Standard 45: Reception, Waiting and Health Information

Why it matters. Patients who wait a long time for a service may leave, or be harmed by delay. Measuring the wait and sharing it against a target shows where action is needed.

Sample. Review waiting time records for every service with a queue for the last 3 months, and the sharing record.

1. Waiting times are measured from arrival or booking, at the point set for each service.

Method. Compare the measurement points in the policy with the times recorded for a sample of visits.

Evidence to show. Waiting time measurement and sharing (WTG-POL-001); waiting time register (URG-REG-002, existing, reused).

Pass when. Every sampled wait has a start and an end time, measured at the set point.

2. Each service has a target waiting time, and waits are compared with it each month.

Method. Check the target for each service and the monthly comparison record.

Evidence to show. Waiting time review record (WTG-FRM-001); queue and wait-time management (ACC-SOP-001, existing, reused).

Pass when. Every service has a set target and a monthly comparison is recorded.

3. Waiting times are shared with patients and staff.

Method. Check the published or posted waiting times and the staff review record for the sample period.

Evidence to show. Waiting time review record (WTG-FRM-001).

Pass when. Waiting times are shared with patients and reviewed with staff each month.

Immediate fail (any one means the criterion is not met)

• A clinic records no waiting times for two years, and patients wait over three hours with no one aware of the average.

Why it matters. A patient whose condition may change while they wait can deteriorate unseen. Assessing urgency on arrival and checking those patients keeps them from being left.

Sample. Review triage and re-check records for every patient who waited in the sample period, including any whose condition changed while waiting.

1. Every patient is assessed for urgency on arrival, and the triage category is recorded.

Method. Check the triage record for each sampled arrival.

Evidence to show. Triage on arrival (URG-POL-001, existing, reused); triage record (URG-FRM-001, existing, reused).

Pass when. Every sampled arrival has a triage category recorded before the wait begins.

2. Patients whose condition may change while they wait are reassessed at the set intervals.

Method. Check each re-check record against the interval set for its triage category.

Evidence to show. Waiting-room re-check (URG-SOP-002, existing, reused); re-check record (URG-FRM-004, existing, reused).

Pass when. Every sampled re-check happened within the set interval.

3. A change in condition triggers an immediate reassessment, and the response is recorded.

Method. Check the records of patients whose condition changed while they waited.

Evidence to show. Observation and early warning chart (HOS-FRM-002, existing, reused).

Pass when. Every recorded change in condition led to a reassessment within the set time.

Immediate fail (any one means the criterion is not met)

• A child with breathing difficulty waits 90 minutes with no reassessment and is found collapsed in the waiting room.

Why it matters. Waiting is hard, and it is harder when no one says why. Telling patients the reason for the wait and giving an updated estimate keeps them calm and informed.

Sample. Review how waiting patients were kept informed over the sample period, including waits longer than the target.

1. Patients who wait are told the reason for the wait on arrival.

Method. Observe reception on several days and check the script and sign used.

Evidence to show. Keeping waiting patients informed (WTG-SOP-001).

Pass when. Every sampled waiting patient is told the reason for the wait.

2. An updated estimate is given where the wait changes.

Method. Check the update record for each wait that went over its estimate.

Evidence to show. Waiting patient update record (WTG-FRM-002).

Pass when. Every sampled change in the estimate was given to the patient.

3. Patients are told what to do if they need help while waiting.

Method. Check the waiting area signs and the record of the help instruction.

Evidence to show. Waiting patient update record (WTG-FRM-002); waiting-room re-check (URG-SOP-002, existing, reused).

Pass when. Every waiting area displays the help instruction, and each sampled patient was given it.

Immediate fail (any one means the criterion is not met)

• A patient waits three hours, is given no reason or estimate, and leaves without being seen.

Why it matters. Health information that is hard to understand does not help. Writing in plain language, and testing it with the people who will use it, makes it usable.

Sample. Review all written health information issued in the last 12 months, and the test record for each item.

1. Written information is written in plain language.

Method. Check each leaflet and sign against the plain-language standard.

Evidence to show. Writing plain-language health information (WTG-SOP-002).

Pass when. Every item meets the plain-language standard.

2. Written information is tested with the people who will use it before it is issued.

Method. Check the test record for each item issued.

Evidence to show. Patient information test register (WTG-REG-001).

Pass when. Every item issued has a recorded test with people who will use it, completed before issue.

3. Written information is available in the languages the population uses.

Method. Check each item against the list of languages used by the population.

Evidence to show. Language access and interpreters (MTR-POL-002, existing, reused).

Pass when. Every item is available in each language the population uses.

Immediate fail (any one means the criterion is not met)

• A leaflet on medicine doses is written in technical language in one language only, and families cannot follow it.

Why it matters. Patients who cannot ask questions, or who do not get answers they understand, cannot take part in their care. Making it possible to ask at any point keeps the patient involved.

Sample. Review patient questions and their answers, and the teach-back records for key decisions, over the sample period.

1. Patients can ask questions at any point and receive an answer they understand.

Method. Observe consultations and check the question and feedback records for the sample.

Evidence to show. Patient questions and teach-back (WTG-POL-002); complaints and feedback (INC-POL-002, existing, reused).

Pass when. Every sampled question received an answer the patient understood.

2. Teach-back is used for key decisions, and its use is recorded.

Method. Check the teach-back record for each key decision in the sample.

Evidence to show. Teach-back record for key decisions (WTG-FRM-003).

Pass when. Every key decision in the sample has a teach-back record.

3. Consent for significant care is given with the information needed to decide.

Method. Check the consent records for the sample.

Evidence to show. Informed consent before significant care (CON-SOP-001, existing, reused).

Pass when. Every sampled consent records the information given and the questions answered.

Immediate fail (any one means the criterion is not met)

• A patient signs a consent form for surgery without understanding the risks, and no one checks.