Elective services patient flow indicators Preview

Information about Patient Flow Indicators (ESPIs)

Note that these performance indicators are subject to ongoing quality improvement that may result in changes to previously reported results. Please check this site for the most recent information.

The performance indicators used here monitor how patients are managed while awaiting an elective (non-urgent) service. They do not measure the volume of elective services delivered, or whether a DHB is delivering the same level of service for its population as another DHB.

As a patient moves through the system there are a number of key decision points — from when people are first referred as outpatients through to when decisions are made as to whether or not treatment is appropriate and/or available. To further understand how these performance indicators are derived, and what they mean, we strongly recommend that you look at the tutorial before viewing the performance indicator results.

The ESPIs demonstrate the extent to which DHBs are meeting the Government’s targets in respect of patient flow processes. The eight ESPIs are:

1. DHB services that appropriately acknowledge and process all patient referrals within 10 working days

Following a request for a specialist opinion, the patient and their primary care practitioner are to be advised within 10 days whether or not a first specialist assessment (FSA) is indicated and can be provided (within six months). If an FSA is not offered, advice on alternative care options should be provided if applicable.

The goal is that all services appropriately acknowledge and process every referral within 10 working days.

2. Patients waiting longer than six months for their first specialist assessment (FSA)

All patients accepted for an FSA should be seen within six months of the date of referral.

The goal is to have no patients waiting more than six months for an FSA.

3. Patients waiting without a commitment to treatment whose priorities are higher than the actual treatment threshold (aTT).

If resources and patient mix remain the same, a service will be able to treat in the future the same volume of patients it has in the past. Thus, based on this historic treatment pattern, a service can predict to a reasonable degree of accuracy, the volume of patients to whom a commitment to treatment within six months can be given.

Commitment should be given to patients with the highest priority. Patient priority is determined by their level of clinical need and is identified by way of a numerical score. Each service is aware of the lowest priority score at which it has historically been able to treat the majority of its patients.

However, for a variety of reasons, a service will appropriately decide to treat a few additional patients who have relatively low priority scores. In recognition of the existence of this latter group, the actual treatment threshold (aTT) is calculated as the 10th centile priority score assigned to all patients treated in the past 12 months. A service should therefore be able to treat all patients above the aTT.

This indicator measures the number of patients above the aTT who have not been given a commitment to treatment.

The goal is to have no patients above the aTT without a commitment to treatment.

4. Clarity of treatment status

Following specialist assessment, all patients should know if and/or when they will receive treatment. Thus patients within the booking system should be assigned a status appropriate to their priority. Where no such status is allocated, patients default to a residual waiting list.

The goal is to ensure no patients are on residual waiting lists.

5. Patients given a commitment to treatment but not treated within six months.

All patients given a commitment to treatment should receive it within six months.

The goal is to ensure no patients with this status remain untreated after six months.

6. Patients in active review who have not received a clinical assessment within the last six months

Active review is a care pathway for patients for whom elective surgery is considered to be the best option for their care, but where:

this service is not available within the current public funding or provider capacity; and
there is a realistic probability that the patient’s condition may meet the threshold for treatment in the foreseeable future.

These are the patients who would next receive treatment if provider capacity increases.

While in the category of active review, patients should receive a clinical assessment every six months. If at any time a patient’s condition deteriorates to the point where their priority score exceeds the aTT, they should be given a commitment to treatment.

If a patient’s condition remains unchanged by the time of the third assessment, they should be returned to the care of their GP.

The goal is to ensure no patients in active review fail to receive their review every six months.

7. Patients who have not been managed according to their assigned status and who should have received treatment

All patients should be assigned a status appropriate to their priority and managed according to that status.

This indicator measures those patients, irrespective of their assigned status, who have a priority score above the aTT and: who have not received treatment within six months and: with regard to those placed in active review, have not received a clinical assessment within the last six months. It is therefore made up of a portion of the patients counted in indicators three and five.

The goal is that no patients appear in this indicator.

8. The proportion of patients treated who were prioritised using nationally recognised processes or tools

A number of tools are available to assist clinicians to assign a priority to patients. Those that meet specified criteria are registered within the national information system as “nationally recognised tools”.

This measure indicates the percentage of patients prioritised using nationally recognised processes or tools.

The goal is to have all patients prioritised using nationally recognised processes or tools.

PDF

The ESPI reports are now in pdf format. Please click here if you need to download Acrobat Reader (This is a free download)

1. National comparison of DHBs

This table provides a high-level comparative summary across all DHBs for each of the eight indicators. It allows you to see both the actual result and also a standardised value, which allows the reader to compare DHB results irrespective of their size.

Lakes DHB and Tairawhiti DHB have a dispensation due to data problems and are therefore deemed to be ESPI compliant for April.

National comparison of DHBs table

2. National comparison of surgical services

This table compares surgical services (but not medical services) nationally. The results for individual DHBs are given in section 5 below.

National comparison of surgical services table

3. Trends in DHB performance over the last twelve months

These tables provide DHB results for each indicator for the last twelve months.

4. Summary of Patient Flow Indicator (ESPI) results for each DHB

This report provides a summary view of the results for each of the eight ESPIs for each DHB. It contains any DHB comments on their data, situation, and future plans.

5. Detail of Patient Flow Indicator (ESPI) results for DHB Surgical Services

This report displays a DHB’s performance for each of the the eight ESPIs across all of its surgical services. It contains DHB comments on their data, situation and future plans.