18 Weeks Referral to Treatment Standard Dental Specialties Task and Finish Group

Transcription

1 18 Weeks Referral to Treatment Standard Dental Specialties Task and Finish Group Patient Scenarios - Dental Specialties (PS- D) The following patient scenarios give examples of patient journeys within Dental Specialties and illustrates at which points the 18 Week RTT waiting time clock starts, pauses and stops. PS-D1. Restorative Dentistry Anne is a teenager who has been referred to her local secondary care Dental Service from her General Dental Practitioner (GDP). Her social circumstances have been somewhat chaotic and her past attendance has been irregular. Anne smokes and has poor oral hygiene. She has not attended for some time and now has established dental disease. She is highly anxious and her GDP feels unable to provide for her in his practice as she is unable to accept local anaesthesia for treatment. She has been referred for a course of treatment, and the need for sedation has been suggested by the referring practitioner. The front upper two teeth are to be restored. The patient s medical history appears to contain nothing of significance. First appointment scheduled for one month s time for initial assessment and First outpatient appointment: Week four Patient attends first outpatient appointment. Dentist undertakes examination and assessment, radiographs are taken. Treatment plan is drawn up. Patient anxiety indicates use of acclimatisation techniques/sedation. Oral hygiene and motivation is poor, will require attention from the hygienist in secondary care before proceeding with operative care. Patient is therefore unfit to proceed to treatment. 18 Weeks RTT clock is paused as patient is unfit to proceed to treatment without intervention from hygienist. Patient remains on waiting list. Onward referral to hygienist the following week. Second appointment: Clock is paused Patient attends appointment to see hygienist for basic instruction and acclimatisation.

2 Patient responds well at this visit, patient is booked to come back the following week. 18 Weeks RTT clock is still paused. Third appointment: Clock is paused Oral hygiene assessed by consultant and improvement is noted. Needle desensitisation treatment, sedation demonstrated. Patient now considered fit to commence treatment. Appointment is booked in a months time. 18 Weeks RTT clock is re-started. Fourth appointment: Week eight of waiting time elapsed Initial restorative work begins along with temporization of worst affected teeth This is considered to be the first definitive treatment therefore 18 Weeks RTT clock stops. Patient continues to attend for treatment PS-D2. Orthodontics John is a nine year old boy who has been referred by his GDP to the Orthodontic department in his local district general hospital. First appointment scheduled for five weeks for initial assessment and First appointment: Week five of waiting time elapsed Reviewed by consultant orthodontist. Patient is found to have early mixed dentition Patient is unsuitable for an appliance at present. The orthodontist requests a set of models and an orthopantomograph (OPT) to check the eruption paths of the unerupted permanent teeth and for any pathology. Patient booked for a review in seven weeks. Second appointment: Week twelve of waiting time elapsed Patient attends for review. Clinical decision is to refer patient back to GDP with a letter advising he is rereferred following the eruption of permanent canines.

3 Re-referral: Week zero Patient is re-referred by GDP as requested previously. First appointment scheduled for seven weeks time. First appointment: Week seven of waiting time elapsed Patient attends appointment. Orthodontist decides that two extractions are required before an appliance can be fitted. An impression will be required for the construction of this appliance. Second appointment: Week fifteen of waiting time elapsed Impression is taken in order to construct the appliance. The 18 Weeks RTT clock is stopped at week fifteen as this is considered to be the first definitive treatment.* Patient booked in for extractions. Third appointment: Waiting time stopped at week fifteen Extractions are performed. Fourth appointment: Waiting time stopped at week fifteen Appliance is fitted. *Although the process from referral to fitting of the appliance actually longer than 18 weeks, the waiting time clock stops at week 15, as taking impressions in order to construct the appliance is considered to be the first definitive treatment. PS-D3: Oral Surgery Moira is a 30 year old woman who requires the extraction of a wisdom tooth. She is on warfarin therapy. First appointment scheduled for six weeks for initial assessment and First appointment: Week six of waiting time elapsed Patient attends her appointment with the consultant. X-Rays and an orthopantomograph are taken. Patient is booked in to have her extraction performed in three weeks time.

4 A letter is sent to her GP to check her international normalized ratio (INR) to ensure it is within the therapeutic range on the day prior to the procedure. GP attendance prior to surgery: Week nine of waiting time elapsed Patient attends GP to check INR. GP finds that INR is outwith the therapeutic range and contacts hospital to advise staff. Following the phone call from the GP regarding the patient s INR the booking for surgery is cancelled. GP reduces warfarin and arranges to monitor INR. 18 Weeks RTT clock is paused - patient remains on waiting list. GP attendance prior to surgery: Clock is paused Patient attends GP to check INR. GP finds that INR is stable and within the therapeutic range to allow the extraction to go ahead. GP informs hospital. Patient is booked to attend for extraction in two weeks. Patient books have INR checked by GP on the day prior to extraction. 18 Weeks RTT clock is re-started. Second appointment: Week eleven of waiting time elapsed Patient is admitted to hospital for extraction as INR has been found to be stable by her GP. Patient undergoes extraction. PS-D4: Oral Medicine David is a 54 year old gentleman referred by his GDP with recurrent aphthae. Referral sent by GDP Referral received by secondary care service 18 Week RTT clock is started on receipt of referral First appointment scheduled for five weeks for assessment. First appointment: Week five of waiting time elapsed Patient attends appointment. Initial tests at the clinic show iron deficiency anaemia. Patient is referred back to his GP for further tests to identify the cause of his anaemia. 18 Weeks RTT clock stops as no further appointments / treatment are required to be provided.

5 PS-D5: General Anaesthetics Jane is a six year old girl who is referred for assessment for multiple extractions under general anaesthetic (GA). First appointment scheduled for four weeks for assessment. First appointment: Week four of waiting time elapsed Patient attends appointment for assessment Patient is added to waiting list and booked to attend in two weeks. Second appointment: Week six of waiting time elapsed Patient attends on the day of surgery as arranged however patient is found to have a chest infection. Patient is unsuitable to undergo GA and therefore extractions cannot be carried out. Patient is to attend GP to be prescribed antibiotics. GP is asked to confirm when the patient will be available for treatment. 18 Weeks RTT clock is paused - patient remains on waiting list. GP attendance: Waiting time clock is paused Patient has now completed course of antibiotics. GP confirms with secondary care that the patient is fit to have treatment. On this confirmation, the 18 Weeks RTT clock is re-started and patient is booked in for extraction in a month. Third appointment: Week ten of waiting time elapsed Patient attends day surgery and undergoes multiple extractions under GA.