Publication - Advice and guidance

Coronavirus (COVID-19): supporting elective care - clinical prioritisation framework

Published: 16 Nov 2020

The framework provides NHS Scotland with clear guidance for prioritising elective care whilst ensuring appropriate COVID-19 safety and priority measures are in place.

Contents
Coronavirus (COVID-19): supporting elective care - clinical prioritisation framework
Active waiting list management

Active waiting list management

The priority matrix set out below outlines classification that should be applied when reviewing a patient’s clinical condition, should they require to be moved between categories. This should be utilised when the clinical team are reviewing a patient’s clinical condition and pathway, while following the principles of Realistic Medicine as set out in Section 4.

Clinical teams should actively review waiting lists with ACRT as the foundation, encompassing EQuIP as an outcome. 

Principles from the Scottish Access Collaborative should be applied as outlined below:

  • patients should be triaged for clinical prioritisation using Active Clinical Referral Triage (ACRT)
  • where there are Effective Quality Interventions Pathways (EQuIP), these should be applied
  • in order for consistency, specialty guidance on clinical prioritisation will be developed through the Modernising Patient Pathways Programme Specialty Groups
  • ensure that there is active review of patients taking into consideration the effects of waiting can have on physical and mental health

Priority matrix

 

Low = 1

Intermediate = 2

High = 3

Risk to life

 

Consider moving patient to p1a/1b

Consider moving patient to p1a/1b

Risk to function

 

Consider moving patient to p2

Consider moving patient to p1a/1b

Worsening disability

 

Consider moving patient to p2

Consider moving patient to p1a/1b

Worsening pain/ physical symptoms

 

Consider moving patient to p2

Consider moving patient to p1a/1b

Existing pain/ physical symptoms

 

Consider moving patient to p2

Consider moving patient to p1a/1b

Existing disability

 

Consider moving patient to p3

Consider moving patient to p2

Length of time already waiting

 

Consider moving patient to p3

Consider moving patient to p2

Psychological  distress

 

Consider moving patient to p3

Consider moving patient to p2

ASA grade (1-3)

 

 

 

Operative facility/staff/kit required

 

 

 

Post-operative care level required

 

 

 

Out of hospital care level required

 

 

 

Column Totals

 

 

 

 

 

 

 

TOTAL SCORE (12-36)

 

X

X

a) ASA category 4 and 5 patients should be in p1a/1b

 

b) Use ONLY with patients that do not fufil the criteria for p1a/1b

 

c) High score suggests inpatient + complex intra/ post-op care needs that must be in place before surgery

Recommended clinical review times for re-prioritisation

 

P2 < 1/12 from listing

 

P3 < 3/12 from listing

 

P4 < 6/12 from listing

 

 

 

 

 

 


Contact

Waiting Times Team: WTIP@gov.scot