Committee is requested to action as follows: Richard Walker. Dylan Williams

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1 BetsiCadwaladrUniversityHealthBoard Committee Paper Item IG14_60 NameofCommittee: Subject: Summary or IssuesofSignificance StrategicTheme/Priority / Valuesaddressedbythispaper Information Governance Committee Data Quality Strategy To submit for approval a Data Quality Strategy for patient data held on Health Board systems. The strategy requires all staff to be trained and competent in their role. Access to systems will not be given/revoked if this cannot be shown via the competency framework. Making it safe / better / sound / work / happen This strategy will drive the improvement of data quality within the Health Board. This will mean less duplication, validation, and correction. Ulitmately it will contribute to improved patient flow and better care. HealthcareStandardaddressed EqualityImpactAssessment (EqIA) - Recommendations: Committee is requested to action as follows: Approve Author(s) Presented by Richard Walker Dylan Williams Date of report 30 th October 2014 Date of meeting 17 th November 2014 BCUHBCommitteeCoversheetv5.02

2 Data Quality Strategy Betsi Cadwaladr University Health Board Informatics Department October 2014

3 Contents Purpose... 1 Scope... 1 Components of High Quality Data... 2 Key Principles... 2 Implications of Poor Data Quality... 3 Responsibilities... 3 Assurance... 4 Training... 4

4 Purpose All organisations need to collect high quality information. Within a healthcare environment this includes data about individual patients that supports their care, and data for wider organisational decision making. It is essential that data is of sufficient quality to enable robust decision making. This is only possible when the organisation has confidence with the data collection process, and processes that provide assurance of this. Patient level data is utlised primarily to manage the care of the patient. However, with appropriate anonymisation it is also used: to inform Health Board planning of services; to inform Welsh Government Policy; to inform Public Health policy and work; to answer press and public queries via Freedom of Information processes; to publish official statistics via Welsh Government and the Office for National Statistics. This strategy sets out the Health Board s approach to ensuring all staff understand their role, undertake their responsibilities with regards data quality, and provide the necessary assurance to the organisation. Scope The principles in this document are applicable both at a departmental and organisational level, and shall pertain to all patient information. The underpinning programme of work however will initially focus on data held within the 4 PAS systems in use, and Symphony, the ED system in use within the Eastern area of the organisation. The rationale for this is to ensure that delivery is achievable and that appropriate focus and resource can be placed upon delivery of the principles. The organisation acknowledges the importance of other critical systems, Telepath/LIMS, RADIS, Therapy Manager, CANISC. The use of the empi to support demographic data and NHS numbers across systems will require high data quality across all systems. However, the starting point must be the PAS/ED data, which feeds a number of systems, and the flow through the healthcare system. This will ensure prioritisation around key aspects that are of corporate importance to the organisation. This shall be reviewed in months times with a view to extending the programme of work. Page 1

5 Components of High Quality Data There are various factors that comprise high quality data, the most important of which is to ensure it is fit for purpose for its intended use. It is therefore fundamentally important to identify the uses of data and by whom it is used, whilst also considering future potential uses of information. It is vital that data conforms to recognised Information Standards, and reflects the various components of quality. For the purposes of the strategy this will be defined using the following Data Quality jigsaw.the Information Department will develop and report a set of measures that represent the 6 elements: DATA QUALITY CONSISTENCY PRECISION ACCURACY Timeliness Consistency Completeness Precision Validity Accuracy Key Principles The over-riding principle is that data quality work is aligned with and supports organisational objectives and priorities. High quality information should be seen as integral to supporting and driving delivery of safe and effective care. Data collection processes must support real-time management of the organisation operationally. This includes real-time bed management, Emergency department waits, and RTT pathway management. To support real-time management there needs to be an organisational culture of getting it right first time, every time, thus mitigating and alleviating the need for retrospective validation. The process for collecting data needs to follow the patient, with data collected chronologically along that journey. This will support the patient pathway, whilst as a bi-product, also being immediately available for management of operational pressures. The ownership of data collection processes and the quality of the information should reside with the Clinical Divisions that are responsible for delivering that care. Page 2

6 Implications of Poor Data Quality Implementation of, and adherence to the principles outlined in this strategy (e.g. removal of system access) could be seen as creating work, and negatively effect patient care. It is therefore essential that all staff recognise that not implementing has higher risks: Incorrect patient demographic detail (address and phone numbers) on a referral will lead to delays contacting patients with suspected cancer. Admitting a patient under the wrong consultant will lead to the care of the patient being attributed to the incorrect consultant including mortality and complications. Patients will not appear on consultant lists. Discharge letters can be sent to the wrong GP Practice. Opening and closing beds on a ward without informing the relevant people will lead to inaccurate occupancy rates being published and inaccurate future bed planning. Incorrectly recording the source/type of admission will significantly effect key reporting indicators such as the Risk Adjusted Mortality Index and Readmission rates. Not admitting and discharging in real time will lead to delays in patient flow and inaccurate occupancy data. Responsibilities The Medical Director is the Executive lead responsible for ensuring data quality, with operational responsibility devolved to the Head of Information. All Health Board staff have a responsibility to ensure that any patient data they collect or process is accurate, and fit for purpose. The Health Board has identified all staff who use the patient administration system. RTT training and the Competency Framework have been identified as mandatory for these staff. All nurses and doctors are also equally responsiblefor the quality and timeliness of data recorded on systems for their patients. New staff will not be given access to the patient administration system unless they have received training. Access will also be revoked if they cannot comply with the Competency Framework within 3 months. Responsibility for ensuring staff have received training and can demonstrate competence lies with the Clinical Divisions. Page 3

7 Assurance The organisation has a responsibility to monitor the various aspects of data quality to provide the relevant level of assurance. The Informatics Department will ensure that these various checks are in place and will report findings via a Quality Indicators Dashboard.This will be reported to the Board via the Medical Director, and direct to clinical divisions. In addition, an Annual Data Quality Statement will be produced. The visibility of data quality issues will be important to the success of this work and this will apply at all levels. Whilst senior managers will need to be appraised of any underlying issues that may affect the decision making process it is equally important that end users receive feedback on any errors and support to ensure future compliance. Compliance with the competency framework will be monitored via the PADR process, and reported via mandatory training reporting. Publication of live Emergency Department and Minor Injury Unit occupancy and bed states by ward will also highlight issues of compliance. Divisions will be supported to implement effective mechanisms for oversight in their individual area. Training The Informatics Department will provide training on the correct use of the National Patient Administration System to support the Wating List Competency Framework, and the Admission, Discharge and Transfer process. Page 4

8 [THE FOLLOWING IS PROVIDED AS EVIDENCE OF OPERATIONAL DATA QUALITY WORK:] Waiting List Skills and Competence Framework for Appointment Clerks, Receptionists and Medical Secretaries PiMS West Area Page 5

9 Introduction This document has been produced to facilitate the process of transition from skilled novice to skilled expert in relation to the administration and management of stages within the patient pathway. Staff should understand the principles of the Guide to Good Practice as well as the principles of Access 2009 and have the knowledge, skills and ability to input data onto PiMS adequately according to both documents. It is intended for use by Medical Secretaries and Appointment Clerks within the West at Betsi Cadwaladr University Health Board. Following attendance of the appropriate PiMS training which will have been provided by the Training Department it is expected that all Medical Secretaries and Appointment Clerks will undertake completion of this Skills and Competence Framework, at induction and on an annual basis at staff appraisal. There are 11 key competencies, which are; 1 General Management of Waiting Lists 2 Clinical Referral Date (CRD) 3 Referrals 4 Soon Category 5 Pooling of Waiting Lists 6 Booking Routine Patients in Chronological Order 7 Partial Booking of Appointments Page 6

10 8 Reasonable Offer (New and Review patients) 9 Did Not Attend (DNA) and Can Not Attend (CNA) 10 Cancellations by the Hospital 11 Validation of Waiting Lists 12 Management of patients who become unavailable for treatment 13 Inpatient and Daycase Waiting Lists 14 Outcome Codes Using this Document Staff must achieve at least level B in every skill and this must be indicated by the mentor and signed in each box (not ticked). It is anticipated that the member of staff may need to have several attempts before achieving a level B. However, if the mentor deems that person competent after their first attempt then this is acceptable too. E D C B A Observed the procedure understands the underpinning rationales Input the data accurately with direct supervision / help Input the data accurately under observation Able to input the data accurately autonomously with no supervision Competent Competent and able to teach others Once completed the competency assessment sheets should be stored in the participant s personal file. References A Guide to Good Practice, Elective Services, July 2005 Access 2009 Guidance for Implementing 26 Week Patient Pathways Training for the Management of Referrals, Appointments, Waiting Lists and Validation (West Modernisation Department March 2010) Betsi Cadwaladr University Local Health Board (West) Page 7

11 Competence Assessment sheet for staff inputting data onto PiMS for: Name of Staff Member: Clinical Area / Base: Employee Number: Name of Assessor: Area / Base: Date: A Competent and able to teach others B Able to input the data accurately autonomously with no supervision Competent Page 8

12 C Input the data accurately under observation D Input the data accurately with direct supervision / help E Has observed understands the underpinning rationales Page 9

13 Competency 1 General Management of Waiting Lists ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Received a copy of and read the document Policy for the Management of Referrals, Appointments and Waiting List Standards. Received a copy of and read the WAG document Rules for Managing Referral to Treatment Waiting Times Understand current component waiting list milestones: 6 10 wks for OPD 6 weeks for Diagnostics 2 weeks for a decision following diagnostics 10 weeks for Inpatients 2 week buffer Be able to monitor waiting lists and be able to highlight any areas of concern meeting targets to a line manger in order to eliminate breaches. Be competent in accessing all PiMS User Guides Competency 2 Clinical Referral Date (CRD) ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the importance of not changing the CRD on PiMS: The CRD is the date that Page 10

14 the referral is received. This date does not change under any circumstance. Register new referrals onto PiMS. Competency 3 Referrals ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE GP & Other External Referrals Understand that generally only referral clerks should create GP/external referrals. Be able to check new incoming referrals are appropriate for the specific sub-specialty and referring condition. Add the patient to a waiting list. Ensure waiting list entries are linked to the appropriate referral. Record on PiMS that the referral has been forwarded onto the Consultant. Record on PiMS that the referral has been authorised by the Consultant. When a referral is returned by the Consultant, amend the waiting list entry if appropriate, according to the Consultants instructions. Understand that a GP Referral should only be created on PiMS if an actual Referral has been received. A&E Referrals Page 11

15 Be able to create a referral on PiMS. This would usually be a self referral but can sometimes be a GP referral if the GP has referred the patient to A&E. Be able to record the reason for referral as Emergency. Understand the need to either close the emergency referral if the patient is discharged from A&E or keep the referral open if they are either admitted, or need a follow-up appointment in OPD. CMATS Referrals (Clinical Musculoskeletal Assessment and Treatment Service) formerly known as TEAMS/ CADAMS and MSK CAT) CMATS sits within primary care and electronically triages all MSK referrals including Orthopaedics/ Rheumatology and Pain. After electronic triage to the appropriate department all referrals will be registered. Understand a new external referral needs to be created for Referrals triaged by CMATS to all relevant specialties including F2F CMATS. After CMATS F2F appointments. If referral into a secondary care speciality is needed the process is as follows: Closing down of the CMATS referral and creating a new external referral for the appropriate speciality. Urgent patients triaged to CMATS F2F Spinal/ General: On receipt of referral contact the patient by phone. If this is unsuccessful immediately send a partial booking letter Page 12

16 (PB1). SELF Referrals Understand the rules when creating a self referral for patients who have: Previously been returned to their GP following DNA or CNA. Patients who return to secondary care through an SOS route. Patients who have been discharged and their referral closed, but have been told to contact the secretary to arrange a follow-up appointment if further problems arise. Closing Referrals Understand the need to close referrals when a patient is discharged Understand that it is the responsibility of all A&C staff to close referrals when appropriate to do so. Be able to close a referral on PiMS. Competency 4 Soon Category ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand that there should only be two categories on PiMS, either Urgent or Routine. Return any referrals that have been marked soon to the Consultant, requesting recategorisation as either Urgent Page 13

17 or Routine. Be able to re-categorise any soon referral on PiMS as either Urgent or Routine. Competency 5 Pooling of Waiting Lists ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles of the pooling system per specialty/ CPG as well as Consultants having their own individual waiting lists. Be able to view several waiting lists (pooled or individual Consultant lists) on PiMS in order to appoint in chronological order. Understand that if a patient requests an appointment with a specific consultant, it may affect their waiting time on the 26 week pathway. Competency 6 Booking routine patients in chronological order. Outpatient appointments Page 14

18 ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles of booking routine patients in chronological order according to their referral to treatment pathway wait. IPDC / Theatre lists ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles of booking routine patients in chronological order according to their referral to treatment pathway wait. Understand the principles of case mix and length of procedure according to Consultant. Be able to produce a theatre list taking into account the above principles. Competency 7 Partial Booking of appointments (New and Review patients) ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles and timescales of the partial booking system for both new and review outpatients. Be able to access and create the following on PiMS: PBS1 Acknowledgement letter (as soon as they have been added to a waiting list). PBS2a Invitation to phone in letter (6 weeks prior to the appointment time) PBS2b Did not respond letter Page 15

19 (within 10 working days of the Invite to phone in letter) PBS3 Remove from waiting list for not responding letter. PBS4 Letter to the GP informing of patients continued cancellations. PBS5 Letter to GP informing them the patient no longer requires an appointment (prior to an appointment being provided). Appointment letter CNA / DNA Letter Record that PBS letters have been sent to the patient, as well as the date sent on PiMS. Be able to create an appointment date on PiMS. Competency 8 Reasonable Offer for New, Review and Inpatients ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles of reasonable offer for new, review and inpatient appointments: Patients must be offered a choice of two dates /times for the appointment, at least two of which must be more than 2 weeks into the future. Understand the principles of refusal of reasonable offer: If the patient is available during the offer period, but refuses a reasonable offer, the 26 week clock will be reset to 0 days. The new clock start will be the date that the patient refuses the offered appointment. Page 16

20 Be able to record refusal of reasonable offer on PiMS. Competency 9 Did Not Attend (DNA) and Can Not Attend (CNA) ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles of DNA s and CNA s: A Does Not Attend (DNA) is recorded where a patient does not attend their appointment without notifying the organisation beforehand even if the patient telephones the appointment centre the day after their due appointment; they are still recorded as a DNA. A Can Not Attend (CNA) is recorded the first time a patient does notify the organisation that they are unable to attend (even up to the day of the appointment). The appointment centres have enough time to try to contact another patient to attend the cancelled slot. The patient is then offered another clinic appointment. If a patient Can Not Attend (CNA) a second time, they are then classed as a DNA and referred back to their GP. Be able to record DNA s and CNA s accurately on PiMS. Remove DNA s and CNA s from the waiting list on PiMS. Be able to generate DNA and CNA letters on PiMS for the GP and patient. Understand that when a patient CNA, their 26 week pathway clock will reset to the date the patient notifies the organisation that they cannot attend. Page 17

21 Close a referral episode on PiMS. Competency 10 Cancellations by the hospital ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand that in the event of the hospital cancelling a patient s appointment, the 26 week clock will continue and another appointment must be made as soon as possible. Understand the cancellation timescales: patient must be given a minimum of 2 weeks notice if a clinic is reduced or cancelled If a patient is cancelled at short notice (anything up to 5 working days) the patient must be contacted by letter and telephone. Understand that it is the clinician s responsibility (and not the appointment clerk, or medical secretary) to identify appropriate patients to be cancelled. Be able to record appropriately on PiMS the hospital cancellation. Competency 11 Validation of RTT Pathways ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Page 18

22 Understand the need for continuous validation of patients on an OPEN pathway. Validation is required for both administrative and clinical reasons to ensure patient numbers on waiting lists are accurate. Be able to access RTT information on the EIS system. Record a validation on EIS accurately. Appointment Clerks Regular validation of stage 1 patients waiting for their first OPD appointment. Regular validation of stage 4 patients who continue to be on an OPEN pathway and waiting for treatment. Medical Secretaries Regular validation of stage 2 patients who have been referred to diagnostics. Regular validation of stage 2b patients who have had their diagnostic tests and are waiting for consultant office review or further OPD review appointment. Regular validation of stage 3 patients who are on an Inpatient waiting list. Both Appointment Clerks and Medical Secretaries Regular validation of stage 4 patients who continue on a review OPEN pathway. Regular validation of stage 5 patients who continue on an Open RTT pathway but not attached to any OPD or Inpatient waiting list. Competency 12 Management of patients who become unavailable for treatment Page 19

23 ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand current Access 2009 rules for patients who become unavailable and read the relevant section within the Rules for Managing Referral to Treatment Waiting Times. Understand current unavailable criteria and timescales: Social Suspensions If the patient is unavailable for < 2 weeks no adjustment will be made to the waiting list clock. If the patient is unavailable between 2 8 weeks an adjustment will be made to the waiting list clock for the period of time that the patient is unavailable. If the patient is unavailable for > 8 weeks refer back to the GP: 1. Remove from the waiting list. 2. Template letter sent to the patient and GP. 3. Waiting list entry closed 4. Close the referral on PiMS. Medical Suspensions Periods of medical unavailability should last no longer than 21 days. Patients medically unavailable for longer than 21 days should be: Removed from the waiting list temporarily. Template letter sent to the patient and GP. Waiting list entry closed. Close the referral on PiMS. Re-referrals of patients who become fit and available for their procedure. Understand the rules and be Page 20

24 able to apply them on PiMS Record all periods of unavailability on PiMS accurately including the reason why they were unavailable. Competency 13 Inpatient and Daycase waiting lists (TCI s) ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Understand the principles behind Same Day Admission (SDA) and Daycase (DC) surgery. Understand why having a pool of patients having attended Preoperative Assessment Clinic (POAC) is an efficient use of resource i.e. utilisation of theatre slots. Be aware that Access 2009 rules state that POAC should be undertaken no more than 6 weeks prior to surgery and should be booked using partial booking. Ensure patients have attended POAC and are fit for surgery before allocating a TCI date. After agreeing a mutually convenient TCI date with the patient, be able to generate a standard TCI letter on PiMS to send to the patient along with any relevant information to confirm the agreed TCI date. Competency 14 Outcome Codes ASSESSMENT CRITERIA A B C D E n/a SIGNATURE DATE Page 21

25 Clinic Outcome Codes Understand the principles of clinic outcome codes and that these should be applied following OPD appointment to ensure we can identify where patients are in the 26 week pathway. Be able to apply a clinic outcome code on PiMS Consultant Office Decisions (COD) Understand the principles of consultant office decisions and when they need to be applied. Be able to apply a Consultant Office Decision to PiMS. Medical Secretaries should be able to check the appropriate clinic outcome code is correct when typing up the clinic letter. Self assessment comments Page 22

26 Assessor s comments Assessor: Please notify ABH.TrainingGroup@wales.nhs.uk when the competency framework is complete. Please Include the following details:- CPG/Corporate Function Staff Name in full Staff Number Job Title Date Competence Framework Completed Date E- learning completed Page 23

27 RTT e Learning (Mandatory every two years) To view the modules on Learning@NHSWales, please ensure your staff number is used to register on the e learning website. please self register at Enrolment Key : 'bcad01' To complete the assessment you will need to enter a password Page 24

28 Assessment Password: SJTA01 Page 25

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