Expanded delay code guidance Value Meaning General principles Valid example Not valid example 1 Patient reason (chosen to delay) 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. A patient who is on holiday and is unavailable for a period greater than 1 calendar week. 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. 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). 2 Clinical consideration (co-morbidities) Where a co-morbidity or complication needs to be addressed before the patient can receive their cancer treatment. Where diagnosis is complex or requires investigations additional to the standard pathway of care. There are cancer-related complications, eg formation of a Where a clinical assessment was not completed within agreed timeframes. Where the patient underwent tests or treatment at a DHB other
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. 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. 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. 3 Capacity constraint Situations 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. 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.