Examples of how the matrix can be used operationally
| Note: A patient with uncomplicated renal stones would usually be categorised as P3 for surgery (ie the patient can be deferred for up to 3 months). Example 1: The patient above, who has already been deferred for 20 weeks, now has mildly impaired renal function (obstructive uropathy). The wait has induced mild actual harm, and with further waiting at P3, there is a high risk of moderate actual harm. Using the matrix, we navigate to the P3/moderate harm box and can see that the recommended action is to re-categorise this patient as P2 (the ‘outcome priority’ is P2). This drives the expedition of any investigations and interventions from within 3 months to within 1 month. Example 2: The patient above presents with severely impaired renal function (severe actual harm). Using the matrix, we navigate to the P3/severe harm box and can see that the recommended action is to re-categorise the patient as P2 or P1b (the decision between P2 and P1b would be a clinical decision). This drives the expedition of any investigations and interventions from within 3 months to within 1 month (P2) or within 72 hours (P1b). Example 3: There is an incidental finding of renal stones in a patient with complete renal failure who is on haemodialysis. The patient has no pain or infection. There has been no actual harm and the clinical assessment is that deferral would be unlikely to cause harm (eg due to pain or infection). This patient might be categorised as P4 as the management of renal stones is not required to save renal function. The patient could potentially be discharged to primary care with appropriate safety-netting for infection risk or pain. |