Reporting of Quarterly Outpatient Activity Information

Data Definition and Guidance Document

Version 3 (March 2026)

1 Background

The Quarterly Outpatient Activity Return (QOAR), the present methodology for the collection of consultant-led outpatient activity, was introduced from the beginning of 2008/09. The Regional Outpatient Activity Return (R-QOAR) was introduced in 2019/20 for the collection of outpatient activity carried out in regional Day Procedure Centres.

On 9 November 2023 the South Eastern Health and Social Care (HSC) Trust launched ‘encompass’ - a new electronic patient record system. The system also went live in Belfast Trust on 6 June 2024, Northern Trust on 7 November 2024 and Southern and Western Trusts on 8 May 2025.

The QOAR and R-QOAR relate to total face-to-face consultant led outpatient activity at each Health and Social Care Trust in Northern Ireland.

A new version of the QOAR was introduced at the beginning of 2014/15, with the main change being that ward attendances seen by a consultant are now reported in the return separately and are not included in the main outpatient activity, as was the case in previous years.

Virtual activity (see definitions) was also previously included within the QOAR. However, following the issuing of virtual activity guidance by the former Health and Social Care Board (HSCB) at the beginning of 2015/16, HAIB introduced a separate return, the V-QOAR, to allow the monitoring of virtual activity. All terminology in the following guidance should therefore be taken to refer to face-to-face appointments only, unless otherwise specified.

The returns are populated by activity data extracted from an encompass report developed by the Department and HSC Trusts. This data is supplemented by any activity not currently recorded on encompass.

Section 1.1 relates to outpatient attendances, patient cancellations of outpatient appointments (CNA), outpatient appointments which the patient did not attend (DNA), hospital cancellations of outpatient appointments, ward attendances seen by a consultant and outpatient appointments cancelled as the result of a patient’s death. Section 1.2 relates to hospital and patient cancellations of outpatient appointments split by the reason for cancellation.

The variable ‘reason for cancellation’ was introduced in 2008/09 as experimental statistics and was only made mandatory for completion from March 2013. Following this decision, an audit of the reasons for cancellation was undertaken and an updated methodology was put in place. All HSC Trust implemented this methodology from 1st July 2013. Following the introduction of the encompass system a further review of the reasons for cancellation was completed in 2025.

Data on attendances at emergency departments in Northern Ireland should be reported on the KH09 (Part 2) data return.

2 Definitions

OUTPATIENT SERVICES - An outpatient service is a consultant led service provided by Health and Social Care Trusts to allow patients to see a consultant, their staff and associated health professionals for assessment in relation to a specific condition. Patients are not admitted into hospital for this assessment. Outpatient services are usually provided during a clinic session providing an opportunity for consultation, investigation and minor treatment. Patients normally attend by prior arrangement. Although a consultant is in overall charge, they may not be present on all occasions the clinic is held. They must, however, be represented by a member of their team.

OUTPATIENT APPOINTMENTS - An outpatient appointment is an administrative arrangement enabling patients to see a consultant, their staff and associated health professionals, following an outpatient referral. Outpatient appointments relate to all appointments with a consultant led service, irrespective of the location in which the service is performed.

NEW ATTENDANCES - A new attendance is the first of a series or the only attendance at an outpatient service with a consultant or their representative following an outpatient referral. In practice, most referrals will be seen as a consequence of a GP referral request; however, referrals may also be received from a range of other sources (see Appendix 1). First attendances at an outpatient clinic that are initiated by the consultant, who has already seen the patient, are classified as review attendances i.e. following an attendance at an Emergency Department or following an inpatient admission.

NEW ATTENDANCE SEEN - This is the number of patients who attended a new outpatient appointment.

NEW ATTENDANCES DID NOT ATTEND (DNA’d) - This is the number of patients who did not attend, and failed to give advance warning to the hospital, for a new outpatient appointment. This includes patients who cancelled their new outpatient appointment on the same day on which the appointment was scheduled. These should not be confused with those who could not attend and who did warn the hospital in advance (before the day on which the appointment was scheduled).

NEW ATTENDANCE COULD NOT ATTEND (CNA’d) - This is the number of patients who did not attend, and gave advance warning to the hospital, for a new outpatient appointment before the day of the scheduled appointment. These should not be confused with those who either did not attend without prior warning or those who could not attend and informed the hospital on the day on which the appointment was scheduled. This does not include new appointments cancelled as a result of the hospital being notified of the patient’s death.

REVIEW ATTENDANCES - A review attendance is an attendance at an outpatient service following; a new outpatient attendance, a previous review attendance, an attendance at an Emergency Department, a domiciliary visit, or following an inpatient admission, for the same condition. Essentially review appointments are all appointments that are not a first appointment. (See Appendix 3 for further information on the categorising of attendance sequence for face-to-face and virtual appointments).

REVIEW ATTENDANCE SEEN - This is the number of patients who attended a review outpatient appointment.

REVIEW ATTENDANCES DID NOT ATTEND (DNA’d) - This is the number of patients who did not attend, and failed to give advance warning to the hospital, for a review outpatient appointment. This includes patients who cancelled a review outpatient appointment on the same day on which the appointment was scheduled. These should not be confused with those who could not attend and who did warn the hospital in advance (before the day on which the appointment was scheduled).

REVIEW ATTENDANCE COULD NOT ATTEND (CNA’d) - This is the number of patients who did not attend, and gave advance warning to the hospital, for a review outpatient appointment before the day of the scheduled appointment. These should not be confused with those who either did not attend without prior warning or those who could not attend and informed the hospital on the day on which the appointment was scheduled. This does not include review appointments cancelled as a result of the hospital being notified of the patient’s death.

NEW OUTPATIENT APPOINTMENTS CANCELLED BY HOSPITAL - This is the number of new outpatient appointments that have been cancelled by the provider Health and Social Care Trust. Such cancellations do not include those cancelled by the patient (Could Not Attend), appointments the patient did not attend without giving prior notice (DNA) and new appointments cancelled by the hospital as a result of the patient’s death.

REVIEW OUTPATIENT APPOINTMENTS CANCELLED BY HOSPITAL - This is the number of review outpatient appointments that have been cancelled by the provider Health and Social Care Trust. Such cancellations do not include those cancelled by the patient (Could Not Attend), appointments the patient did not attend without giving prior notice (DNA) and review appointments cancelled by the hospital as a result of the patient’s death.

WARD ATTENDANCE SEEN BY A CONSULTANT
An attendance at a ward by a patient for the purpose of examination or treatment by a consultant/doctor is an outpatient appointment/attendance. These patients would not currently be admitted to the health care provider. The care is for the prevention, cure, relief or investigation because of a disease, injury, health problem or other factor affecting their health status.

This includes:

• disease (physical or mental) confirmed or suspected - inclusive of undiagnosed signs symptoms,
• injury - inclusive of poisoning - confirmed or suspected,
• health problem e.g. prostheses or graft in situ,
• other factors influencing the health status of non-sick persons e.g

pregnancy,
family planning,
potential donor (organ or tissue),
potential problem requiring prophylactic (preventative) care,
bereavement or other problem requiring health professional counselling,
cosmetic surgery,
other.

PRIVATE PATIENT ATTENDANCES - A private patient is one who has opted to have treatment outside the Health Service and has undertaken to pay for all expenses incurred, including treatment and accommodation costs. Private patient attendances relate to private patients who attend an outpatient appointment at a facility provided by a Health and Social Care Trust. These should not be confused with independent sector attendances, which relate to attendances at a private sector healthcare company that is contracted by HSC Trusts in the provision of healthcare or in the support in the provision of healthcare. Any cost of these independent sector attendances is paid by the Health Service and not the patient.

REASONS FOR CANCELLATION - An outpatient appointment may be cancelled by either the provider Health and Social Care Trust (a hospital cancellation) or the patient (patient could not attend – CNA).

Hospital Cancellations may occur for the following reasons:
• Consultant unavailable
• Medical staff / Nurse unavailable
• Patient treated elsewhere
• Consultant cancelled appointment
• Appointment rescheduled (brought forward)
• Appointment rescheduled (put back)
• Cancelled following validation / audit (not used on encompass)
• Administrative Process
• Hospital transport not available
• Cancelled by hospital in order to rebook as alternative booking method (not used on encompass)
• Patient died

Patient Cancellations (CNA) may occur for the following reasons:
• Patient cancelled appointment as it is no longer required
• Patient cancelled but the appointment is still required
• GP cancelled appointment (not used on encompass)

PATIENT DIED - This is an appointment which has been cancelled due to the hospital being notified of the patient’s death. Cancellations due to the death of a patient are not included within the figures for either Patient Cancellations (CNA) or hospital cancellations.

VIRTUAL ACTIVITY - A virtual appointment is a planned contact by a Healthcare Professional responsible for the care of a patient for the purposes of clinical consultation, advice and treatment planning. It may take the form of a telephone contact, video-link intervention, an email or a letter.

Virtual contact between a Healthcare Professional and a patient can be regarded as a Virtual Outpatient Attendance only as long as it replaces what would have been a face-to-face attendance at an outpatient clinic and that it directly supports the diagnosis and care planning of a patient/client. It is not intended to facilitate the recording of every contact/phone call. Further information on the definition and recording of virtual activity can be found in the V-QOAR guidance.

3 Collection of Data

OUTPATIENT ACTIVITY

• All activity at a consultant led service is counted as an outpatient attendance and should be included on the QOAR/R-QOAR returns (excluding virtual and independent sector activity which is reported on separate returns). The patient does not necessarily have to see the actual consultant at such a visit, but they must be assessed by either the consultant or a member of the consultant’s team.

• All activity performed by consultants and health professionals employed by the Health and Social Care Trusts in hospitals in Northern Ireland should be recorded. This includes activity performed as part of ‘in-house’ waiting list initiatives and private patient consultations.

• Activity commissioned by the Health and Social Care Trusts, but performed by Independent Sector providers, irrespective of the location of the service, should not be recorded on these returns.

• Activity will be reported by specialty. Prior to encompass the specialty related to the specialty of the consultant that performed the activity and was derived from the consultant’s contract of employment. On encompass the specialty is based on the Department specialty mapped to Treatment Function Code. Therefore, specialties do not match those previously reported.

• Activity should be reported irrespective of the location at which the service is delivered but should be attributed to the Trust that holds the contract for the consultant, or member of their team, that provided the service.

• Services not controlled by a consultant e.g. those led by a nurse or Allied Health Professionals should not be included on this return. Integrated Clinical Assessment and Treatment Services (ICATS) are reported on a separate return.

• Attendances at a group session provided by a consultant led service should be recorded as an outpatient attendance. The number of outpatient attendances will relate to the number of patients present who have identifiable patient records, even if the patients are seen together in a group. (Note this is different to a couple/family scenario – see point below).

• At some appointments a family or a couple may be treated together. The number of attendances to be recorded should be the number for whom a separate appointment was made, e.g. if a couple are seen together under the same appointment, this should be counted as one outpatient attendance. If separate appointments were made for them, this should be counted as two outpatient attendances.

• Activity of consultants on domiciliary visits for which a fee is payable should not be counted as outpatient attendances. Other home visits and visits to an inpatient of a different specialty, e.g. for assessment, should be counted as outpatient attendances. Whoever has the contact collects and returns the data.

• On no account should consultants visiting their own inpatients on a ward be included as outpatient attendances.

• At some appointments, one or more doctors may see a patient together. In such a case only one attendance should be recorded.

• If another health professional sees a patient in a consultant outpatient clinic, with a doctor, this should be recorded as a patient on the return for the appropriate discipline, as well as the attendance being recorded for the outpatient clinic, e.g. if a patient sees a consultant and an occupational therapist together, this should be recorded as one outpatient attendance and one face-to-face contact for the occupational therapist.

PERIPHERAL OUTPATIENT SERVICES

For the majority of specialties, a patient’s attendance will reflect the HSC Trust to which they have been referred and the location where they attended the appointment. However, not all outpatient services are provided at each of the five HSC Trusts in Northern Ireland. In such circumstances patients from one HSC Trust may attend an appointment for a service provided at another HSC Trust, or, in other cases, a consultant, or a member of their team, from one HSC Trust may provide a visiting ‘outreach’ service at another HSC Trust. In addition, within an HSC Trust, a consultant may hold services at various locations within their own Trust.

These ‘peripheral’ outpatient services can therefore be:
• regional specialties which are organised centrally but hold outpatient appointments throughout the five Trusts, or
• consultants from any specialty from one HSC Trust that provide a ‘visiting’ outreach service at another HSC Trust.
• consultants from any specialty who may hold services at various locations within their own Trust.

Data on outpatients attending peripheral services should be recorded and returned by the HSC Trust which holds the contract for providing the service. With regional specialties this is likely to be the organising Trust, i.e., in the case of cancer services in the Cancer Centre these are reported by the Belfast Trust. For visiting consultants at another HSC Trust, the contract could be either with the Trust holding the clinic, or with the consultant’s Trust. The same rule applies in both scenarios; whoever has the contract collects and returns the data.

REASONS FOR CANCELLATION: REGIONAL AND SUB-REGIONAL CODES

The total number of appointments cancelled by (i) the provider Health and Social Care Trust and (ii) the patient are reported in Section 1.1 of the QOAR/R-QOAR.

The reason for cancellation should also be recorded for each cancelled appointment. Total number of cancelled appointments, by reason for cancellation is reported in Section 1.2 of these returns.

The reason for cancellation has now become mandatory within the Health Service in Northern, and an agreed list of regional codes and definitions can be found in Appendix 2.

This list of regional codes must be utilised in a standardised manner across all Health and Social Care Trusts. If no reason for cancellation has been recorded, Trusts must report this as ‘No reason for cancellation recorded’. Trusts must not use the reason ‘Other’.

Additional Reason for Cancellation Codes to be added to the QOAR

To ensure standardisation of codes, if Trusts require any new codes under the variable ‘reason for cancellation’, the request should be taken through the Hospital Information Group (HIG) or Information Standards Working Group (ISWG).

4 Reporting of Data

SECTION 1.1 - OUTPATIENT ACTIVITY

The number of attendances for a new (first) outpatient appointment should be reported in Column B.1 of the returns. These include private patient attendances, which are also recorded separately.

The number of patients who did not attend a new outpatient appointment and failed to give advance warning to the hospital (DNA’d) should be recorded in Column C.1 of the returns. Patients who could not attend a new outpatient appointment and informed the hospital on the day of the appointment (CNA on the day) should also be reported in Column C.1 of the returns.

The number of patients who could not attend a new outpatient appointment and informed the hospital before the day of the appointment (CNA’d), should be reported in Column D.1 of the returns. This does not include new appointments cancelled as a result of the hospital being notified of the patient’s death.

The number of attendances for a review outpatient appointment should be reported in Column E.1 of the returns. These include private patient attendances, which are also recorded separately.

The number of patients who did not attend a review outpatient appointment and failed to give advance warning to the hospital (DNA’d) should be recorded in Column F.1 of the returns. Patients who could not attend a review outpatient appointment and informed the hospital on the day of the appointment (CNA on the day) should also be reported in Column F.1 of the returns.

The number of patients who could not attend a review outpatient appointment and informed the hospital before the day of the appointment (CNA’d), should be reported in Column G.1 of the returns. This does not include review appointments cancelled as a result of the hospital being notified of the patient’s death.

The number of outpatient appointments as a result of a patient attending a ward for examination or treatment by a consultant should be reported in Column H.1. New and review appointments should be combined.

The number of new outpatient appointments cancelled by the hospital should be reported in Column I.1 of the returns.

The number of review outpatient appointments cancelled by the hospital should be reported in Column J.1 of the returns.

The total number of appointments cancelled as the result of the patient’s death, both new and review, should be reported in Column K.1 of the returns.

Attendances by private patients are included within the main body of the returns but are also separately reported in Column L.1 of the return. The total number of private patient attendances, both new and review, should be reported in Column L.1.

SECTION 1.2 - REASONS FOR CANCELLATION OF APPOINTMENTS

The total number of appointments (i) cancelled by the hospital and (ii) cancelled by the patient (CNA) is also reported in Section 1.2 of the returns, split by the reason for cancellation.

The sum total of cancellations, recorded in Column B.2 in Section 1.2 of the returns should equate with the sum total of reasons for appointments cancelled by the hospital and cancelled by the patient, excluding patient deaths, as reported in Columns C.2 to Q.2 in Section 1.2.

The total recorded in Column B.2 of Section 1.2 should also equate with the number of appointments cancelled by either the hospital or the patient as reported in Section 1.1 of the return (Column D.1 + Column G.1 + Column I.1 + Column J.1). This is calculated automatically in column M.1. If the total number of cancellations in Column B.2 does not equate to the number reported in Section 1.1 of the return, a ‘FALSE’ warning will appear. If this happens, you should revisit the number of cancellations and ensure that the correct number is reported in both Sections 1.1 and 1.2.

Column D.1 (new CNA) and column G.1 (review CNA) should agree in total with or be more than the total of column M.2 to column O.2 (patient cancellation reasons). This total may exceed the total of column M.2 to column O.2 as there may be some patient cancellations which have either been incorrectly recorded or not recorded.

Column I.1 (new cancelled by the hospital) and column J.1 (review cancelled by the hospital) should agree in total with or be more than the total of column C.2 to column L.2 (hospital cancellation reasons). This total may exceed the total of column C.2 to column L.2 as there may be some hospital cancellations which have either been incorrectly recorded or not recorded.

A patient cancellation on the day of the appointment should be reported as a DNA and are therefore not included in Section 1.2 of the returns.

SCHEDULE

HAIB issue a timetable each quarter instructing HSC Trusts to run the encompass report on a particular date. This is usually three weeks after the end of each quarter, allowing HSC Trust administrative staff sufficient time to ensure their outpatient data are recorded correctly on encompass. The timetable also includes the date by which HSC Trusts must submit their QOAR/R-QOAR returns to HAIB each quarter. Sufficient time is given to allow HSC Trusts to run their report, collect data not recorded on encompass, and then populate the returns.

5 Data Validation

Each quarter, following receipt of the QOAR/R-QOAR returns from each HSC Trust, HAIB validate the data by comparing figures at Trust and at specialty level for the current quarter and against each of the four quarters of the previous year. Any irregularities are queried with HSC Trusts.

The validations queries are compiled for each of the five HSC Trusts. Trusts are required to provide an explanation for all queries within a week, as well as to confirm figures or provide amendments where necessary. Whilst it is mainly Part 1.1 that will be queried, on occasions queries will be raised regarding Part 1.2.

At the end of each financial year the last quarter’s data is sent out for validation, along with any outstanding queries for the previous quarters of that year and presented to HSC Trusts for final sign-off. Trusts are given two weeks to respond to this.

6 Data Use

Data submitted by HSC Trusts to the DoH on the QOAR/R-QOAR are Accredited Official Statistics. Accredited Official Statistics are produced to high professional standards set out in the UK Statistics Authority Code of Practice for Official Statistics. They are required to comply with the Code’s core Principles namely Trustworthiness, Quality and Value, including Release Practices.

Provisional data on the number of new attendances are published quarterly in the Northern Ireland Waiting Time Statistics: Outpatients Waiting List Bulletin.

Following final sign off from HSC Trusts, data on new and review attendances, did not attends and cancellations, is then published in the annual Hospital Statistics: Outpatient Activity Statistics report. The most recent publication, together with previous editions, can be found at the following link:

(https://www.health-ni.gov.uk/articles/outpatient-activity)

Outpatient activity data split by financial year, HSC Trust and specialty are also published in Microsoft Excel format at the above link.

Outpatient activity data are also used in:

• Ministerial answers to both Written and Oral Assembly questions;

• Departmental responses to correspondences received from the NI Assembly Health Committee, Public Accounts Committee, Northern Ireland Audit Office and other stakeholder bodies such as the Patient Client Council;

• Ministerial briefing material;

• Health compendium publications, and

• Responses to data requests from HSC, politicians, journalists, voluntary / charitable organisations and members of the general public.

7 Contact Details

This document will be reviewed and updated periodically. Frequently asked questions can be found in Appendix 1.

If you have any issues relating to the contents of the document or the collection of outpatient activity information in general, please contact:
Hospital Activity Information Branch
DoH
Annex 2, Castle Buildings
Stormont
Tel: 028 90522521
E-mail: Statistics@health-ni.gov.uk

APPENDIX 1: Frequently Asked Questions

What are the main sources of referral for a first outpatient appointment?

While the majority of referrals for a first outpatient appointment will be made by a General Practitioner, referrals may also be received from a range of other sources. A full list of the sources from which a referral for a first outpatient appointment may be received is outlined below.

• General Practitioner / General Dental Practitioner, including referrals submitted via the Clinical Communications Gateway (CCG)

• ICATS following triage, i.e. where a patient is initially referred by their GP for an ICATS service, but at the paper triage stage it is decided that the patient is not suitable to be treated by ICATS and needs to be seen by a consultant. The patient will be referred as a GP referral

• Emergency Department (not initiated by same consultant to whom the patient is being referred)

• Other consultant (other than Emergency Dept)

• Self-referral

• Prosthetist

• Another Health Practitioner

• Family Planning Service

• Voluntary Agency

• Criminal Justice Agency

• Screening Service

• ICATS following a diagnostic test or treatment

Should nurse led activity be reported on these returns?

No. These returns relates solely to activity performed in a consultant led outpatient service. Activity performed in a non-consultant led service, such as those led by nurses, allied health professionals etc. should not be reported on these returns.

Should ICATS activity be reported on these returns?

No. ICATS is the term used for a range of outpatient services for patients, which are provided by integrated multi-disciplinary teams of health service professionals, including GPs with a special interest, specialist nurses and allied health professionals. Activity at ICATS services is not regarded as consultant led activity and should not be recorded on the QOAR/R-QOAR.

From 1st April 2010, a number of ICATS were officially introduced within the HSC, and a data return, the Quarterly ICATS Activity Return (QIAR), was introduced by the Department in 2010/11. HSC Trusts should submit data on ICATS activity to HAIB on this return on a quarterly basis.

Should virtual activity be reported on these returns?

No. These returns relate solely to activity that takes place in a face-to-face environment. Any virtual outpatient activity must be recorded on the V-QOAR, and HSC Trusts should submit virtual outpatient activity data to HAIB on a quarterly basis.

It should be noted that neither the QOAR/R-QOAR nor the V-QOAR is intended to facilitate the recording of every contact/phone call made by the consultant, or member of their team.

Can a face to face attendance occur after a virtual attendance, and, if so, how should this be recorded?

Following a new virtual attendance, it may be decided that a patient needs a face-to-face appointment. In this case a patient will be booked in for a review face-to-face attendance. The initial new virtual attendance will be recorded on the V-QOAR, but the review attendance will be counted as a review attendance on the QOAR/R-QOAR. Any subsequent face-to-face review appointments will also be recorded on the QOAR/R-QOAR. If, however, following a face-to-face review appointment a patient is given a virtual review appointment this should be recorded on the V-QOAR as a review virtual attendance.

Referrals for a face-to-face appointment from another consultant following a virtual attendance are treated as a new attendance and should be recorded on the QOAR/R-QOAR.

Should independent sector activity be reported on these returns?

No. Outpatient activity at Independent Sector providers is downloaded from a separate encompass report.

HSC Trusts are provided with guidance, detailing how they should record details of patients transferred to the Independent Sector for assessment, on encompass. Following assessment, the Independent Sector provider informs the transferring HSC Trust who records the patient’s outpatient wait as being complete. These records are then validated against financial invoices received by the HSC Trust from the Independent Sector provider for each transferred patient. HAIB then download this activity from encompass. This data is not validated by HAIB.

Where should private patient attendances be recorded?

Private patient attendances relate to patients who pay a fee and attend an assessment with a Health and Social Care consultant at a Health and Social Care facility. They are included within the main outpatient activity figures (where they should be separated into new and review attendances) and also listed in the Private Patient attendances column. Data in this column relate to total attendances and are not split by appointment type. These columns should therefore not be added together.

Does a patient have to be assessed by a consultant in charge of the team in order for their attendance to be reported on the return?

Not necessarily. A patient does not have to be seen by the actual consultant in charge of the team, however in order for the attendance to be recorded as an outpatient attendance, the patient should be seen by either the consultant or a member of a consultant led service. For example, if a patient is seen by a nurse in a service that is under the overall control of a consultant, this activity should be reported on this return. If on the other hand, the patient is seen by a nurse who is not working as part of a consultant led team, the service is considered to be nurse led and should not be reported on this return.

Any contact between the patient and the consultant or a member of their team, that is not face-to-face, but is its equivalent, should be counted as virtual activity and recorded on the V-QOAR.

If a patient attends an appointment with a consultant, following an initial attendance at an Accident and Emergency Department, how should this be reported?

As a result of increasing efforts to improve the quality of care provided by the health service, Emergency Department attendees are increasingly being given appointments for re-attendances. This has focused attention on the difference between a follow-up attendance at an ED clinic and an attendance at an outpatient clinic of a consultant in the ED specialty.

The key elements of an outpatient attendance at a clinic of the ED specialty are that the patient is given an appointment and is seen by a consultant of the ED specialty or member of their team in a clinic with a recognised clinic purpose (e.g. Fracture Clinic, Trauma Clinic etc). This activity is recorded in the outpatient activity return as a review outpatient attendance against specialty 180. A follow-up attendance at an Emergency Department is a re-attendance where the patient sees a nurse, or the patient is seen by an ED consultant but the attendance is not within a clinic session with a recognised clinic purpose. These attendances should be reported on KH09 (Part 2) as a follow-up attendance at an Emergency Department. Any re-attendance where the patient sees a consultant of a different specialty or their team should be recorded as the appropriate outpatient attendance in that consultant’s specialty.

Hence, the fact that a patient is given a specific appointment time for a follow-up ED attendance does not necessarily mean that this attendance should be automatically counted as an outpatient attendance (rather than an ED follow-up). The purpose of the clinic and the department specialty of the clinic are critical factors. The advice contained in this answer, is particular to Emergency Departments and should not be applied generally.

Does the patient have to attend a face to face consultation at a hospital in order for the attendance to be reported on the returns?

Not necessarily. The face-to-face consultation may take place at a location outside of the hospital.

For activity performed outside of a hospital, the attendance should be attributed to the Trust that holds the contract for the consultant, or member of their team, that provided the service.

Should Waiting List Initiative (WLI) activity be included within these returns?

Yes. Health Service patients will attend an outpatient appointment at an HSC hospital, at either a routinely provided or core consultant led outpatient service, or at a consultant led service additionally provided by the HSC Trust. These latter services (sometimes referred to as ‘Waiting List Initiatives’ or ‘Waiting List Reduction’) should be recorded as one would the routinely provided or core outpatient activity.

This WLI and WLR activity should not be confused with outpatient activity carried by an Independent Sector provider.

APPENDIX 2: Reasons For Cancellation

Since the reason for cancellation has now become mandatory for all Trusts to record, an agreed list of regional codes and definitions can be found below. This list includes only the codes used on the new encompass system.

This list of regional and sub-regional codes must be utilised in a standardised manner across all Trusts.

Regional Code	QOAR Regional Group Description	Sub Regional Codes
HCON	CONSULTANT UNAVAILABLE • Unique to consultant staff • Use to record any consultant absence related to clinical/personal/admin reasons	Clinician - Clinician Not Available Provider Personal Hospital - Clinician Self Isolating Hospital - Consultant on Annual Leave Hospital - Consultant on Sick Leave Hospital - Consultant on Call Hospital - Consultant on Personal Leave Hospital - Consultant on Study Leave Hospital - Consultant at Meeting/Audit/Interview Hospital - Consultant at Court Hospital - Consultant Covering Theatre Hospital - Change of Consultant
HMED	MEDICAL STAFF / NURSE UNAVAILABLE • Relates to all Health Professionals (Midwife, Medical, Nursing and AHP) • Use to record absence related to clinical/personal/admin reasons for staff other than consultants	Hospital - Supporting Staff Unavailable Hospital - Non-Consultant on Annual Leave Hospital - Non-Consultant on Sick Leave Hospital - Non-Consultant on Personal Leave Hospital - Non-Consultant on Study Leave Hospital - Non-Consultant at Meeting/Audit/Interview
HPTE	PATIENT TREATED ELSEWHERE • Use to record an appointment which is cancelled by the hospital as the patient is already being treated in hospital, being treated by another specialty, or referred to another specialty, or appointments needs to be moved to a new location i.e. change of location or discharged back to GP. • Used to record patients funded by the HSC but treated in the independent sector.	Hospital - Currently Admitted Hospital - Patient Seen Separately for Same Condition Hospital - Patient Discharged from Trust Hospital - Transferred to Another Trust Hospital - Added to IP/DC Waiting List
HCCA	CONSULTANT CANCELLED APPOINTMENT • Use to record a patient who has had their appointment cancelled by the consultant as treatment is no longer required, e.g. the result of diagnostics determines that the consultant does not need to review the patient.	Hospital - No Longer Required
HABF	APPOINTMENT RESCHEDULED – BROUGHT FORWARD • Use to record any appointments cancelled by the Hospital where the appointment has been brought forward. • This relates to appointments where the: · date and time have been changed · time has changed, but the date remains the same	Hospital - Appointment Rescheduled (Brought Forward)
HAPB	APPOINTMENT RESCHEDULED – PUT BACK • Use to record any appointments cancelled by the Hospital where the appointment has been put back. • This relates to appointments where the: · date and time have been changed · time has changed, but the date remains the same	Hospital - Equipment or Instrument Not Available Hospital - Awaiting Further Investigations Hospital - Clinic Reorganisation Prep/Med Incomplete Clinician - Medical Reason Equipment Maintenance/Repair Hospital - eRS Priority Change Hospital - eRS Rejected Hospital - No Capacity Other Cancel: Silent Walk in Error Hospital Cancelled: Oncology Treatment Plan Changes Other: CMS Therapy Cap Service Not Authorized Provider: MRI Screening Form Marked Do Not Proceed Hospital - Major Incident Hospital - COVID-19 Preparedness Hospital - Other Clinician - Patient Unfit Hospital - Funding Issue Hospital - Industrial Action Clinician - More urgent case / List Overrun Hospital - Appointment Rescheduled (Put Back) Hospital - Cancelled due to technical issues Hospital - No Interpreter available Hospital - Adverse Weather Hospital - Cancelled due to Hospital Pressures
HADE	ADMINISTRATIVE PROCESS • Use to record any appointment which is cancelled by the Hospital as a result of an error in the admin process – this is not exclusively confined to Booking Centre processes.	Hospital - Admin Error Clinician - Merged with Another Encounter Hospital - Clinic Cancelled/Reduced Hospital - Insufficient Notice Hospital - Clinic Overbooked Hospital - Change in Clinic Code Hospital - Change of Clinic Location
HTNA	HOSPITAL TRANSPORT NOT AVAILABLE • Use to record any appointment which is cancelled by the Hospital due to a transport reason.	Hospital - Ambulance Unavailable/Not Booked
PNLN	PATIENT CANCELLED APPOINTMENT AS IT IS NO LONGER REQUIRED • Use to record if the patient has called the hospital to cancel their appointment, and to state that no further appointment is required. • Local codes to be removed from this regional code: · Patient DNA’d · Patient DNA’d previous appointment · Problem gone (duplicate)	Patient - Not Now Required Patient: Cancelled via MyChart Patient - no longer Pregnant Patient - Referred to Another HSC Cons
PCSR	PATIENT CANCELLED BUT THE APPOINTMENT IS STILL REQUIRED • Use to record an appointment cancelled by the patient due to personal reasons, where an appointment is still required.	Patient - Unwell Patient - Date Unsuitable Patient - Insufficient Notice Patient - Lack of Transportation Patient - Fast Pass / Short Notice List Patient Cancelled: Scheduled from Short Notice List Patient: Cancelled via automated reminder system Patient - COVID-19 Concerns Patient - Failed to Confirm Patient - Failed to Follow Pre-Op Guidance Patient - Weather Patient - now pregnant Patient - DNA for Covid Swab

Cancellations due to the death of a patient (HRIP and PRIP) are reported separately on Section 1.1 of the return and should not be included within the figures for either Patient Cancellations (CNA) or hospital cancellations.

APPENDIX 3: Categorising And Recording of Attendence Sequence for Virtual and Face to Face Appointments

Whilst virtual activity will be recorded separately from face-to-face activity, it should be noted that a patient may undergo a sequence of attendances that will involve a combination of the two. Whether these will be counted as new or review attendances will depend on the precise sequence of attendances. The main scenarios (prior to discharge), and how and where these should be recorded, are discussed below.

Following referral, a patient may be triaged to a core or a designated virtual clinic for a virtual new appointment. This will be recorded on the V-QOAR as a virtual new attendance. The patient may then be given a virtual review appointment, which will be recorded on the V-QOAR as a virtual review attendance. Any subsequent virtual attendances will also be recorded as virtual review attendances on the V-QOAR.

Virtual new → Virtual review → Virtual review
V-QOAR → V-QOAR → V-QOAR

Following referral, a patient may be triaged to a core or designated virtual clinic for a virtual new appointment. This will be recorded on the V-QOAR as a virtual new attendance. However, following this virtual new attendance it is decided that the patient requires a face-to-face appointment. This will be recorded on the QOAR/R-QOAR as a review attendance. Any subsequent face-to-face attendances will also be recorded on the QOAR/R-QOAR as review attendances.

Virtual new → Face to face review → Face to face review
V-QOAR → QOAR/R-QOAR → QOAR/R-QOAR

As (ii) but following the review face-to-face attendance that is recorded on the QOAR/R-QOAR, the patient is given a virtual appointment. This third attendance will be recorded on the V-QOAR as a virtual review attendance.

Virtual new → Face to face review → Virtual review
V-QOAR → QOAR/R-QOAR → V-QOAR

Following referral, a patient is triaged to a clinic for a face-to-face appointment. This will be recorded on the QOAR/R-QOAR as a face-to-face attendance. Following this face-to-face attendance the patient is given a virtual appointment. This will be recorded on the V-QOAR as a virtual review attendance. Any subsequent virtual review attendances will also be recorded as virtual review attendances on the V-QOAR.

Face to face new → Virtual review → Virtual review
QOAR/R-QOAR → V-QOAR → V-QOAR

As (iv), but following the virtual review attendance, the patient is given a face-to-face appointment. This third attendance will be recorded on the QOAR/R-QOAR as a review attendance.

Face to face new → Virtual review → Face to face review
QOAR/R-QOAR → V-QOAR → QOAR/R-QOAR

As well as the scenarios above, if patients have multiple review appointments, these could switch between virtual and face-to-face appointment types. Therefore, care must be taken to record this appropriately.