Waiting Time of Arrival and Discharge - Essay Example

Introduction The Department currently has an arbitrary 'good practice' waiting time of 30 minutes between arrival and discharge. This survey will provide a benchmark for the Department to determine the length of time patients are actually waiting for treatment once they arrive Method Data was manually collected from all patients receiving radiotherapy treatment course in the week commencing 1 May 2006 using a pre-prepared form (see sample at Appendix 1). This form is based on the one devised by the Royal College of Radiologists for undertaking the Radiotherapy Waiting Times Re-audit in 2004.1 It was decided that most of the information would be automatically generated by the Patients' Administration System (PAS). It was believed that this would have four main benefits: Reduction of data entry error Reduced data entry time Greater compliance Cross-referencing for data validity checking Data Protection Compliance In order to ensure compliance with the Data Protection Act it was decided to ensure that any data which might uniquely identify any patient would not be part of the study. The section of the form, which contained the patient's name, was used only for cross-referencing the accuracy of the data auto generated from the PAS. This was undertaken by a research student employed for the duration of the study. This detachable section was then shredded and discarded. Choice of Variables The choice of variables reflects those used by the Royal College of Radiologists in its Re-audit of Radiotherapy Waiting Times 2003 report. It also ties in with the major audit undertaken by the Department annually. This will enable us to cross-reference and to align the data with a view to making recommendations for necessary improvements in the service. Choice of Queries The queries presented are a sub-set of the total queries available from the data garnered during the study. They reflect two major concerns namely to determine: Overall waiting times and Waiting times by gender Data on overall waiting times will feed into the Department's annual report and incremental improvements in service. Waiting times by gender is part of a larger study into inequalities of access to the service. The Department wishes to identify whether there is any disparity and if so to determine cause, and remove it promptly. Choice of Fields The data collected manually was the minimum required in order to conduct the study, namely whether the patient attended for treatment, arrival time and discharge time. Data Validation A mixture of data validation techniques were used: Data type - it is not possible to enter alphanumeric text in a field which has been designated as a date/time field. Primary key - ensures that no two records have exactly the same data entered. Input mask - used on the year of birth field to ensure that no more than 4 digits were used. Limit to list - the Diagnosis, Dosage, Waiting List Status and Gender fields were limited to the prescribed coded choices. This method was chosen to further protect patient confidentiality in the event that the privacy of the data was compromised. Data Verification Most of the data used in the survey was auto-generated from the PAS. Data was double checked against the PAS by the Research Assistant. Results 60 patients were treated during the study period. Compliance with completing and returning the forms was 100%. This accuracy was determined by cross-referencing the number of expected and completed treatments with the number of forms returned. The following findings were explicit from the dataset: There was no immediately apparent correlation between gender and wait time. The average weight time for all treatment types exceeded the good practice 30 minutes. There was no immediately apparent correlation between waiting list status and the amount of time patients spent in the department. Conclusions Implications for Patient care The less time patients spend in the Department, the more able the Department will be able to address some of the concerns raised by the Patients' Liaison Group namely; Exposure to public gaze at a time when patients have poor body image Seeing other patients in poor condition Undue stress if delays increased waiting time for treatment Physical discomfort Practice It appears that requiring patients to attend on the hour, regardless of the actual appointment time, treatment type and waiting list status is limiting the number of treatments the Department can perform in a day. A more detailed analysis and review should be undertaken to determine whether weighting the data for other variables, for example waiting list status, can assist the Department to better meet its internal targets to increase throughput of all patients. A balance must be struck to ensure there is sufficient time built in for Sanitary staff to sterilise the treatment areas between treatments. Word count: 800 Appendices Appendix 1 - Data Capture Form RADIOLOGY DEPARTMENT Radiotherapy Treatment Waiting Times Audit Please detach the top section prior to returning the form to A N Other in Room 41. Kindly return the form to A N Other no later than 8 May 2006. Instructions for completing this form: Complete only the highlighted sections. Where required, put a circle around the most appropriate choice. Patient Name A N OTHER Unit number CO-789X Form identifier BM0001 Detach form here Form identifier BM0001 Year of Birth 1966 Diagnosis 1 Gender M Site treated 1 Dose (Gy) (ICRU50) 1 Day of treatment Mon Patient Attended for Treatment (Y/N) No Appointment time 16:40 Arrival time 16:35 Departure time 17:35 Treatment intent Radical (skin) - 1 Waiting list status Radical (non-skin) - 2 Palliative - 3 Emergency - 1 Adjuvant - 4 Urgent - 2 Pre-operative - 5 Routine - 3 Post operative - 6 At the end of the study period please return all forms minus the top section to A N Other in Room 41. Thank you for your assistance. Appendix 2 - Tabular Report Showing All Fields And All Records Tabular Report showing All Data Form YOB Gender Site treated Diagnosis Dose (cGy) Appointmen Time patient Departure Waiting list t time status NH0031 1953 M Head and Neck 3 1 09:15 09:00 10:15 R NH0032 1944 F Breast 2 3 09:30 09:00 10:30 R NH0033 1935 F Breast 2 3 09:45 09:00 10:00 U NH0034 1947 M Lung 1 5 10:00 09:00 10:15 R NH0035 1958 M Lung 1 5 10:15 10:00 10:45 R NH0036 1963 F Head and Neck 3 1 10:30 10:00 11:00 R NH0037 1936 F Breast 2 4 10:45 10:00 11:15 R NH0038 1967 F Bladder 1 2 11:00 10:00 11:30 U NH0039 1950 F Pelvis 4 1 11:15 11:00 11:45 R NH0040 1943 M Prostate 4 4 11:30 11:00 11:45 R NH0041 1977 F Breast 2 5 11:45 11:00 12:00 R NH0042 1938 M Brain 3 2 12:00 11:00 13:00 E 11 May 2006 Page 1 of 1 Appendix 3 - Columnar Report Displaying Three Fields Grouped By A Fourth Field. Showing All Records. Columnar Report - Grouped on Site Treated Site treated Time patient Departure Dose (cGy) Bladder 10:00 11:30 2 Brain 11:00 13:00 2 Breast 11:00 12:00 5 10:00 11:15 4 09:00 10:00 3 09:00 10:30 3 Head and Neck 10:00 11:00 1 09:00 10:15 1 Lung 10:00 10:45 5 09:00 10:15 5 Pelvis 11:00 11:45 1 Prostate 11:00 11:45 4 11 May 2006 Page 1 of 1 Appendix 4 - TABULAR REPORT BASED ON INTERACTIVE CRITERIA INPUT Wait List Gender F Site treated Breast Waiting list status R Gender F Site treated Breast Waiting list status U Gender F Site treated Breast Waiting list status R Gender F Site treated Breast Waiting list status R 11 May 2006 Page 1 of 1 Appendix 5 - GRAPHS CREATED IN EXCEL Figure 1 - Showing % Patients by Gender Figure 2 - Showing Average Wait Time Depending on Diagnosis References Clinical Oncology Patients' Liaison Group. Making Your Radiotherapy service more patient friendly. 1999 Greenhaugh, T (1997): How to read a paper: The basics of evidence based medicine; London, BMJ Publications. Joint Council for Clinical Oncology. Reducing delays in cancer treatment: some targets. London: Royal College of Physicians. 1993 Royal College of Radiologists. A national audit of waiting times for radiotherapy. London: Royal College of Radiologists. 1998 Royal College of Radiologists. Re-audit of Radiotherapy Waiting Times 2003. London: Royal College of Radiologists. 2004 Royal College of Radiologists- http://www.rcr.ac.uk Read More