Inter Hospital Transfer Guide to using to Electronic Referral System for Receiving Hospitals
1 Disclaimer All information used in this demo are fictitious. Any resemblance to real names is entirely coincidental.
2 What is the IHT System? The Inter-Hospital Transfer electronic system is the primary method for referring, receiving and managing inpatient transfers for non-elective/ unplanned procedures. This is also used for all Treat and Return day case patients.
3 Why use the IHT System? It Is the most efficient way and safest of requesting a transfer and sending patient level information between sites [uses encrypted data transfer] Ensures patient safety when sending patient clinical information [avoids all potential pitfalls of a fax system] Allows hospitals to directly communicate with each other about the patient s status [avoids phone calls and communication delays] Tracks patient demand [important for bed managers] Documents a patient s pathway from admission to discharge, regardless of hospital. [basis for monitoring a patient s pathway Length Of Stay] Provides an audit trail of the patient s care [good governance]
4 The IHT System is only as good as the collaborative effort of all its users The IHT system has been in place for a number of years and evidence of its value is clear. But its effectiveness depends on all users using the system to the same standard.
5 The IHT System is Mandatory Using the IHT electronic system is a requirement in your trust contract. The target is 100%
6 CAVEAT The IHT electronic system is currently limited to referrals within your cluster/sector e.g. SWL/ SEL/ NWL/ NCL. This means that referrals to hospitals outside this area (e.g. across the river) cannot be put onto the IHT electronic system. The spread of users of the IHT system is constantly growing so this may change in time.
7 A mixed system does not work Sending some referrals using the IHT electronic system AND others by fax is inefficient, poor governance and potentially unsafe for the patient. If fax communication between referring and receiving hospitals is, on occasion, still required - this must be done in addition to the IHT electronic referral
8 What information can the IHT provide? When used properly, the IHT system shows: Referral information: Patient demographics Referrer details Clinical Assessment of patient Patient Medical Hospital Investigations Results (blood, infection and urine) Risk (TIMI/other) Transfer status (track the status of the referral) Patient pathway information (admit to request, request to transfer, transfer to procedure, procedure to discharge)
9 The IHT system requires teamwork Receiving hospitals responsibilities: Data completeness and accuracy Incomplete data e.g. no procedure dates/ discharge dates means the patient record is incomplete. Remember this is also an audit trail of patient quality of care and patient pathway Length of Stay. Up-to-date communication with the referring hospital Timely updates to the referring hospital is key to timely transfers for efficiency and out of courtesy. Please remember to check the system for updates. Timely data entry/updates in the IHT system The data entered should reflect real time status of the patient. E.g. Not returning a patient on the system means the referring hospital cannot discharge the patient on the system on their end.
10 The IHT system requires teamwork Referring hospital responsibilities: Data completeness and accuracy Incomplete data e.g. no investigations done, transfers the responsibility to the receiving hospital which delays their ability to turnaround beds. This is an audit trail of patient quality of care and patient pathway Length of Stay. Up-to-date communication with the receiving hospital Timely updates to the receiving hospital is key to timely transfers for efficiency and out of courtesy. Remember to check the system for updates. Timely data entry/updates in the IHT system The data entered should reflect real time status of the patient. E.g. don t forget to discharge a patient on the IHT system who has been returned. This is not a system to be updated once a week/ when you have time.
11 Logging into the IHT system North Central London: North West London: Enter into internet browser If based in St. Mary s Hospital: If based at Hammersmith Hospital: South East London: South West London: http://cardiac.uclh.nhs.uk https://cardiac.st-marys.nhs.uk/transfers smh-srv24/transfers nwlcn-transfers/transfers https://cardiac-network.kingsch.nhs.uk https://nww.cardiac.stgeorges.nhs.uk Save in your favourites for future reference!
The Home page of each site will look like this 12
13 The IHT system Home page To log in, click on Receiving Hospital
14 Logging on Enter your - IHT username, - Password - Select your receiving hospital. Click Logon to continue to the referring hospital transfer list.
15 An Overview of the IHT system Before receiving a referral request let us go over some of the basics
16 The Receiving hospital Transfer List It is the Home page when using the IHT system It displays details of all IHT transfer requests and status
17 Using the inpatient Transfer List 5 4
18 The inpatient Transfer List SEARCH to find patient IHT records by ID number or by name. Note: Records not updated for 60 days will not be displayed but can be accessed by doing a search TABS to view patient IHT records by category All procedure Types, Angio/PCI, Cardiology or Surgery. TAB FILTERS to filter further patient IHT records by category Active records, New (records), Pending Requests, On Hold (requests for transfers put on hold), Transfers (patients transferred) and Returned Patients (patients returned back from the receiving hospital) 4 5 ID number to view a patient s record in detail COLUMN TITLE to sort the table. First click = ascending order, second click = descending order
19 The inpatient Transfer List TAB FILTERS - Transfers list Alerts are displayed in the first column to highlight the transfer status: YELLOW ALERT Requests for transfer taking longer than 2 days to be accepted RED ALERT HOLD Requests for transfer taking longer than 5 days to be accepted A patient record has been put on hold by either the referring or receiving hospital TO PRINT A COPY OF THE TRANSFER LIST 1. Right click anywhere on the list, below the blue title bar. A menu will appear 2. Click on print. Change print orientation to landscape and print
20 Referring view on the inpatient Transfer List ALL hospitals using the IHT system will have a referring list and a receiving list so that hospitals can refer or receive cardiology and cardiac surgery inpatients.
21 The Patient Pathway stages Each stage requires an action by the Referring OR Receiving hospital New Patient Edit (New Patient) Request Review Request Receive Procedure Referring hospital creates a patient record Referring hospital completes patient clinical information Referring hospital sends the Transfer request Receiving hospital reviews and accepts a Transfer request (patient is not yet transferred) Patient is transferred to the Receiving hospital Patient undergoes procedure in Receiving hospital Plan Discharge/Return - Discharge Receiving hospital determines management plan Receiving hospital discharges/ returns patient to Referring hospital which then discharges patient
22 Receiving hospital options on the IHT system: BEFORE a transfer request is made to the Receiving hospital Preview a patient record AFTER a transfer request is made by the Referring hospital Review a request (and accept the transfer) Hold Not accept (refuse to accept) Receive (transfer a patient) i.e. patient arrives at the Receiving hospital AFTER a transfer request is received by the Receiving hospital Revoke Procedure Plan Discharge/Transfer
23 Preview a patient record BEFORE a Transfer Request is made Referring hospitals can send a preview of a patient record to a Receiving hospital with comments for discussion e.g. suitability BEFORE completing a transfer request, seen in the Transfer List: This does not start the Request to Transfer clock but continues the Admit to Request to Transfer clock.
24 BEFORE a transfer request is made Preview Options Click the Journal to view any messages/comments from the Referring hospital Menu options. Click the Patient ID number on the Transfer list to view the patient details and menu options.
25 Journal View messages from the Referring hospital Click the Comment to send a message to the Referring hospital
26 Send a message to the Referring hospital The Status on the Transfer List will indicate if a message has been left by either the Referring or Receiving hospital:
Receiving hospital options AFTER a Transfer Request is made: 27
28 Journal patient record audit trail The Journal shows Click the dates/time on the New and Patient, status/stages to enter of a the patient s pathway, patient's entered details into the into IHT the IHT system system from admission to discharge, as the patient is transferred from the referring hospital to the receiving hospital.
29 Review Request and accepting the transfer Fields and boxes marked with a red asterisk are mandatory. Comments box allows free text to enable the Receiving hospital to request for specific information from the referrer. This detailed request for information can be viewed in the Journal page by the Referring and Receiving hospitals Review a Transfer Request when making a decision to accept
30 Review Request Options Explained Request Under Review: Request being discussed/ reviewed More Information Required: Referral information provided is insufficient. Use dialogue box to request for further information Medically Accepted: Patient is accepted as suitable for transfer but no plan as to where and when the transfer will occur Accepted for Immediate Transfer: Patient requires immediate transfer due to a clinical condition. Use: when the Specialist registrar for the week personally contacts a referring hospital and immediate transfer is agreed OR when a bed becomes available for patients originally accepted as Standard Cardiology Transfer When Bed Available.
31 Review Request Options Explained Accepted When Bed Available: Use for patients accepted for transfer BUT no bed yet identified AND for all day case patients until a date is allocated. Accepted for Day Case Transfer: Use for day case patients and a date is allocated. Use dialogue box to communicate the transfer details to the referring hospital Accepted for Standard Cardiology Transfer When Bed Available: Use for patients who do NOT fit the day case criteria. When a bed is available, the status will be changed to Accepted for Immediate Transfer. Use dialogue box to communicate the transfer details to the referring hospital
32 Hold a transfer request When completed, click the Update to change the status on the Journal, the Transfer List and Patient Details page. Enter Reason RULE OF THUMB: The hospital putting the HOLD is responsible to CANCEL HOLD as appropriate. Both referring and receiving hospitals can HOLD a patient pathway.
33 Not Accepted to reject a Transfer Request State reason for not accepting the patient. Click Next to remove the Transfer Request from the Receiving Hospital s Transfer List. [The Transfer Request will remain on the Referring hospital Transfer List page with a status Transfer Inappropriate.
34 Receive When the patient arrives at the Receiving hospital Click the Update tab to change the patient status from Transfer Requested to Patient Transferred on the Transfer List page.
35 Attachments View/ add scanned ECG or reports Thumbnails of any attachments provided by the Referring Hospital can be viewed here. Click on thumbnail to enlarge view Click Add Attachment tab to add any images Additional notes can be pasted or typed into the Notes box
EuroSCORE 36 Some Receiving hospitals require a EuroSCORE form to be completed before a Transfer Request for surgery can be made. Click Complete to return to the Patient Details page
37 Other Actions - Editing options/ further requests Further requests include: - Additional information - Further procedure - Create new transfer based on this record (ref next slide for more detail) Click Next to to return to the Patient Details page.
38 Other Actions Create new transfer based on this record This Option: Allows Receiving hospitals to create a new Transfer Request either to another hospital OR department e.g. Cardiology to Cardiac Surgery. Creates a NEW Transfer Request with a new Episode ID number, using the same Referring Hospital number and Admission date to the Referring hospital to link this record to the original transfer request. Patient Pathway Length of Stay will then be measurable. Removes the original Transfer record from the Transfer List. After completing this option: Go to the Referring view - find the new transfer request. Click REQUEST on the left hand side menu to make a formal Transfer Request. The patient record will be visible from the Receiving view with a TRANSFER REQUESTED status. From the Receiving view, Transfer List/Patient ID, RECEIVE the Transfer Request into your hospital/department as appropriate
39 Receiving hospital options AFTER a Transfer Request has been transferred (Patient Received ): All stages of the patient stay at the receiving hospital must be updated on the original patient record received to ensure continuous documentation of the patient pathway.
40 Revoke Receive after patient is transferred Click Revoke Receive to cancel/revoke the accepted transfer. Type in the Reason
41 Revoke Receive after patient is transferred The options to Review Request and Receive become available again Status on the Patient Details page will show that the Received transfer has been revoked.
42 Procedure patient undergoes a procedure/s Defaults to the date and time of entry. Multiple procedures can be entered. Complete this page for each procedure entry. Click Update when complete. This option is a LIVE option i.e. only available in real time, when a patient has been received/transferred. It is not available when the patient has already been discharged.
43 Procedure patient undergoes a procedure/s All procedures can be viewed from the Patient Details page (Transfer List/Patient ID) AND in the Patient Journal page (Transfer List/Patient ID/Journal) Any procedure entry will change the patient transfer status on the Referring AND Receiving hospital Transfer List page to Procedure The Receiving hospital is responsible for adding the procedure details to the record received!
44 Plan post procedure Defaults to the date/time of entry. If Internal Referral OR Await further procedure option is chosen, the Procedure Required will need to be entered Patient can be Discharged home from this option All Plan details can be viewed at the bottom of the Patient Details page (Transfer List/Patient ID)
45 Discharge/Transfer Discharge options Patient DISCHARGED GP care/ Home/ Referring hospital Discharge options will be one of these Patients can be DISCHARGED HOME or DISCHARGED TO THE REFERRING HOSPITAL OTHER ADMISSION or ADMISSION TO OTHER WARD see next Slide
46 Discharge/Transfer Discharge Other Admission OR Admission to Other Ward This option: Is used to refer a patient to another dept e.g. Cardiology to Medicine Removes the patient record from the Receiving hospital Transfer List Take note of the Patient Name/ ID Number BEFORE choosing this option so you can find the file again! From the Referring view, Search for the patient record by Name or ID Number. Click on the Episode ID of the discharged patient record. Click the OTHER ACTIONS option on the left hand side menu. Choose Create new transfer based on this record. Follow as per SLIDE 38
47 Attachments and Other Actions Same as Slide 35 Same as Slide 37-8
48 Searching for a patient record - from the Transfer List page Search by Transfer ID or by Name If you have a problem with the name search due to a misspelt name, the system recognises the use of wild cards i.e: % matches any sequence of characters, e.g. k%m would match kim, kam or kalms _ matches a single character, e.g. k_m would match kim or kam The name search will also find forenames, as these follow the surname after a comma and space: %, l_d e.g. LICHOTA, Lidia, GRABAS, Ludwik, ANTIPOVA, Lydia
49 Adding patients directly admitted to the Receiving hospital for Cardiac Surgery Same as Slide 37-8 Click Add Patient to List
50 Complete Patient Information Same as Slide 37-8 Click Add Patient to List
51 Complete Receive Fast-track Click YES for patient transferred to add patient to the Receiving List
52 Menu Options once patients has been transferred Click Add Patient to List All the menu options are the same as those if a patient had been transferred from a Referring Centre
53 NOTE: Plan Select Internal referral if the plan is for the patient to have a surgical procedure following the cardiology intervention. This will notify the surgical team as the patient will appear under the surgical tab i.e. added to the list of surgery patients
Patient Status will be updated and patient will be on the Surgery List 54
Cardiac Surgery: Update the Procedure done 55
Cardiac Surgery: Discharge as described earlier 56
57 Discharge History Discharge History = a list of all patients discharged Reports = download reports
58 Housekeeping for Receiving Hospitals The IHT system is a LIVE; system and requires all data to be updated in real time 1. Receiving Hospitals must ensure the Inpatient Transfer List is accurate and updated - Procedure Update procedure information and date on patient record - Discharge All patients ensuring the correct date and time. 2. Receiving Hospitals must communicate with Referring Hospitals on the status of the Transfer request on updates/information, using REVIEW REQUEST/ MORE INFORMATION REQUIRED free text/ dialogue box (Remember this is a communication tool for all transfers!)
59 Understanding The Inpatient Transfer List STATUS New Patient A Request for Transfer has not been completed i.e. patient has NOT been referred but is on the Referring hospital system Transfer Requested A Request for Transfer has been successfully made to a Receiving hospital Transfer Revoked The Referring hospital has cancelled a Request for Transfer the request is removed from the Receiving hospital s Transfer List. Hold The Referring hospital has put the Transfer Request on HOLD which stops the clock on the IHT system until the Transfer Request is restarted. Request Restarted The Referring hospital has cancelled HOLD option and the Request for Transfer has been restarted. Information Supplied The Referring hospital has supplied further information requested by the Receiving hospital.
60 Understanding The Inpatient Transfer List STATUS Transfer Inappropriate The Request for Transfer is not acceptable at the Receiving hospital and the Not Accepted option has been used. The patient s details are removed from the Receiving hospital s list but remain on the Referring hospital s list with a status of Transfer Inappropriate. Reasons for this must be reviewed by the Referring hospital in Transfer List/Patient Details and appropriate action taken on the IHT system. Patient Transferred The patient has arrived at the Receiving hospital - patient status changes from Transfer Requested to Patient Transferred. Procedure The patient has undergone a procedure at the Receiving hospital. Procedure details can be viewed on the Transfer List (Patient Details) and scroll to the bottom where the procedure details are recorded. Patient Returned The patient has been returned to the Referring hospital. When a patient is discharged home from the Referring hospital, Discharge the patient on the IHT system to remove patient s details from the active Inpatient Transfer List. (Details are stored on the database). This ends the patient pathway Length of Stay.
61 Accurately Documenting Length of Stay is a Collaborative Effort Measuring the patient pathway Length of Stay (LOS) requires these dates and times to be accurate: Admission (by the Referring hospital) Request to Transfer (by the Referring hospital) Receive (by the Receiving hospital) Procedure (by the Receiving hospital) Returned/Discharge (by the Receiving hospital) Discharge (by the Referring hospital) Remember if you do not check the dates and times when updating records, these will default to the date and time of your data entry/update!
62 Understanding delays in LOS (first admission to final discharge) Patient pathway LOS target for CABG< 21 days: Patient pathway LOS target for Angio/PCI < 5 days: ADMISSION - REQUEST (c/o Referring hospital) Target LOS < 5 days CABG Target LOS < 1 day PCI Time has been accounted for to allow for investigations to be done. Transferring a patient without investigations transfers the burden to the Receiving hospital which will increase the request discharge LOS Keeping a patient for 5 days and transferring them without investigations mean a higher likelihood of a patient pathway LOS > 21D. There are no other LOS targets for other conditions/procedures but all trusts have internal pressure to keep this low.
63 Understanding delays in LOS (first admission to final discharge) Patient pathway LOS target for CABG< 21 days: Patient pathway LOS target for Angio/PCI < 5 days: REQUEST TO TRANSFER (c/o Receiving + Referring hospital) Target LOS < 5 days CABG Target LOS < 2 days PCI This is determined largely by the early review of transfer requests/ patient records and efficient bed management to be done within 5 days. Delays in bed management by the Receiving hospital increase LOS. Referring hospitals sometimes shop around for alternative Receiving hospitals. The LOS target agreement was that only when waiting times are more than the target days can referring hospitals send patients to an alternative hospital. Poor communication results in wasted time and effort by bed managers in the Receiving hospital. This requires collaboration so close communication is key!
64 Understanding delays in LOS (first admission to final discharge) Patient pathway LOS target for CABG< 21 days: Patient pathway LOS target for Angio/PCI < 5 days: TRANSFER - DISCHARGE (c/o Receiving + Referring hospital) Target LOS < 11 days CABG Target LOS < 2 days PCI This LOS measure is dependent on the Receiving hospital entering the following IHT data: Receive the patient, Procedure done, Procedure date and Patient Returned to Referring hospital OR Patient Discharged. Omitting an entry OR inaccuracy of data entry (e.g. discharge date is earlier than procedure date) makes measuring LOS not possible/ incorrect. Receiving hospitals must Return or Discharge a patient on the IHT system in real time. Failure to Return a patient to the Referring hospital means the Referring hospital cannot Discharge the patient, making LOS incorrect. Delays in bed management by the Referring hospital delays the return of a patient and increases LOS. Referring hospitals must Discharge all returned patients on the IHT system as needed
65 Be aware of dates and times when updating the patient record Double check the dates already entered in the patient details first, before updating any dates. Remember if you do not check the dates and times, these will default to the date and time of your data entry/update! [If incorrect, the patient pathway Length of Stay cannot accurately be measured.]
66 The IHT Electronic System is a LIVE system Using the IHT system as a database updating it as an administrative task for documentation purposes is an incorrect use of the system. It is a LIVE system to manage the transfer of patients between Referring and Receiving hospitals in real time. The IHT system is only effective if all those using the system use it in the same way, to the same standard.
67 Logging off Click the Logoff button
68 Safeguarding data entry, timeliness and accuracy on the IHT Electronic System Each hospital must have a designated IHT co-ordinator who will: Check the transfer list and information updates/communication from the receiving hospital regularly. Ensure data entry timeliness, accuracy and completeness Issue/ manage usernames and passwords Raise any issues with IHT use as appropriate This is ideally an administrative post which will liaise with clinical nurse specialists, bed managers etc.
69 For further advice About a referral you have received Please contact the referring hospital On help using the system NCL Cardiac and Stroke Network Lee Taffe lee.taaffe@nhs.net NWL Cardiac and Stroke Network Sylvia Stoianova s.stoianova@nhs.net SL Cardiac and Stroke Network Alison Basa alison.basa@slcsn.nhs.uk