understand bottlenecks,
identify capacity issues and determine whether the issue was irregular or systematic
comparison of the actual pathway with time at each milestone against locally agreed
milestones is often helpful
sub-categorising avoidable and unavoidable delays by each stage of the pathway
findings should be presented back to clinical and management teams/departments
actions should be identified and immediately put into place to prevent further similar
avoidable breaches.
Delivering Cancer Waiting Times: A Good Practice Guide NHS Interim Management and Support (2015). Available on
the FCT Quickr website https://collab.moh.govt.nz/fastercancertreatment or https://www.england.nhs.uk/wpcontent/uploads/2015/03/delivering-cancer-wait-times.pdf
Expanded delay code guidance
4
Value
Meaning
1
Patient reason
(chosen to delay)
General principles
 Must be able to demonstrate
the patient generated the
delay by choosing to wait
longer.
 Patients should be supported
to understand their care
pathway and treatment
options and to make informed
decisions.
 Patients should be offered
reasonable choice and given
sufficient notice of their
appointments and treatments.
If patients are unable to
attend at very short notice or
are given little choice this
should not be considered a
patient reason/choice delay.
Valid example
 A patient who is going on holiday
and is unavailable for a period
greater than 1 calendar week4.
 A patient who is not available to
attend any offered appointments
and the impact of the delay is
greater than 1 calendar week
(from the earliest date offered).
 A patient who changes their
mind about their treatment
(*note, this should generate a
review of the information and
support provided to the patient to
make a decision on their care
and treatment).
 A patient who does not attend
(DNA) their appointment or
treatment (*note, DNAs should
be reviewed to understand any
contributing factors and how
patients can be supported to
attend).
 Patient seeks a second opinion.
 Patient chooses to delay due to
the specialist being unavailable
(eg, on leave) and has declined
to be treated by another
specialist who is available.
Not valid example
 A patient who is unavailable to
attend on an appointment or
treatment date offered (so long
as they are able to accept an
alternative date that does not
delay their care by more than 1
calendar week).
 A patient who wants to take a
few days to consider their
options and discuss with
family/whanau (so long as this
does not delay their care by
more than 1 calendar week).
 Patient’s agreed treatment
option is not offered at their
DHB-of-domicile (so long as the
treatment is part of a standard
treatment pathway. Improving
coordination and provision of
care across DHBs should be a
key focus of FCT).
The period of 1 calendar week is given as a guide for when these types of delay can be coded as ‘patient reason’ (a patient-generated delay) rather than ‘capacity
constraint’ (a delay due to the system not supporting patient choice and access).
2
Clinical
consideration
(co-morbidities)
 Where a co-morbidity or
complication needs to be
addressed before the patient
can receive their cancer
treatment.
 Should not be used where
there are delays to
assessments, tests or
procedures that are part of
the standard plan of care as
these should be factored into
the treatment pathway and
timeframe.
3
Capacity
constraint
 Situations where the capacity
of the system, DHB, service
or process have limited the
ability to achieve the FCT
health target.
 Had more capacity or
improved processes been
available it could reasonably
be expected that the patient
would not have breached.
 Where diagnosis is complex or
requires investigations additional
to the standard pathway of care.
 There are cancer-related
complications, eg formation of a
defunctioning stoma prior to
chemo or radiation therapy.
 There are intercurrent problems
or pre-existing co-morbidities
that need to be managed prior to
treatment. Eg: patient requiring
steroids to manage chest
symptoms prior to starting
chemotherapy or patient
requiring antibiotics to treat
urinary tract infection prior to
having the prostate biopsied.
 The patient fails anaesthetic
assessment.
 There is a delay post-biopsy to
allow healing and/or infection to
subside (eg, between TRUS
biopsy and MRI; after a LLETZ
cone or formal cone biopsy).
 Where a patient receives fertility
treatment/preservation prior to
treatment.
 Lack of resources – theatre,
equipment, facilities or
workforce.
 Process constraint, including
administrative errors.
 Communication and process
issues in the transfer of patient
care between DHBs/hospitals.
 Where a clinical assessment
was not completed within agreed
timeframes.
 Where the patient underwent
tests or treatment at a DHB other
than their DHB-of-domicile (so
long as it was part of a standard
treatment pathway. Improving
coordination and provision of
care across DHBs should be a
key focus of FCT).
 Volume study prior to
implantation of low-dose
radiotherapy seeds for
brachytherapy.