Patients should only be added to waiting lists (that is, regarded as 'ready for surgery' for the purpose of monitoring waiting times, and for the purpose of allocation of a surgery date) when they are personally and clinically ready for surgery.
Patients deferred for personal reasons should not be added to the waiting lists until they are ready for surgery. They should be suspended from the waiting list if they defer after being ready for surgery.
Code 1 Ready for surgery
Patients who are prepared to be admitted to hospital or to begin the process leading directly to admission for surgery.
The process leading to surgery could include investigations/procedures done on an outpatient basis, such as autologous blood collection, pre-operative diagnostic imaging or blood tests.
Code 2 Not ready for surgery - staged patients
Patients who have undergone a procedure or other treatment and are waiting for follow-up elective surgery, where the patient is not in a position to be admitted to hospital or to begin the process leading directly to admission for surgery, because the patient's clinical condition means that the surgery is not indicated until some future, planned period of time.
Examples include a patient who has had internal fixation of a fracture who will require removal of the fixation device after 3 months, a patient who requires a 'check' cystoscopy to check for cancer 12 months after surgery to remove a tumour in the bladder, and a patient requiring rectal cancer surgery 6-8 weeks after neoadjuvant chemoradiotherapy for colorectal cancer.
Code 3 Not ready for surgery - pending improvement of clinical condition
Patients for whom surgery is indicated, but not until their clinical condition is improved, for example, as a result of a clinical intervention.
Examples include patients who require a cardiac work-up before a total hip replacement and patients with respiratory insufficiency who require physiotherapy to maximise respiratory function before a hernia repair.
For such patients, a decision has already been made that surgery should take place. Patients should not be regarded as 'not ready for surgery-pending improvement of their clinical condition' when they are undergoing routine monitoring or investigations before a decision is made as to whether surgery is required.
Code 4 Not ready for surgery - deferred for personal reasons
Patients who for personal reasons are not yet prepared to be admitted to hospital. Examples include patients with work or other commitments that preclude their being admitted to hospital for a time.