TITLE WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES DOCUMENT # 1151 APPROVAL LEVEL Alberta Health Services Executive Committee SPONSOR Chief Medical Office; Chief Operating Office CATEGORY Quality Health Care and Services INITIAL APPROVAL DATE July 12, 2013 INITIAL EFFECTIVE DATE September 2, 2013 REVISION EFFECTIVE DATE N/A NEXT REVIEW September 2, 2016 NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section. corporatepolicy@albertahealthservices.ca. The Corporate Policy website is the official source of current approved corporate policies, procedures, PURPOSE The policy aims to: Provide direction on wait time measurement, management, and reporting for all scheduled health services within Alberta Health Services (AHS) in response to the principles and requirements proposed by Alberta Health (AH). Serve as the foundation for the implementation and evaluation of wait time measurement, management, and reporting. Specific clinical governance documents (e.g., policies, procedures) will be developed as required and implementation plans completed to indicate measurable progress regarding wait time measurement, management, and reporting. Support the objective of improving and optimizing access to scheduled health services for all Albertans. POLICY STATEMENT The policy is based on the following principles: Albertans should have reasonable access to timely and appropriate care and service, including primary care. Accessibility to publicly funded health services is based on need, not on the ability to pay. Health services are delivered in ways that understand the experiences, recognize the perspectives, and respond to the health needs of individuals, families, and communities. Decisions made across the health system are based on the best available evidence and a holistic view of health and wellness. Alberta Health Services 2013 PAGE: 1 of 7
WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES September 2, 2013 1151 2 of 7 APPLICABILITY Compliance with this policy is required by all AHS employees, members of the medical and midwifery staffs, students, volunteers, and other persons acting on behalf of AHS (including contracted services providers as necessary). This policy is subject to all applicable laws. POLICY ELEMENTS 1. Accountability and Responsibility 1.1 AH is accountable to Albertans and is responsible for establishing: a) requirements for measurement, management, and reporting (including nomenclature); b) timestamps and wait time intervals (see Appendix "A"); 1.2 AHS is accountable to AH and is responsible: a) for the development of a wait time measurement and management program with standardized content to enable policy compliance; b) for the development of an implementation plan and schedule for measurement and effective management of scheduled health services' wait time information in accordance with AH established timelines and requirements; and c) to ensure appropriate information management/information technology (IM/IT) capability to collect, measure, manage, and report wait time data for the public and AHS regulated health professionals. 1.3 AH and AHS are jointly responsible for the establishment of mutually-acceptable performance measure definitions, benchmarks, calculations, and reporting requirements. Performance benchmarks are approved and directed by AHS and AH. AH and AHS are also jointly responsible for the establishment of IT capability to support policy compliance. 1.4 Provincial teams, working in partnership with zone operations, are responsible for the development and maintenance of wait time measurement, management and reporting standards. Operational areas are responsible for implementation. 2. Referral and Wait Measurement and Management 2.1 The collection and use of consistent and accurate wait time data, supported by standard processes, enables AHS to identify where delays occur. 2.2 Standardizing the referral processes will support complete and appropriate referrals, eliminate confusion and rework that contribute to delays, and improve access.
WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES September 2, 2013 1151 3 of 7 2.3 Wait time data is used to support quality improvement, equity and transparency. AHS will ensure that wait time information across the continuum of care: a) is measured using standardized classifications, definitions, and timestamp rules 1 ; b) is managed using established performance benchmarks based on diagnosis and/or clinical urgency, and leading practice for process improvement; c) is reportable in a manner that is accessible to the public and health professionals and is in compliance with the Health Information Act (Alberta) and other relevant privacy legislation; and d) meets compliance, monitoring, and audit requirements. 2.4 Access and Service Delivery a) Not all services exist in all geographic areas in Alberta; however, the goal is to ensure the provision of safe, quality, and equitable care to all Albertans. b) AHS will establish access criteria for scheduled health services: (i) by program/service area; (ii) that is evidence-based; and (iii) that is based on clinical need. c) Each program/service area will ensure their wait lists are consolidated and complete. d) Reported wait times should reflect the system wait once the patient is medically and functionally ready to treat, and remove any voluntary wait times or times when a patient is not socially ready to treat. 2.5 Communication a) AHS has an obligation to communicate with patients and the referral source. This communication includes confirmation of referral receipt, the estimated wait time, and the outcome of the visit (assessment, consultation, treatment, or surgery). In the case of programs receiving referrals from non-regulated health professionals (e.g. family, friend, neighbor, etc.), communication details to the referral source is at the discretion of the program/service, and according to standards set within that program/service. b) Patients and their families share the responsibility for communication with their health professional(s) and are encouraged to discuss access to the scheduled health services, anticipated wait times, changes in condition, and personal choice. 1 See Appendix A for stamp Definitions.
WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES September 2, 2013 1151 4 of 7 2.6 Reporting a) Wait time data will be generated electronically from clinical operations that have IT systems to support this work. IT systems may be new (such as the implementation of ereferral) or existing (an enterprise scheduling application or operating room system) 2. b) Standard and consistent collection of timestamp information will be required across AHS regardless of which IT system is used to generate this data. c) The minimum data set will capture: (i) Referral wait time: from 'ready for scheduling' date (T3) to 'attend first service' date (T5); and (ii) Service wait time: from 'ready to treat' date (T7) to 'initiate/perform service' date (T9). d) Wait time information that is captured in near real time will be used to support operational areas to manage their waitlists, referral and scheduling processes, and wait time measurements, and will be used to identify where delays occur to support quality improvement. e) Wait time data may also be used retrospectively to support strategic, research, or planning decisions and to manage access performance. DEFINITIONS Appropriate care and service means the health services that are relevant to patient needs and are based on accepted or evidence-based practice. Benchmarks are standards of comparison based on clinical evidence or leading practice. Benchmarks reflect a standard to achieve. Targets support year over year improvement in relation to a benchmark. Targets characterize what is achievable in relationship to current performance and the benchmark. If performance is at the benchmark, performance benchmarks and targets can be the same. Clinical urgency refers to the priority level for the patient to receive a referral, an assessment, treatment, or a scheduled health service based upon clinical needs. Functionally ready means the patient (or alternative decision maker) is physiologically and cognitively able to proceed with the referral or scheduled health service. Health service refers to any documented assessment, treatment, diagnostic procedure, surgical procedure, medical procedure, rehabilitation, or other procedure offered by or supervised by a regulated health professional. 2 Additional manual reporting is not expected to occur. The exception is any area that is currently mandated (either federally or provincially) to report (e.g. Tier 1 measures). These areas will continue with manual processes until IT systems are in place to electronically support this reporting requirement.
WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES September 2, 2013 1151 5 of 7 IT capability refers to an AHS enterprise information management system or electronic business intelligence that is used for recording referral information, capturing time stamps, and extracting data to report activity. Medically ready means the patient meets appropriate, standardized medical criteria to proceed with a scheduled health service. Patient refers to any individual (or alternative decision maker) who seeks or receives health advice or a health service; alternatively, a patient may be called a client or resident. Program/Service refers to a health program or service related to a defined patient population or clinical specialty. Programs/services include, but are not limited to, surgical services, continuing care, diagnostic services, seniors health, medical services, and rehabilitation services. Primary care includes health promotion services (including community and family practice), disease prevention, screening tests and examinations, rehabilitation therapy and nutritional and psychological counselling (Health Canada, 2012). Publicly-funded means services that are funded in whole or in part by the Government of Alberta. Referral refers to a requisition for the purposes of requesting a service. A request for service includes any request by a referral source for a health service. Referral Source refers to the originator of the referral, and can include (but is not limited to) the patient, a regulated health professional, school, family member, or other alternate decision maker. Referral Wait refers to the time interval between the date when the referral is received by the referred health professional and the date when the patient has the first consultation with the referred health professional. Central intake or pre-consult assessment is included as a part of the referral wait time. Referral wait time is typically relevant when an opinion or consult is required from a health professional (as opposed to a procedure or service). In cases where series of s are required, the end date of a referral wait time is the date of the first /consult/assessment. Regulated Health Professional refers to a health professional who holds a practice permit and is a regulated member of a College governed by the Health Professions Act or other legislation governing the regulating body of a health professional. Scheduled Health Service refers to any non-emergent service where an is booked ahead of the visit. A scheduled health service may also be known as routine or elective service.
WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES September 2, 2013 1151 6 of 7 Service Wait refers to the time interval between the decision to treat date and date the health service is performed or initiated. In cases where a series of treatments or procedures are required, the end date of a service wait time is the date of the first treatment or procedure or to empower patients in their self care or shared care. Service wait time is typically relevant when a medical procedure is being performed on a patient but may also be an intervention to support the patient in timely access to care and service. In cases where series of treatments or procedures are required, the end date of a service wait time is the date of the first treatment/procedure. Socially Ready means the patient or substitute decision maker is ready and willing to proceed with the referral or scheduled health service and does not request a voluntary wait. stamp refers to the date that a specified health care activity or task is taken. Triage refers to the act of sorting referrals and prioritizing based on diagnosis and/or clinical urgency. Voluntary Wait refers to the wait time resulting from a patient choice not to proceed with a referral or health service with the first available regulated health professional or on the first available date. Also referred to as patient unavailable time. Wait List refers to a list of patients waiting for a specified, consult or health service. Wait refers to the time the patient waits for a specified health care activity or task, such as an, consult, or health service. The patient can experience a wait time between any two timestamps. Wait Interval refers to the number of days an appropriate patient waits from one timestamp (start of interval) to another timestamp (end of interval). REFERENCES Appendix A The Patient Journey Measured by Stamps REVISIONS None.
WAIT TIME MEASUREMENT, MANAGEMENT, AND REPORTING OF SCHEDULED HEALTH SERVICES September 2, 2013 1151 7 of 7 The Patient Journey Measured by Stamps APPENDIX A The patient journey can be represented by a series of timestamps associated with the different steps in the care process. The building blocks of the patient journey consist of referral waits and service waits. Each wait time interval is measured from one timestamp to another timestamp. In the event that the patient journey involves multiple referrals, consultations or diagnostic services, the time stamps are established for each referral/consultation process. Book Stamp 0 First Appointment with Referral Source Stamp 1 Referral Wait Service Wait Redirect referral Request additional information No No Receive referral Appropriate? Yes Complete? Yes Ready for scheduling Book Attend Decision to Treat Ready to Treat Book service Initiate/Perform service Communication back to referring source Stamp 2 Date Referral Received Stamp 3 Stamp 4 Stamp 5 Date of first with specialist/ service Stamp 6 Date both patient and specialist determine service Stamp 7 Date Patient is medically, socially, and functionally ready for service Stamp 8 Stamp 9 Date initiated or performed service Stamp 10 Date a communication is sent to referring source The Stamps are: Reference: AH/AHS Stamps and Clock Rules (Jan 3, 2012) Stamp Stamp 0 (T0) Stamp 1 (T1) Stamp 2 (T2) Stamp 3 (T3) Stamp 4 (T4) Stamp 5 (T5) Stamp 6 (T6) Stamp 7 (T7) Stamp 8 (T8) Stamp 9 (T9) Stamp 10 (T10) Definition Date the patient books the initial health service. Date the patient attends first with the regulated health professional Date the referral is received by the specialist Date the referral information is complete for the specialist to proceed to screening, assessment, consultation or health service and the patient has completed any voluntary wait and is medically, socially and functionally ready for an Date an is booked for the patient to see specialist Date the patient attends the first with the specialist for screening, assessment, consultation or other health service Date the patient and specialist decide on a health service (also known as the decision to treat date) Date the patient determined to be medically ready, functionally ready and socially ready to receive the health service, excluding pre-admission tests (also known as the ready to treat date) Date the patient is booked for a health service Date the health service is performed or initiated Date of communication back to the referral source regarding the results of the, consultation or health service