Guidance

AAA screening: Guidance for the waiting times tracker report

Updated 22 April 2025

Applies to England

1. Overview

Waiting times are important in the NHS abdominal aortic aneurysm screening programme pathway standards. Waiting times standards have been monitored since June 2013. This has resulted in significant improvements in waiting times for patients to be seen at a vascular specialist appointment.

A quarterly report is produced within SMaRT (screening management and referral tracking) to monitor achievement of the standards and identify where improvements can be made. The report is populated by information entered by the screening providers relating to assessments, surgery and delays. It is important all providers enter information using consistent definitions.

This guidance outlines how to categorise delays in being seen by a vascular specialist and in receiving specialist treatment. Recording delay reasons for assessments and surgery is a mandatory requirement within the software.

2. Specialist assessment outcomes

2.1 Specialist assessment outcome categories

The date and outcome of specialist assessments can be recorded in the ‘specialist assessment’ tab of SMaRT. There are 4 assessment outcome categories available.

Further investigation

The further investigation outcome should be used where the patient has a non-standard AAA.

This is a patient thought unlikely to be fit for intervention and booked for non-standard investigation or referred for medical treatment (for example coronary angioplasty, bypass or chest referral). This category may also include referral to a tertiary centre outside of the ‘usual’ screening programme referral pathways.

If the patient does not go on to have surgery, a further assessment with the final outcome, for example, ‘surgery declined’ or another suitable delay reason should be recorded.

Surgery declined

This should be used if the man declines any further assessment or intervention.

Surgery planned

This should be used for a man who has a standard AAA and is undergoing routine pre-intervention tests. It includes men who have a planned surgery date and those who have chosen to defer their treatment for an agreed period of time.

Unsuitable for surgery

This should be used where a man is unsuitable for surgery and will not benefit from surgery. This might include men:

• who have a terminal illness
• where the risks of complications from surgery outweigh the risk of AAA rupture
• whose treatment and recovery in another department is likely to be more than 12 months

3. Assessment delays

Men referred to a vascular service for treatment should be seen by a vascular specialist within 2 weeks (14 calendar days) of their last conclusive scan.

If a man is not seen within 2 weeks, local screening providers receive an alert through SMaRT. The local screening provider can then enter the reason for the delay in attending the first vascular specialist appointment in the ‘delays’ tab. The assessment may be delayed several times and each delay should be entered. Any delays for subsequent assessments or testing should be recorded under ‘surgical delays’ (not ‘assessment delays’).

Subsequent assessments can, however, be entered to record subsequent decisions such as:

• ‘surgery planned’
• ‘unsuitable for surgery’
• ‘declined surgery’

This information should be entered in the ‘specialist assessment’ tab.

3.1 Referral alerts

SMaRT will prompt providers to enter a reason why a man has not attended a first specialist assessment after his target assessment date. An alert will appear if the man has not attended an assessment within 14 calendar days of his last conclusive scan.

A delay reason must be recorded. Once entered, the man is removed from the alert. SMaRT will continue to put the man back on the alerts every 2 weeks, prompting the provider for further reasons for delay until the appointment is attended or has one of the ‘not stated’ delay reasons as outlined below.

3.2 Assessment delay categories

There are 7 assessment delay categories within SMaRT which are mapped to either ‘valid’ or ‘invalid’ categories of delays. Valid delays are related to the patient. Invalid delays are related to the hospital.

Delay due to patient factors (valid delay)

These delays will be related to patient choice. For example, the man may:

• be on holiday and ask to defer their appointment to a later date
• forget the appointment, not attend and then have to rebook
• have problems with transport to the hospital
• have a mild illnesses (where a patient is not receiving medical treatment)

Delay due to patient co-morbidities (valid delay)

These are delays due to co-morbidities which require medical treatment before the man can be seen for assessment. For example, the man may be:

• under the care of a cardiologist at the time of referral
• hospitalised and receiving care

For less serious illnesses such as cold or flu, where the man is not hospitalised, the delay should be categorised as ‘delay due to patient factors’.

Not seen: false positive (valid delay)

This category is for men who did not have a first assessment because they should not have been referred. This can occur if the scan taken by the screening technician undergoes a QA review and the AAA is found to be less than 5.5cm.

This category can also be used if a man is referred for an iliac aneurysm in error. Selecting this category will discharge a patient from the referral pathway.

Not seen: patient declined (valid delay)

This category is for man who did not have a first assessment because they declined the specialist assessment and further treatment. Selecting this category will discharge a man from the referral pathway.

Not seen: co-morbidity preventing attendance (valid delay)

This category is for patients who will never be able to attend their first specialist appointment due to a co-morbidity, such as a terminal illness. Selecting this category will discharge a patient from the referral pathway.

Not seen: other (valid delay)

This covers delays for men who are not seen for their first specialist assessment for any other reason. The reason should be documented in the delay notes. It is expected that very few men would be included in this category.

One example would be a man who ruptures between referral and their specialist assessment appointment and has to undergo emergency surgery. Selecting this category will discharge a patient from the referral pathway.

Delay due to hospital factors (invalid delay)

This reason is related to the hospital and its operational activities. These examples may be applicable in this situation:

• delayed referral from the screening programme to vascular services
• appointment with vascular services outside of 2 weeks

4. Surgery delays

Men referred to a vascular service for treatment should be operated on within 8 weeks (56 calendar days) from the date of their last conclusive scan.

If a man is not operated on within 8 weeks, local screening providers will receive an alert through SMaRT. The local screening provider must then enter the reason for the delay in surgery. The surgery may be delayed several times and the reason for each delay should be entered.

4.1 Referral alerts

Screening providers will be prompted to enter a reason in SMaRT for why the man has not been operated on within 8 weeks. A referral alert will appear if the man has no surgery date entered 56 calendar days after their last conclusive scan. Once the delay reason has been entered the man will be removed from the alert.

SMaRT will continue to put the man back on the alerts every 4 weeks, prompting the provider for further reasons for delay until one of the following is entered:

• a surgery date
• a specialist assessment outcome of ‘unsuitable for surgery’, ‘surgery declined’, ‘not known’ or ‘other’
• one of the ‘no surgery’ delay reasons

4.2 Surgical delay categories

There are 9 surgical delay categories within SMaRT and they are mapped to ‘valid’ or ‘invalid’ categories of delays. Valid delays are related to the patient. Invalid delays are related to the hospital.

Delay due to patient factors (valid delay)

These delays relate to patient choice. For example, the man may:

• be on holiday and ask to defer their surgery to a later date
• have issues with transport to the hospital
• have a mild illness, where they are not receiving professional medical treatment (such as a cold)

Delay due to patient co-morbidities (valid delay)

These are delays due to co-morbidities which require medical investigation or treatment before surgical repair can be undertaken.

For example, the man may:

• have a minor condition that needs to be prioritised and treated first under a different speciality
• be hospitalised and receiving care

Less serious illnesses where the man is not hospitalised should be captured under ‘delay due to patient factors’.

No surgery: false positive (valid delay)

This category covers men who do not require surgery as their aneurysm is either less than 5.5cm, or their finding is not an aneurysm. This is usually following the tests requested after the first specialist appointment. Selecting this category will discharge the patient from the referral pathway.

No surgery: patient declined (valid delay)

This category is for a man who has declined surgery following one or more specialist assessments. Selecting this category will discharge the man from the referral pathway.

No surgery: patient unsuitable for surgery (valid delay)

This category is for men who are found to be unsuitable for surgery after initial referral, following testing at or after the first specialist appointment. Selecting this category will discharge the patient from the referral pathway.

Delay due to awaiting stent (valid delay)

This records a delay where a customised stent is required and has to be ordered. It can also be used to capture delays where there is a complex anatomy and the man may require further work-up prior to surgery.

Not seen: other (valid delay)

This category is for men who were not operated on for any other reason. This reason should be added in the delay notes. We expect that very few patients would be included in this category.

One example would be a man whose AAA ruptures after his specialist assessment appointment and he needs emergency surgery. Selecting this category will discharge the man from the referral pathway.

Delay due to referral to tertiary centre (valid delay)

Men who are referred to a tertiary centre either by the vascular service or at the request of the patient should be assigned to this category. It is the responsibility of the referring screening provider to follow up on the outcomes of the man with the tertiary centre.

Delay due to hospital factors (invalid delay)

This reason is related to the hospital and its operational activities. Examples include:

• delays in testing, receiving results and other administrative delays
• surgery being offered after 8 weeks
• surgery delayed due to staff illness or holiday
• surgery delayed due to lack of hospital beds

This category should also be used if the surgery has to be abandoned and rescheduled for another time.

4.3 Incidents arising from delays to surgery

If a patient waits more than 12 weeks for an operation (they will be on an alert for a second time), and they have an invalid delay reason, they should be investigated by the service and reported to the regional commissioner’s programme board.

If a patient’s AAA ruptures after waiting more than 8 weeks for surgery, then this should be managed by the trust as a potential serious incident in line with Patient Safety Incident Response Framework.