Document Control - northdevonhealth.nhs.uk · 0.1 April 2020 Draft Initial version for consultation...

Outpatient Covid-19 SOP Draft v0.1 03042020

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Document Control

Title

Outpatient Covid-19 Guidance Standard Operating Procedure

Author April Adams

Author’s job title Head of Outpatients

Directorate Surgery

Department Team/Specialty Outpatients Outpatients

Version Date

Issued Status Comment / Changes / Approval

0.1 April 2020

Draft Initial version for consultation

0.2 April 2020

Draft Update following review with Deputy Medical Director & Associate Director of Operations Planned Care

0.3 April 2020

Draft Updated new referral guidance

0.4 April 2020

Draft Updated following review by Patient Access Lead

0.5 April 2020

Draft Updated following Ops Cell discussion. Recommendation to Clinical Reference Group for approval.

1.0 April 2020

Final Approved by Clinical Reference Group & issued.

1.1 April 2020

Final Formatting change

Main Contact April Adams, Head of Outpatients Outpatient Department North Devon District Hospital Raleigh Park Barnstaple, EX31 4JB

Tel: Direct Dial – 01271 370262 Tel: Internal – 3262 Email: [email protected]

Lead Director Director of Operations

Document Class Standard Operating Procedure

Target Audience All staff involved in outpatient services

Distribution List Lead Clinicians Service Managers Group Managers Patient Access Coordinators Lead Secretaries Booking Team Leads Community Hospital Admin Hub Leads

Distribution Method Trust’s internal website

Superseded Documents

Issue Date April 2020

Review Date June 2020

Review Cycle Three months



Consulted with the following stakeholders: (list all)

Service managers

eRS Manager

Access Leads

Deputy Medical Director

Associate Director Operations – Planned Care

Contact responsible for implementation and monitoring compliance: Head of Outpatients

Education/ training will be provided by: Outpatient Systems Training Team

Approval and Review Process

Covid Operations Cell Covid Clinical Reference Group

Local Archive Reference G:\COVID-19 - OPS HUB\Outpatients SOP Local Path G:\COVID-19 - OPS HUB\Outpatients SOP Filename Outpatient Covid-19 SOP Draft v0.5 06042020

Policy categories for Trust’s internal website (Bob) Outpatients, Covid-19,

Tags for Trust’s internal website (Bob)



CONTENTS

Document Control ............................................................................................................... 1

1. Background .................................................................................................................. 4

2. Purpose ........................................................................................................................ 4

3. Scope ............................................................................................................................ 4

4. Location ........................................................................................................................ 4

5. Equipment .................................................................................................................... 4

6. Procedure ..................................................................................................................... 4

7. References ................................................................................................................. 10

8. Associated Documentation ....................................................................................... 10



1. Background

2. Purpose

2.1. The Standard Operating Procedure (SOP) has been written to:

Provide guidance for the management of all outpatients during the Covid-19 outbreak.

3. Scope

3.1. This Standard Operating Procedure (SOP) relates to all staff involved in the booking and management of outpatient clinics.

4. Location

4.1. This Standard Operating Procedure can be implemented in all areas that are involved in outpatient processes.

5. Equipment

TrakCare

6. Procedure

6.1. Existing Booked Appointments up to 10th May 2020

6.1.1. Clinician Responsibility

6.1.1.1. Using the clinic lists from Trak review all booked appointments up to the 10th May 2020 and apply risk stratification below to determine appropriate requirements for the patients. If there is to be a change to the appointment the action needs to be noted on the clinic list and fed back to your service manager. This is to be completed by Thursday 9th April 2020.

6.1.1.2. If an appointment is to change to a video or telephone appointment it is important that these appointments still take place on the date and the time of the original appointment. If the appointment date and time needs to change this must be communicated to your service manager



6.1.2. Service Manager Responsibility

6.1.2.1. To ensure that all clinical reviews of booked appointments up to 10th May have taken place by Thursday 9th April 2020.

6.1.2.2. To coordinate the contacting of patients to advise of any changes to their appointments utilising the support of the PAC team, RTT validators, CMC staff and Outpatient reception staff. If the appointment is within the next 2 weeks the patient must be spoken to on the phone, for all other appointments a letter could be sent advising of the change. If an appointment is to be converted to a video appointment ensure the process in appendix 1 has been completed to ensure the patient has the appropriate information and the relevant equipment is available to the clinician.

6.1.2.3. To ensure that any changes to appointments have been accurately updated on Trak;

6.1.2.4. Ensure any appointments now taking place by telephone or video have the correct telephone or video appointment type on Trak. Appendix 2 details the process for changing the appointment type.

6.1.2.5. Ensure that all appointments are booked for the time and date that the clinician is anticipating to do the appointment.

6.1.2.6.

6.1.2.7. Bring forward any booked urgent appointments to the week beginning 30th March.

6.2. New Referrals


6.2.1.1. The CCG has approved the following;

Routine referrals will no longer be coming through to secondary care from DRSS

Urgent and 2WW referrals will come through DRSS as normal and should be reviewed and triaged in the normal way

DRSS will be able to reduce these referrals if they can work off speciality specific guidance, Formulary & Referrals website, Clinical Referral Guidelines and MyHealth Devon content, ideally Pan Devon. If patients do not fulfil these criteria they will be held by DRSS.

6.2.1.2. Each specialty should appoint a lead to draft their DRSS guidance and ideally link with specialties across the patch, the template in appendix 5 should then be completed.



6.2.1.2.1. For any urgent and 2WW referrals that are received into the organisation these should be triaged as normal considering the questions below;

Can the patient be managed through advice and guidance to the GP? If the answer is yes please follow the process in appendix 3.

Can the patient be deferred until after the Covid period? Add DELAY COVID into the free text comments . Ensure a letter is sent to GP and patient using the appropriate letter template and completed via Epro to advise of delay.

Can the patient be consulted via telephone? If yes add TELEPHONE into the free text comments or on the paper referral letter if triage by paper.

Can the patient be seen via video? If yes add VIDEO into the free text comments or on the paper referral letter if triage by paper

6.2.2. Booking Team Responsibility

6.2.2.1. All DRSS referrals will come through to us as ASIs these must be processed in the normal way and added to a TrakCare wait list

6.2.2.2. If the outcome of the clinician triage is advice and guidance please follow the process in appendix 3.

6.2.2.3. If TELEPHONE or VIDEO is identified in the free text comments please ensure the appointment type on the wait list are updated to reflect this and type the original appointment type into the wait list comments.

6.2.2.4. Only two week wait and urgent appointments should be booked and you should only be booking up to two weeks ahead.

6.2.2.5. If a video appointment is to be booked follow the process in Appendix 1.

6.3. Existing New Referrals on the wait List without Appointments


6.3.1.1. First priority is to review the new OP wait list for urgent referrals without appointments. This is available through the FOP report which your service manager has access to. Review referrals and identify what patients can be delayed until after Covid. If an urgent appointment is required identify whether patients could be consulted via telephone or video appointment. This information must then be fed back to your Service Manager

6.3.1.2. Any clinicians not immediately being utilised to manage Covid inpatient surge plans should also review the new OP wait list for routine referrals and determine where telephone or video appointments are appropriate. This information must then be fed back to your Service Manager.



6.3.1.3. For any clinicians directly involved in Covid inpatient work only urgent and 2WW appointments should be taking place.

6.3.1.4. For any clinicians not directly involved in Covid inpatient work routine appointments can continue but must not be face to face appointments.


6.3.2.1. Ensure wait list reviews have taken place.

6.3.2.2. If a clinician has identified that a telephone or video appointment is appropriate, coordinate the wait list entries being updated to reflect a telephone or video appointment type following the process in appendix 2. The original appointment type should be copied into the wait list comments.

6.3.2.3. Advise booking team of when this has been completed for each of your services.

6.3.2.4. Ensure letters sent to all patients on wait lists who are going to be delayed to advise of this. Template letter is available and process is to be support by all outpatient admin teams.

6.4. Follow Up Wait Lists


6.4.1.1. First priority is to review all time critical follow up wait list entries where the recall date falls before the 30th June 2020 and advise if appointment can be deferred until after this. This is available through the FOP report which your service manager has access to. If appointment can be delayed please advise an appropriate recall date. If appointment is still needed before 30th June advise if it can be a telephone or video appointment. Consider whether patients with a recall date after 30th June also need to be reprioritised to ensure chronology. This information must be given to your Service Manager.

6.4.1.2. Any clinicians not immediately being utilised to manage Covid inpatient surge plans should also review the follow up OP wait list for routine follow ups with a recall date before 30th June and determine where telephone or video appointments are appropriate. This information must then be fed back to your Service Manager.

6.4.1.3. For any clinicians directly involved in Covid inpatient work only urgent and 2WW appointments should be taking place.

6.4.1.4. For any clinicians not directly involved in Covid inpatient work routine appointments can continue but must not be face to face appointments.




6.4.2.1. Ensure that time critical wait list reviews have taken place.

6.4.2.2. Ensure that wait list entries are updated to reflect the clinical decisions;

6.4.2.3. If appointment to be deferred amend the recall date and ensure a letter is sent to patients to advise of the delay to their appointment, a Word document template letter available to utilise.

6.4.2.4. If appointment type to be changed to video or telephone, amend appointment type using process in appendix 2 and ensure original appointment type entered in wait list comments.

6.4.2.5. Advise booking team of when this has been completed for each of your services.

6.5. Clinic Management


6.5.1.1. Ensure that clinic cancellation process is followed for future clinics that are no longer running.

6.5.1.2. Ensure where a clinic is able to support video appointments that this appointment type is mapped to the clinic.

6.5.2. Booking Team Responsibility

6.5.2.1. When Service Managers have advised that the initial wait list review process has taken place are complete follow normal processes to book appointments.

6.5.2.2. For clinicians involved in inpatient Covid work only book 2WW and urgent appointments should be booked.

6.5.2.3. For clinicians not directly involved in inpatient Covid work, routine appointments should only be booked if authorised by a service manager or group manager and should not be face to face appointments.

6.5.2.4. Only book 2 weeks ahead.

6.5.2.5. If booking a face to face appointment please use script in appendix 6 when contacting the patient by phone to arrange the appointment.

6.5.2.6. If a telephone appointment is required it can be force booked into face to face appointment slots but must be booked with a telephone appointment type.

6.5.2.7. If a video appointment is required ensure the process in appendix 1 is followed.

6.6. Clinic Outcoming




6.6.1.1. All outcomes should be completed as normal for all face to face, telephone and video appointments and returned to the relevant reception team to update on TrakCare.

6.6.1.2. If a telephone clinic is being undertaken at home please utilise the remote outcome forms which can be found on BoB http://ndht.ndevon.swest.nhs.uk/outcome-forms/. These are to be returned to [email protected].

6.6.1.3. If a follow up appointment is required please identify on outcome form if this is to be face to face, telephone or video. You MUST also include a recall date.

6.6.1.4. Due to increased likeliness of patient unavailability the DNA process should be relaxed and clinicians are encouraged to use the DNA rebook outcome rather than DNA discharge.

6.6.2. Outpatient Reception Responsibility

6.6.2.1. Process outcome forms on TrakCare as normal.

6.6.2.2. Only book a follow up appointment if it is required in the next 2 weeks. If a telephone appointment is required it can be force booked into a face to face slot but the booked appointment must have telephone as the appointment type. If a video appointment is required ensure it is booked into a mapped video appointment slot and follow process in appendix 1.

6.6.2.3. When adding to wait list if a telephone or video appointment is specified please use these appointment types and where known add the normal face to face appointment type to the wait list comments.


6.6.3.1. To review unrecorded outcome report and where entire clinics have not been outcomed to follow up with clinicians.

6.7. Clinic Prep

6.7.1. Outpatient Admin Teams

6.7.1.1. 24 working hours before the clinic contact any patients booked in as face to face to check if symptomatic using script in Appendix 4.

6.7.1.2. Prep notes for clinics as normal including telephone clinics, if clinicians are undertaking these in offices the notes can be collected from outpatient admin teams ready for the clinic.

http://ndht.ndevon.swest.nhs.uk/outcome-forms/

mailto:[email protected]



6.8. Data Quality

6.8.1.1. Additional Covid-19 data quality issues will be monitored by the Outpatient Systems Training team who will liaise with Service Managers and admin teams to ensure issues addressed.

6.8.1.2. Additional issues covered will be;

Appointments where appointment type is face to face but comments entered for Video or Telephone

Wait list removal reason of return to referrer with advice to ensure an Epro letter has been completed.

Cancelled appointments not rebooked or added to a wait list

6.8.1.3. The Outpatient Systems Training team will prioritise the 3 issues above along with blank recall dates and unrecorded outcomes.

7. References

All existing Outpatient SOPs Patient Access

8. Associated Documentation

8.1. Northern Devon Healthcare NHS Trust Policies for :

8.1.1. All existing outpatient TrakCare SOPs

8.1.2. Access Policy



Appendix 1: Patient Triage / Outcome: Video Consultation

Record appointment accurately on Trakcare

Ensure the correct appointment type

is selected on TrakCare

If changing previously booked face to face appointment retain current timeslot and ‘Transfer’ to video consultation appointment type

Contact patient

Confirm with patient that they are able and happy to attend their appointment via

video

Confirm patient has access to a device with camera and microphone

If patient does not want a video appointment or does not have the necessary equipment

available offer patient a telephone appointment instead.

Send patient appointment information

Send video consultation appointment

letter which includes link to join appointment:

https://www.northdevonhealth.nhs.uk/pat

ient-information/video-consultations/

and include patient information leaflet

https://www.northdevonhealth.nhs.uk/patient-information/video-consultations/

https://www.northdevonhealth.nhs.uk/patient-information/video-consultations/

https://www.northdevonhealth.nhs.uk/wp-content/uploads/2020/04/AA-PatientLeaflet_NHSEngland-NDHT-QR.pdf



Appendix 2: Changing an Appointment Type

How To Transfer An appointment (re-booking)

This section will guide you to transfer/rebook a patient’s booked appointment. You should always try to transfer the patient’s appointment rather than cancel, as the information for the booked appointment will transfer over to the next appointment i.e. appointment type comments that have been written etc. there will of course times were you will need to cancel.

N.B. Applies to all re-bookings that are not an e-RS appointment types prefixed with a “z” (i.e. zNew Gen Neuro NDDH eRS) If e-RS appointment follow process for cancelling and rebooking from wait list.

Search for patient

Select ‘Appt List’

Tick ‘Select’ box for appointment that needs to be transferred (re-booked)

Click on the ‘appointment type’ hyperlink for the appointment that needs transferring

Input the reason for transfer

Input comments for transfer in the comments box i.e. Telephone appointment

Click on the ‘Transfer’ hyperlink

Change to appropriate appointment type i.e Fu Gastro - telephone

Click ‘find’ a list of dates and times will appear

Click on “Overbook/ Edit Ellipsis” at the bottom of the left hand screen with the relevant appointment type

The Appointment and Overbooking Details screen will now appear.

The specialty and Resource (Care Provider) should already be prepopulated.



Populate/amend fields as follows:

Specialty Should already be prepopulated Resource Select appropriate Clinician (should already be

populated) Date Date of the clinic you wish to book, once the date has

been entered, you can click ‘day details’ from this screen and view the clinic you are force booking into.

Time Time Clinician has indicated Appointment Location Select from drop down box the

appropriate location Overbook Reason Select most appropriate reason; all Clinician

should approve overbookings first. Session Type (this may be greyed out, if only one clinic that day is

running). From drop down list select appropriate session type, paying special attention to the session times e.g. am or pm

Duration Length of time patient requires slot, particularly needed when booking into multiple time slots.

Comments Add comments where applicable



Click ‘update’

Click ‘update’ at the top of the left pane

How to Force Book (New or Follow Up) Patient From an OP Wait List or OP Return Wait List

This section will guide you to force booking (overbook) a patients appointment whether this be a New or follow up appointment into a clinic where the patient is currently on a waiting list. Normally this function will be used following the request from the Clinician to see a patient on a specific date and time. Using this function you technically could book a patient anywhere regardless if there is a clinic or not so use cautiously.

Search for patient

From the main menu select OP Wait List ‘OP Wait List’ or ‘OP Return Wait List’

NB, when reviewing a patient’s waiting lists you can select either OP Wait List or Op Return Wait List the functionality is the same

From the Waiting List Entries tick the Select box of the appropriate patient’s waiting list entry, you are looking for a status of ‘initial’ under the specialty you require.

From the main menu click ‘1st App’

The Appointment Search screen will display with the fields pre-populated from the information recorded from the waiting list. If any of this information is incorrect then it must be corrected on the OP Return Wait List and not from this screen as changes made here will not be saved and will not be applied if the appointment requires rebooking at a later date.

Click ‘find’ – which will then display a selection of date and times.

Scroll down and click on the ‘Overbook/Edit’ Ellipse

The Appointment and Overbooking Details screen will now appear.

The specialty and Resource (Care Provider) should already be prepopulated.

Populate/amend fields as follows:

Specialty Should already be prepopulated Resource Select appropriate Clinician (should already be

populated)

https://live.ennd.mpls.hs.intersystems.thirdparty.nhs.uk/trakcare/csp/websys.csp?TUID=1964&TUID=179



Date Date of the clinic you wish to book, once the date has been entered, you can click ‘day details’ from this screen and view the clinic you are force booking into.

Time Time Clinician has indicated Appointment Location Select from drop down box the

appropriate location Overbook Reason Select most appropriate reason; all Clinician

should approve overbookings first. Session Type (this may be greyed out, if only one clinic that day is

running). From drop down list select appropriate session type, paying special attention to the session times e.g. am or pm

Duration Length of time patient requires slot, particularly needed when booking into multiple time slots.

Comments Add comments where applicable

Click ‘update’



Appendix 3: Advice & Guidance Clinical staff Responsibilty

If triaging through eRS the existing advice & guidance is unaffected

Triaging via TrakCare – From the Vetting Outcome field select Returned to referrer with advice & dictate advice letter to referrer.

Triaging via Paper – Write Returned to referrer with advice on the Referral Letter and return to Booking Team as normal & dictate advice letter to referrer.

Medical Secretary Responsibility

Type Advice Letter in EPRO where applicable and send to Referrer

Booking staff Responsibility

Update the Vetting Outcome to x admin completed - Returned to referrer with advice

Remove the Wait List selecting the Initiator as Hospital and the Removal Reason of 22 Returned to referrer with advice

Reporting staff (risk mitigation)

Create and run a fortnightly report to extract all waiting list removals with reason of 22 Returned to referrer with advice in order for operational teams to check that a corresponding EPRO letter has been sent to the GP



Appendix 4: Script for Face to Face 24 Hour Pre Checks

“Have you had a fever and or a new cough in the last 48 hours or have you been confirmed as COVID-19 positive?”

If answer is yes advise patient not to attend outpatient appointment and send details to clinician for review & advise on next steps



Appendix 5: CRG Blank Referral Template

COVID-19:

Devon <speciality> service guide

Key Messages non slider

<DATE>

Scope

This information provides guidance on the management of <speciality> patients

across Devon during the Covid-19 pandemic. The information is based on ….

National guidance

Links to guidance

2WW referrals

e-Referral Service Selection

Specialty:

Conditions with specific guidance

<Condition>

Urgent referrals

Routine referrals

Urgent advice



Advice & Guidance/Telemedicine services

Covid 19 High risk patient advice

Devon <speciality> contact information

Supporting Information

Patient Information MyHealth website

Evidence

Pathway Group This guideline has been signed off on behalf of the NHS Devon Clinical

Commissioning Group

Publication date:



<Information page title>

Introduction main content text

Selfcare and more information

Managing my condition

Main content text

Useful information about <page title>

Main content text (including links to external sites/resources)

Videos about <page title>

URLs – and details

Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed and it may be

recommended that you are seen by a hospital clinician. Information to support you in choosing your

preferred hospital, including waiting times can be found using the links below.

How long will I wait?



If a hospital assessment and/or treatment is clinically recommended your

information will be sent to a specialist. Click below to find out more about

waiting times for routine hospital assessment and/or treatment.

What support is available?

Support for managing my condition <page title>

Main content text (support groups/services/charities (clinically approved))

Publication date: <Month YYYY>

https://myhealth-devon.nhs.uk/local-services/find-services-near-me



Appendix 6: Script for Booking Teams When Booking Appointment

When booking a face to face appointment for a patient over the telephone please ensure you read the following key information to the patient prior to ending the conversation:

Please contact the booking office on the following telephone number……………………should you develop symptoms of COVID 19 prior to your appointment.

Please only come in to the hospital building at the time of your appointment - please do not attend any earlier as we look to enforce the government guidelines around social distancing. Car parking is not an issue at the hospital.

Wherever possible, please attend your appointment alone. The only exceptions to this will be if you meet any of the following criteria:

o Children (under 18 years of age) – can be accompanied by one

parent or guardian; o Anyone with a learning disability or dementia- can be

accompanied by one family member/companion/carer if attending alone is likely to cause anxiety;

o Those likely to be receiving difficult test results or diagnosis- can

be accompanied by one family member/companion/carer; or o Anyone with a disability who will not be able to access information

or will require assistance during an examination- can be accompanied by one family member/companion/carer.

Document Control - northdevonhealth.nhs.uk · 0.1 April 2020 Draft Initial version for consultation...

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