Events on a pathway#

Patient Pathways are made up of a series of individual events. These could be treatments, patients’ contacts with the hospital, or administrative actions taken to log a patient’s progress through the pathway. Whilst each of these events are unique, but they fall into different types. Below is a list of the different event types currently included in the patient tracker, with details of how they are identified using the data from different hospital systems.

Referral#

Description#

A referral is a request for a patient to be seen by a specialist. This is the first event in a patient’s pathway.

Definition#

A referral event is the only event guaranteed for a patient pathway as is the the event used to generate the patient’s pathway. It is defined in the following way:

  • The referral event is taken from the REFERRAL table, and correlated with the patient pathway using the REFERRAL_ID field.

  • The event is then enriched with the most recent PTL record with a REFERRAL_ID matching the REFERRAL_ID of the referral event.

RTT Start#

Description#

The date at which the RTT clock resumes after a pause for a patient.

Definition#

The RTT start is taken from the RTT table, and correlated with the patient pathway using the REFERRAL_ID field. The date for the event is taken from the pause end date field for the RTT record.

First OPA#

Description#

The first outpatient appointment for a patient.

Definition#

The first OPA is taken from the APPOINTMENTS table, and correlated with the patient pathway using the REFERRAL_ID field. The event is defined in the following way:

  • The appointments are filtered to only include appointments with a REFERRAL_ID matching the REFERRAL_ID of the pathway.

  • The appointments that fall into a therapy specialty are filtered out.

  • The status of the OPA is then calculated in the following way:

    • Booked

      • Booked date not NULL

      • Not cancelled: is NULL

      • Not DNAed: is NULL

    • Cancelled

      • If cancellation date not NULL

    • DNA

      • If not attended and date is in past

    • Attended

      • Attended date is not null

    • Outcomed

      • Need to have attended

      • Outcome not NULL

Diagnostic#

Description#

All imaging reported on CRIS (excluding PET scans).

Definition#

Due to there not being a referral ID in the CRIS data, the diagnostic events are correlated using fuzzy matching with the patient pathway. The process of generating a diagnostic event is as follows:

  • The pathways are filtered to only include those which patient has a CRIS record based on the hospital number.

  • The pathways are then filtered to only include those which have a specialty that matches a specialty in the CRIS data.

  • The pathways are then filtered to only include those which have an event date within a specified threshold of a matched CRIS record.

  • In the event of multiple pathways matching the same CRIS record, the pathway with the closest event date is selected.

Diagnostic - Other#

Description#

Any other diagnostic outside other diagnostic categories.

Definition#

These events are generate from a subset of the records in the orders table, where the order is a diagnostic order but does not belong to any of the other diagnostic categories. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Diagnostic - Histopathology#

Description#

Histopathology results.

Definition#

These events are generated from the orders table, where the order is a histopathology order. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Audiology#

Description#

Audiology appointments.

Definition#

These are generated in the same way as the first OPA and follow-up OPA events, but with the specialty filtered to only include audiology.

Cardiology#

Description#

Diagnostic cardiology (ECGs, Echo, etc.).

Definition#

These events are generated from the orders table, where the order is a cardiology order. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Neurophysiology#

Description#

Diagnostic neurophysiology (EEG, etc.).

Definition#

These events are generated from the orders table, where the order is a neurophysiology order. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Pathology#

Description#

All pathology orders.

Definition#

These events are a combination of events from orders, as well as results. For the orders table, the events are generated where the order is a pathology order. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events. For the results table, the events are generated where the result is a pathology result. Similarly to the orders, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

PET Scan#

Description#

PET scans.

Definition#

These events are generated from the orders table, where the order is a PET Scan. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Diagnostic - Cytology#

Description#

Cytology orders.

Definition#

These events are generated from the results table, where the result is for Diagnostic Cytology. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

MDT#

Description#

MDT arranged on Medway.

Definition#

These events are generated from the orders table, where the order is to do with MDT. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Discharged#

Description#

Patient discharged.

Definition#

The discharged event is taken from the RTT table, and correlated with the patient pathway using the REFERRAL_ID field. The date for the event is taken from the discharge date field for the patient record.

Therapy#

Description#

A first outpatient appointment with therapy specialties (occupational therapy, orthodontics, orthoptics, orthotics, pain management, physiotherapy, rehabilitation, speech and language therapy).

Definition#

Therapy events taken from the APPOINTMENTS table, and correlated with the patient pathway using the REFERRAL_ID field. The event is defined in the following way:

  • The appointments are filtered to only include appointments with a REFERRAL_ID matching the REFERRAL_ID of the pathway.

  • The appointments that don’t fall into a therapy specialty are filtered out.

  • The status of the therapy event is then calculated in the following way:

    • Booked

      • Booked date not NULL

      • Not cancelled: is NULL

      • Not DNAed: is NULL

    • Cancelled

      • If cancellation date not NULL

    • DNA

      • If not attended and date is in past

    • Attended

      • Attended date is not null

    • Outcomed

      • Need to have attended

      • Outcome not NULL

Pre-Appointment#

Description#

Pre-operative events including pre-operative assessments.

Definition#

These events are generated from the PRE_APPOINTMENT table, and correlated with the patient pathway using the REFERRAL_ID field. The event is defined in the following way:

  • The pre-appointments are filtered to only include pre-appointments with a REFERRAL_ID matching the REFERRAL_ID of the pathway.

  • The status of the pre-appointment event is then calculated in the following way:

    • Booked

      • Booked date not NULL

      • Not cancelled: is NULL

      • Not DNAed: is NULL

    • Cancelled

      • If cancellation date not NULL

    • DNA

      • If not attended and date is in past

    • Attended

      • Attended date is not null

    • Outcomed

      • Need to have attended

      • Outcome not NULL

Blood Transfusion#

Description#

Blood transfusion.

Definition#

These events are generated from the orders table, where the order event is a Blood Transfusion. As with events/orders from the CRIS data, these events are correlated using fuzzy matching with the patient pathway. The fuzzy matching uses the same process as the diagnostic events.

Surgery#

Description#

Listed for surgery.

Definition#

Surgery events are generated from the PTL table due to no reliable means of linkage from the BLUESPIER table. The event is defined in the following way:

  • The surgery records are selected from the PTL table (the TCI and DTA records)

  • A new surgery is created for each DTA

  • Statuses are attached to it by looking for TCI records after the DTA, but before the following DTA

    For example:

    PTL surgery records:

    referralid

    date

    activity

    DTAG

    1

    1-jan

    DTA

    1

    1

    2-jan

    offered

    1

    1

    3-jan

    declined

    1

    1

    4-jan

    DTA

    2

    1

    5-jan

    declined

    2

    Surgery records:

    referralid

    activitydate

    offered

    declined

    ETC

    1

    1-jan

    2-jan

    3-jan

    1

    4-jan

    5-jan

Other Treatment/RTT change#

Description#

Any other treatment outside of the other categories or incorrectly coded on the system.

Definition#

These events are generated from the PTL table. The event is defined in the following way:

  • The PTL records are filtered to only include records with a REFERRAL_ID matching the REFERRAL_ID of the pathway

  • The PTL is filtered to only include records with a treatment PTL code (30 or 90)

  • Any PTL records which correspond to known surgery or therapy events are filtered out

  • An event is created for each remaining PTL record

Follow Up OPA#

Description#

Follow up appointment.

Definition#

The follow-up OPA is taken from the APPOINTMENTS table, and correlated with the patient pathway using the REFERRAL_ID field. The event is defined in the following way:

  • The appointments are filtered to only include appointments with a REFERRAL_ID matching the REFERRAL_ID of the pathway.

  • The appointments that fall into a therapy specialty are filtered out.

  • The status of the OPA is then calculated in the following way:

    • Booked

      • Booked date not NULL

      • Not cancelled: is NULL

      • Not DNAed: is NULL

    • Cancelled

      • If cancellation date not NULL

    • DNA

      • If not attended and date is in past

    • Attended

      • Attended date is not null

    • Outcomed

      • Need to have attended

      • Outcome not NULL

Death#

Description#

Patient has a date of death.

Definition#

There is a date of death in the PATIENT demographics table.

RTT Stop#

Description#

Patient has an RTT stop.

Definition#

There is a pause date in the RTT table.