Term

Meaning

4 Hour

The four-hour A&E waiting time target is a pledge set out in the Handbook to the NHS Constitution.  This is defined as below –

The clock starts from the time that the patient arrives in A&E and it stops when the patient leaves the department on admission, transfer from the hospital or discharge.

For ambulance cases, arrival time is when hand over occurs or 15 minutes after the ambulance arrives at A&E, whichever is earlier. In other words, if the ambulance crew have been unable to hand over 15 minutes after arrival that patient is nevertheless deemed to have arrived and the total time clock started.

Total time in the Department ends when the patient is discharged, transferred, or admitted.

i) Discharged from the provider. Time of discharge from the provider is defined as

when the patient’s clinical episode is finished, unless they are waiting for hospital arranged transport or social care/social service support. In these cases, the time of departure is the time the patient leaves the department. Patients awaiting family or ‘private’ transport or who wish to make their own arrangements should be considered discharged once the clinical episode is complete whether or not they have actually left the department.

ii) Transferred. Transfer is defined as transfer to the care of another NHS organisation or other public/private sector agency (for example social services). Time of transfer is defined as when the patient leaves the department.

iii) Admitted. An emergency admission via A&E is defined as leaving the A&E department with a valid CDS admission code.

Time of admission is defined as the time when such a patient leaves the A&E department and ceases to be under the care of the A&E consultant. The patient may go to:

• An operating theatre

• A bed in a ward

• An X-ray or diagnostic test or other treatment directly en-route to a bed in a ward (as defined below) or operating theatre. However, leaving A&E for a diagnostic test or other treatment does not count as time of admission if the

patient then returns to A&E to continue waiting for a bed

• A Same-Day Emergency Care (SDEC) unit

4-12 Hour Wait

The four-hour A&E waiting time target is a pledge set out in the Handbook to the NHS Constitution.  This is defined as below –
The clock starts from the time that the patient arrives in A&E and it stops when the patient leaves the department on admission, transfer from the hospital or discharge.

Patients should be counted where their total time in A&E is 04:00:01 hours or greater. Patients with a total time of 04:00:00 hours or lower are not be counted in this report.

For ambulance cases, arrival time is when hand over occurs or 15 minutes after the ambulance arrives at A&E, whichever is earlier. In other words, if the ambulance crew have been unable to hand over 15 minutes after arrival that patient is nevertheless deemed to have arrived and the total time clock started.

Total time in the Department ends when the patient is discharged, transferred, or admitted.

i) Discharged from the provider. Time of discharge from the provider is defined as when the patient’s clinical episode is finished, unless they are waiting for hospital arranged transport or social care/social service support. In these cases, the time of departure is the time the patient leaves the department. Patients awaiting family or ‘private’ transport or who wish to make their own arrangements should be considered discharged once the clinical episode is complete whether or not they have actually left the department.

ii) Transferred. Transfer is defined as transfer to the care of another NHS organisation or other public/private sector agency (for example social services).

Time of transfer is defined as when the patient leaves the department.

iii) Admitted. An emergency admission via A&E is defined as leaving the A&E department with the a valid CDS admission code

Time of admission is defined as the time when such a patient leaves the A&E department and ceases to be under the care of the A&E consultant. The patient may go to:

• An operating theatre

• A bed in a ward

• An X-ray or diagnostic test or other treatment directly en-route to a bed in a ward (as defined below) or operating theatre. However, leaving A&E for a diagnostic test or other treatment does not count as time of admission if the patient then returns to A&E to continue waiting for a bed

• A Same-Day Emergency Care (SDEC) unit

A&E

Accident and Emergency Department

Admission Rates

Admitted means that an emergency admission via A&E is defined as leaving the A&E department with  a valid CDS admission code. The rate is the proportion of patients admitted at A&E compared to those arriving as type 1 attendances in A&E.

Admissions

Admitted means that an emergency admission via A&E is defined as leaving the A&E department with the a valid CDS admission code.

All organisations

All organisations connected to the Integrated Care Board Selected using the NHS 111 Service.

Ambulance Disposition

The NHS 111 system is an interlinked series of algorithms, or “pathways”, that link questions and items of care advice leading to clinical endpoints or “dispositions”. The system presents a series of questions to the Healthcare Advisor  to determine the most appropriate clinical response or disposition. A disposition will specify the level of care and timeframe that a patient needs at the time of the call. It does not seek to diagnose patients but assesses symptoms to direct them to the most appropriate care setting for further assessment where required. It is also used by Clinicians to support their assessments.  An ambulance disposition calls for an ambulance to attend the patient at their location.

Ambulance Service Providers

Ambulance service provider means a person engaged in the business of transporting sick, disabled or injured individuals by ambulance to or from facilities or institutions providing health services. In this case via Ambulance Trusts.

Ambulance Services

Ambulance Services means a service in which the patient’s condition requires medical transportation where the use of specialised medical skills and/or equipment is medically necessary and crucial to the safe transportation of the patient.

Ambulance Trusts

Ambulance trusts provide a range of services including; handling 999 calls. co-ordinating and dispatching ambulances. providing clinical interventions on the scene for seriously ill patients and transporting people to hospital in an emergency.

Answered Calls

Calls answered by a NHS 111 telephonist.

Appointment Time (GP)

The period of time between booking an appointment and attending, as an example same day or next day.

Appointment Type (GP)

In this instance it relates to either a face to face or telephone/other appointment.

Attendance Type

Type 1 A&E department is a consultant led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.

Type 1 attendances are all unplanned attendances in the reporting period at Type 1 A&E departments, whether admitted or not.

Type 2 departments are consultant-led facilities but for specific conditions, for example, eye conditions or dental problems.

Type 3 departments treat minor injuries and illnesses, such as stomach aches, cuts and bruises, some fractures and lacerations, and infections or rashes.

Calls abandoned

Calls made to the NHS 111 service but abandoned before answered by a telephonist.

Calls received

All calls made to the NHS 111 service

CDS Admission Code

A CDS Type forms part of an electronic health record extract.

CDS Type  is a code to identify the specific type of Commissioning Data Set (CDS).

An example would be –
011 – Emergency Care Attendance

Contract Name

This is the organisation which has the contract for supplying the NHS 111 service.  Often an Ambulance Service.

Dashboard

A visual display of a selection of charts/visuals relating to a particular topic.

Decision to Admit

A record of the event that a clinical decision to admit a patient to a particular Health Care Provider has been made by or on behalf of someone, who has the right of admission.

ED 

Emergency Department

ED Disposition

The NHS 111 system is an interlinked series of algorithms, or “pathways”, that link questions and items of care advice leading to clinical endpoints or “dispositions”. The system presents a series of questions to the Healthcare Advisor  to determine the most appropriate clinical response or disposition. A disposition will specify the level of care and timeframe that a patient needs at the time of the call. It does not seek to diagnose patients but assesses symptoms to direct them to the most appropriate care setting for further assessment where required. It is also used by Clinicians to support their assessments.  An ED disposition calls for a patient to attend their nearest ED by their own methods.

Face to face  (GP)

A appointment which is in person at the doctors surgery or at the patients home.

Face to face Response

This is where a physical attendance is required rather than via telephone or other method.

Filters

A drop down list enabling the user to reduce the number of items contained in a particular visual to provide a more focussed result.

GP

General Practitioner

GP Appointments

An arrangement to meet with a member of the team at the doctors practice a person is registered with.  This can be face to face, over the phone or video call.

Details of which GP activities are included, partially included or not included –
Included
scheduled surgery appointments
scheduled telephone consultations

The following activities are partially included, if they are in the GP system as individual appointments and booked to a patient:

telephone triage
online consultations
home visits
immunisations
enhanced access appointments

Appointments outside of core hours with a valid status (‘attended’, ‘did not attend’ (DNA) or ‘unknown’) will also be included.

Not included

Administration
supervision
consultation activity NOT booked via appointment systems
training
meetings
paperwork
contacting specialists
teaching
prescriptions: reviewing
prescriptions: actions and results
running the business
dealing with complaints
complying with regulation
processing laboratory tests
cancelled appointments that were not rebooked

ICS

Integrated care systems (ICSs) are partnerships that bring together NHS organisations, local authorities and others to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas.  England is split into 42 ICS’s.

Incidents

An Ambulance Incident  is a call to the Ambulance Control Room that, following initial triage, requires a face to face response from the Ambulance Service or can be resolved with telephone advice and any appropriate actions agreed with the patient.

LOS

Length of stay in this instance looking at those who are discharged on the same day or were there for 1 day plus.

National Average

The average of all results for England

NHS 111

NHS 111 is a telephone and online service taking non emergency calls/enquiries.  It is first point of contact for members of the public with an urgent but non-emergency health concern, providing advice and signposting assistance to onward care where required.

Non Elective Admission

Admissions are split into two types, elective and non-elective. Non-elective admissions are emergency admissions and elective admissions include all other types.

Pareto

This is a chart type that are often used to identify areas to focus on first in process improvement. Pareto charts show the ordered frequency counts of values for the different levels of a categorical or nominal variable.

Period

The number of years history selected in the parameters at the top of the page.

Post decision to admit

A record of the event that a clinical decision to admit a patient to a particular Health Care Provider has been made by or on behalf of someone, who has the right of admission.  Post decision to admit is the period of time after that decision has been made.

Service Average

An average over all organisations delivering NHS 111 Contracts.

Transport to ED

Transport via the Ambulance service to an Emergency Department.

Trend

Trend charts are used to show trends in data over time.

Trolley Wait

A ‘trolley-wait’ is the time between when a doctor in A&E decides that a patient’s condition is serious enough that they need to be admitted to hospital for further treatment and when the patient is actually admitted.

Trust

An NHS Trust is an ORGANISATION. An NHS Trust is a legal entity, set up by order of the Secretary of State under section 25 of, and Schedule 4 to, the National Health Service Act 2006, to provide goods and services for the purposes of the health service.  A Trust is part of an ICS.

Type 1

Type 1 A&E department is a consultant led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.

Type 1 attendances are all unplanned attendances in the reporting period at Type 1 A&E departments, whether admitted or not.

Waiting 12hours +

The waiting time for an emergency admission via A&E is measured from the time when the decision is made to admit, or when treatment in A&E is completed (whichever is later) to the time when the patient is admitted.

i) Time of decision to admit is defined as the time when a clinician decides and records a decision to admit the patient or the time when treatment that must be carried out in A&E before admission is complete – whichever is the later.

ii) An emergency admission via A&E is defined as an A&E attendance with a valid admission disposal code. Time of admission is defined as:

For admitted patients, the time when such a patient leaves the department to go to:

An operating theatre
A bed in a ward
An X-ray or diagnostic test or other treatment directly en-route to a bed in a ward (as defined below) or operating theatre.
However, leaving A&E for a diagnostic test or other treatment does not count as time of admission if the patient then returns to A&E to continue waiting for a bed.

For transfers, the time when such a patient is collected for transfer to another provider. Where a patient is transferred to another hospital, it is expected that they  will be taken immediately to a bed in an appropriate ward on arrival. The waiting period at the first Trust will end when the ambulance crew collect the patient for transfer. If further assessment and/or treatment is necessary in the A&E department of the second (receiving) Trust, a fresh waiting period begins when assessment and/or treatment is completed in that A&E Department.

For waits of 12 hours + this includes patients whose waiting time for an emergency admission is 12:00:01 hours or longer.