NHS Information Authority

Data Standards Programme

Prior to the reorganisation of classification lists (DSCN 21/98/A04), the relationships of OUT-PATIENT ATTENDANCE CONSULTANT were:

must be related to one and only one LOCATION TYPE
or must be if at a clinic to one and only one OUT-PATIENT APPOINTMENT: CONSULTANT
or must be related to one and only one WARD

Following the publication of DSCN 21/98/A04, the entity LOCATION TYPE was changed to an attribute of OUT-PATIENT ATTENDANCE CONSULTANT, however, this meant that the relationships of OUT-PATIENT ATTENDANCE CONSULTANT were:

must be if at a clinic to one and only one OUT-PATIENT APPOINTMENT: CONSULTANT
or must be related to one and only one WARD

which then implied that such attendances could only take place within clinics and wards, which is incorrect.

This DSCN corrects that inaccuracy.

CLINIC ATTENDANCE CONSULTANT

CLINIC ATTENDANCE CONSULTANT

A type of OUT-PATIENT ATTENDANCE CONSULTANT

An attendance at which a PATIENT is seen by a CONSULTANT, or member of the CONSULTANTS firm, at a CONSULTANT CLINIC.

A PATIENT attending a clinic will always be given an OUT-PATIENT APPOINTMENT CONSULTANT (even when arriving with no prior notice), but appointments will not always result in an attendance.

This class is also known by these names:

Context	Alias
plural	CLINIC ATTENDANCES CONSULTANT

Attributes of this Class are:

	O	COLPOSCOPY PRIME PROCEDURE TYPE
		colposcopy only
		TIME SEEN

Each CLINIC ATTENDANCE CONSULTANT

must be related to one and only one OUT-PATIENT APPOINTMENT CONSULTANT

OUT-PATIENT APPOINTMENT CONSULTANT

Each OUT-PATIENT APPOINTMENT CONSULTANT

	must be related to one and only one CONSULTANT CLINIC SESSION
	must be related to one and only one CONSULTANT OUT-PATIENT EPISODE
	may be related to one or more APPOINTMENT SLOT
	may be related to one or more OUT-PATIENT ATTENDANCE CONSULTANT
	may be related to one or more CLINIC ATTENDANCE CONSULTANT

OUT-PATIENT ATTENDANCE CONSULTANT

An attendance at which a PATIENT is seen by a CONSULTANT, in respect of one referral, that is not a visit to the home of a PATIENT for which a fee is payable under paragraph 140 of the Terms and Conditions of Service. For the purposes of this definition 'CONSULTANT' includes a member of the CONSULTANT's firm or locum for such a member.

A PATIENT attending a clinic will always be given an OUT-PATIENT APPOINTMENT CONSULTANT (even when arriving with no prior notice), but appointments will not always result in an attendance. If a PATIENT is seen by a CONSULTANT at a CONSULTANT CLINIC then this will be a CLINIC ATTENDANCE CONSULTANT. An attendance may involve more than one person (e.g. a family). The number of attendances to be recorded should be the number of PATIENTS for whom the particular CONSULTANT has identifiable individual records and which will be maintained as a result of the attendance.

A visit to the home of a PATIENT made at the instance of a hospital or specialist to review the urgency of a proposed admission to hospital, or to continue to supervise treatment initiated or prescribed at a hospital or clinic is covered by this definition.

OUT-PATIENT ATTENDANCE CONSULTANT also includes a PATIENT being seen by a CONSULTANT from a different SPECIALTY during a CONSULTANT EPISODE (HOSPITAL PROVIDER) in circumstances where there is no transfer of responsibility for the care of the PATIENT.

If the PATIENT is currently subject to a MENTAL HEALTH CARE SPELL and the consultant they are in contact with during attendance is their allocated Care Programme Approach key worker then a FACE TO FACE CONTACT CPA KEY WORKER should also be recorded.

This class is also known by these names:

Context	Alias
plural	OUT-PATIENT ATTENDANCES CONSULTANT

OUT-PATIENT ATTENDANCE CONSULTANT

Attributes of this Class are:

K		ATTENDANCE DATE
K		ATTENDANCE IDENTIFIER
	O	COLPOSCOPY PRIME PROCEDURE TYPE
		colposcopy only
		FIRST ATTENDANCE
		LOCATION TYPE
	O	MEDICAL STAFF TYPE SEEING PATIENT
		OUTCOME OF ATTENDANCE
	O	TIME SEEN
		if patient attends at a clinic appointment

OUT-PATIENT ATTENDANCE CONSULTANT

Each OUT-PATIENT ATTENDANCE CONSULTANT

K	must be related to one and only one CONSULTANT OUT-PATIENT EPISODE
	must be if at a clinic to one and only one OUT-PATIENT APPOINTMENT CONSULTANT
	or must be related to one and only one WARD
	may be related to one and only one WARD
	may be related to one or more DECISION TO ADMIT
	may be for treatment at one and only one ORGANISATION SITE
	may be related to one or more PATIENT DIAGNOSIS
	may be related to one or more PATIENT PROCEDURE

WARD

Each WARD

K	must be related to one and only one HEALTH CARE PROVIDER
	must be related to one and only one SERVICE POINT
	may be related to one or more DAILY WARD LISTING
	may be related to one or more HEALTHY PERSON STAY
	may be related to one or more HOME LEAVE
	may be related to one or more OUT-PATIENT ATTENDANCE CONSULTANT
	may be related to one or more RIGHT OF ADMISSION
	may be related to one or more WARD ATTENDANCE
	may be related to one or more WARD BED AVAILABILITY
	may be related to one or more WARD OPERATIONAL PLAN
	may be related to one or more WARD STAY

KC65 2

Central Return Form Guidance

KC65 - Colposcopy Clinics: Referrals, Treatments and Outcomes

Part A - Women referred to colposcopy by referral indication and result of referral

1. Part A of the KC65 return is a count of the number of women referred for colposcopy. This information is used to monitor referral patterns to ensure that guidelines on referral are being followed.

2. A colposcopy is a PATIENT PROCEDURE carried out during an OUT-PATIENT ATTENDANCE CONSULTANT on a PATIENT. The PATIENT will have been referred to the Colposcopy Clinic:

   -	following a SCREENING TEST carried out either as part of a SCREENING PROGRAMME or opportunistically.
   or
   -	as a result of clinical indication

   In cases where there is both a clinical indication and a SCREENING TEST referral smear, the referral should be treated as clinical indication.

3. The data is based on the woman's first OUT-PATIENT APPOINTMENT CONSULTANT in the quarter regardless of whether she attended the clinic or not.

   Please note that the total number referred as recorded in Part A should equal the total number waiting as recorded in Part B as both parts relate to the same cohort of women.

2. A colposcopy is a PATIENT PROCEDURE carried out during a CLINIC ATTENDANCE CONSULTANT on a PATIENT. The PATIENT will have been referred to the Colposcopy Clinic:

   -	following a SCREENING TEST carried out either as part of a SCREENING PROGRAMME or opportunistically.
   or
   -	as a result of clinical indication

   In cases where there is both a clinical indication and a SCREENING TEST referral smear, the referral should be treated as clinical indication.

3. The data is based on the woman's first OUT-PATIENT APPOINTMENT CONSULTANT in the quarter regardless of whether she attended the clinic or not.

   Please note that the total number referred as recorded in Part A should equal the total number waiting as recorded in Part B as both parts relate to the same cohort of women.

Referral Indication - Screening smear (line 0001)

3. This line counts all the women with a REFERRAL REQUEST for coloposcopy with a COLPOSCOPY REFERRAL INDICATION of Screening smear. These are PERSONS IN A SCREENING PROGRAMME who have been given a SCREENING TEST as part of a planned SCREENING PROGRAMME. It also includes women screened opportunistically, these women have had a SCREENING TEST with the OPPORTUNISTIC SCREENING INDICATOR of Yes.

   In addition, if a PERSON IN A SCREENING PROGRAMME has been suspended from the SCREENING PROGRAMME following colposcopy and is currently having surveillance smears as indicated by SCREENED WHILE SUSPENDED INDICATOR of Yes, it may be that an abnormal smear will cause the woman to be re-referred to colposcopy. In this case the COLPOSCOPY REFERRAL INDICATION should be Screening smear, regardless of whether or not she has been discharged from colposcopy at this time.

Referral Indication - Clinical indication (line 0002)

4. This line counts all the women with a REFERRAL REQUEST for coloposcopy with a COLPOSCOPY REFERRAL INDICATION of Clinical indication.

   Where a woman is referred with symptoms and is given a SCREENING TEST the COLPOSCOPY REFERRAL INDICATION should still be Clinical indication and not Screening smear. Where no symptoms are present the COLPOSCOPY REFERRAL INDICATION should not be Clinical indication.

   Results of referral smear

5. The information in columns 2-9 is based on the cervical screening test results, which led to the REFERRAL REQUEST. Classifications are those of CYTOLOGY RESULT TYPES of a REQUEST FOR PATHOLOGY INVESTIGATION and are in accordance with the categories shown in box 22 of HMR 101/5 Request/Report for Cervical or Vaginal Cytology.

   Entries recorded in Other (column 9) should only occur in exceptional circumstances. NHS Cervical Screening Programme (NHSCSP) guidelines state that all smears should be identified as belonging to one of the eight recognised category classifications of CYTOLOGY RESULT TYPE. Other (column 9) does not correspond to these recognised categories and should be used to record those rare cases in which a recognised category is not appropriate. Where an entry is present in Other (column 9) then supporting notes should be recorded in the available box on the first page of the KC65 form.

   Where the cervical screening test results which led to the REFERRAL REQUEST indicates more than one result type, the most severe result should recorded as the CYTOLOGY RESULT TYPE.

Inadequate (column 2)

5. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Inadequate sample (cat.1).

   NHS Cervical Screening Programme guidelines state the recording of three cervical screening tests with a CYTOLOGY RESULT TYPEclassification of Inadequate sample (cat.1) indicates referral to colposcopy however, referral to colposcopy may occur following an inadequate smear for other reasons.

Borderline changes (column 3)

6. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Borderline changes (cat.8).

   NHS Cervical Screening Programme guidelines state the recording of three cervical screening tests with a CYTOLOGY RESULT TYPEclassification of Borderline changes (cat.8) indicates referral to colposcopy however, referral to colposcopy may occur following a borderline smear for other reasons.

   Mild dyskaryosis (column 4)

7. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Mild dyskaryosis (cat.3).

Moderate dyskaryosis (column 5)

7. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Moderate dyskaryosis (cat. 7), including abnormal, unclassifiable and ungraded smears.

Severe dyskaryosis (column 6)

8. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Severe dyskaryosis (cat.4).

Severe dyskaryosis/invasive carcinoma (column 7)

9. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Severe dyskaryosis/?invasive carcinoma (cat.5).

Glandular neoplasia (column 8)

10. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of ?Glandular neoplasia (cat.6), including adenocarcinoma.

Other (column 9)

11. A count of the number of women with a CYTOLOGY RESULT TYPEclassification of Other.

    This should only be used in the rare situations where usual categorisation is not appropriate. Examples include women with incomplete or missing records and women who have moved from abroad.

    Where an entry is present in Other (column 9) then supporting notes should be recorded in the available box on the first page of the KC65 form.

No referral smear (column 10)

12. A count of the number of women who have been referred to the colposcopy clinic with a REFERRAL REQUEST with a COLPOSCOPY REFERRAL INDICATION of Clinical indication.

Total number referred (column 11)

13. This is the total of women referred for colposcopy, split between with those referred with a COLPOSCOPY REFERRAL INDICATION of Clinical indication and those referred with a COLPOSCOPY REFERRAL INDICATION of Screening smear.

Total (line 0003)

14. This is the total for all women counted in columns 2 to 11.

CDS090 EPISODE AND ATTENDANCE DETAILS - OUT-PATIENT AND WARD ATTENDERS CDS TYPES

 CDS090 Episode and Attendance Details - Out-Patient and Ward Attenders CDS Types 

HP020 CLINICS

 HP020 Clinics 

HP040 OUT-PATIENT ATTENDANCES

 HP040 Out-Patient Attendances 

KC65 COLPOSCOPY CLINICS: REFERRALS, TREATMENTS AND OUTCOMES

 KC65 Colposcopy Clinics: Referrals, Treatments and Outcomes 

KH09 CONSULTANT OUT-PATIENT ATTENDANCE ACTIVITY & ACCIDENT AND EMERGENCY SERVICES ACTIVITY

 KH09 Consultant Out-Patient Attendance Activity & Accident and Emergency Services Activity 

QM08 OUT-PATIENT FIRST ATTENDANCES - PROVIDER

 QM08 Out-Patient First Attendances - Provider 

QM08R OUT-PATIENT FIRST ATTENDANCES: RESPONSIBLE POPULATION BASED

 QM08R Out-Patient First Attendances: Responsible Population Based 

HP020

Model View Diagram - Overview

HP020 - CLINICS

1. This diagram shows entity types relevant to PATIENTS who are due to attend OUT-PATIENT CLINICS.

2. A PATIENT is booked into an OUT-PATIENT CLINIC by having an OUT-PATIENT APPOINTMENT.

2. A PATIENT is booked into an OUT-PATIENT CLINIC by having an OUT-PATIENT APPOINTMENT.see HP040

3. An OUT-PATIENT APPOINTMENT may result in a CLINIC ATTENDANCE NON-CONSULTANT or an OUT-PATIENT ATTENDANCE CONSULTANT (see HP040).

3. An OUT-PATIENT APPOINTMENT may result in a CLINIC ATTENDANCE NON-CONSULTANT or a CLINIC ATTENDANCE CONSULTANT.

4. CLINIC ATTENDANCES NON-CONSULTANT are linked to a particular OUT-PATIENT CLINIC. These OUT-PATIENT CLINICS are either NURSE CLINICS, CONSULTANT CLINICS, FAMILY PLANNING CLINICS or MIDWIFE CLINICS.

5. A CLINIC ATTENDANCE NON-CONSULTANT may be a NURSE OR MIDWIFE CONTACT which is the responsibility of a NURSE or a MIDWIFE.

6. An OUT-PATIENT APPOINTMENT CONSULTANT may result in OUT-PATIENT ATTENDANCES CONSULTANT.

6. An OUT-PATIENT APPOINTMENT may result in CLINIC ATTENDANCE CONSULTANT.

HP040

Model View Diagram - Overview

HP040 - OUT-PATIENT ATTENDANCES

1. This diagram shows entity types relevant to patients making OUT-PATIENT APPOINTMENTS. Attendances may be at a CONSULTANT CLINIC, a type of OUT-PATIENT CLINIC.

2. A CONSULTANT OUT-PATIENT EPISODE will comprise one or more OUT-PATIENT ATTENDANCES CONSULTANT. OUT-PATIENT ATTENDANCES CONSULTANT will always form part of a CONSULTANT OUT-PATIENT EPISODE although they do not always occur at CONSULTANT CLINIC SESSIONS.

3. CLINIC ATTENDANCES CONSULTANT will always have an OUT-PATIENT APPOINTMENT CONSULTANT (even when the PATIENT arrives with no prior notice), but an OUT-PATIENT APPOINTMENT CONSULTANT will not always result in an attendance.

4. An episode could involve shared consultant care in which case the CONSULTANTS sharing responsibility for the PATIENTS with the main CONSULTANT are SHARED CARE OUT-PATIENT CONSULTANTS.

5. For each CONSULTANT CLINIC, sessions are generally held at regular intervals in the same LOCATION. CONSULTANT CLINIC SESSIONS have a number of APPOINTMENT SLOTS. Patients attending sessions will be allocated one or more APPOINTMENT SLOTS.

6. The attribute TIME SEEN, used to calculate the waiting time between the appointment and consultation, need only be recorded for OUT-PATIENT ATTENDANCES CONSULTANT on a sampling basis to be determined locally.

6. The attribute TIME SEEN, used to calculate the waiting time between the appointment and consultation, need only be recorded for CLINIC ATTENDANCE CONSULTANT on a sampling basis to be determined locally.

7. A PATIENT PROCEDURE performed during an OUT-PATIENT ATTENDANCES CONSULTANT must have at least one PATIENT PROCEDURE CLASSIFICATION classified by a READ CLASSIFICATION.

7. A PATIENT PROCEDURE performed during an OUT-PATIENT ATTENDANCE CONSULTANT must have at least one PATIENT PROCEDURE CLASSIFICATION classified by a READ CLASSIFICATION.

8. OUT-PATIENT ATTENDANCES CONSULTANT may lead to a DECISION TO ADMIT.

Please address enquiries about this DSCN to:-
Data Standards Team
NHS Information Authority
Aqueous II
Aston Cross
Rocky Lane
Birmingham
B6 5RQ

Tel: 0121 333 0333