Inter-hospital transfer Guide to using to Electronic Referral System for Referring 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 Referring hospitals responsibilities: Data completeness and accuracy Incomplete data e.g. not doing investigations 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.
10 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 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. 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.
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 Referring Hospital
14 Logging on Enter your - IHT username, - Password - Select the hospital you are referring from. Click Logon to continue to the referring hospital transfer list.
15 An Overview of the IHT system Before making a referral let us go over some of the basics
16 The Referring 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 Receiving 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 the patient
22 Patient Details page Click on patient ID on the Transfer List All options to deal with a patient transfer is available from this menu on this page. Menu Options will change depending on the stage of the patient transfer
23 Referring hospital options on the IHT system: BEFORE a transfer request is made by the Referring hospital AFTER a transfer request is made by the Referring hospital AFTER a patient is received by the Receiving hospital AFTER a patient is returned by the Receiving hospital Edit a patient record Request (formally send the transfer request to the Receiving hospital) Delete the transfer request Attachments (add scanned ECG/ reports) Other Actions (Edit, Additional information, Create new referral) Hold (the transfer request) Revoke (delete a transfer request) Supply information (additional information relevant to the transfer) euroscore (calculate if required by the Receiving hospital) Discharge (home/ another hospital)
24 Creating a Referral New patient Click on the New Patient, to enter a patient's details into the IHT system
25 Creating a Referral New Patient Fields and boxes marked with a red asterisk are mandatory. Fill in the Address, postcode and tel. no. if these are not mandatory Click on Next to continue. A patient cannot be referred until all screens have been completed
26 Referring Hospital Referring Hospital When completed, click the Clinical Assessment tab to continue the referral (all entries will be saved) OR Save to return to the Patient details page to continue later. To avoid exiting out of the referral page, click the tabs directly - only clicking SAVE at the very end.
27 Patient Details page if you click Save at any point Click Edit to return to the Referral tabs. Click List to go to the Inpatient Transfer List.
28 Referring Hospital Clinical Assessment Reports can be copied and pasted into free text boxes When completed, click the Medical History tab to continue the referral (all entries will be saved) OR Save to return to the Patient Details page to continue later.
29 Referring Hospital Medical History Reports can be copied and pasted into free text boxes When completed, click the Investigations tab to continue the referral (all entries will be saved) OR Save to return to the Patient Details page to continue later.
30 Referring Hospital - Investigations Reports can be copied and pasted into free text boxes When completed, click the Results tab to continue the referral (all entries will be saved) OR Save to return to the Patient Details page to continue later.
31 Referring Hospital - Results Click Save to continue. The Risk page will open up ONLY when all the mandatory fields are complete. If not, you will return to the Patient Details page.
32 Referring Hospital Risk - Timi Most sections will be prepopulated with results from the proceeding screens You will always be asked to manually confirm the appropriateness of the TIMI Risk Assessment When completed, click Save to return to the Patient Details page OR Request Transfer to continue on to the Request page
Referring Hospital EuroSCORE 33 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
34 Referrer options BEFORE completing the Transfer Request Referring hospital Options Until the Transfer Request is complete it is NOT yet visible to the Receiving hospital
35 EDIT A TRANSFER REQUEST EDIT option to Edit or Add additional information to any of the referral tabs. DELETE A TRANSFER REQUEST DELETE option to delete the Transfer Request before it is formally sent.
36 Attachments View/ add scanned ECG or reports Click Attachment to send images (ECG reports etc) and reports with the Patient Record: Additional notes can be pasted or typed into the Notes box Thumbnails of any attachments will be viewed here. Click Add Attachment tab to add attachment
37 Other Actions - Editing options/ further requests This Option: Allows Referring hospitals to create a new Transfer Request to another hospital 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 Patient record from the Transfer List.
38 Patient Details after clicking Save OR COMPLETE Click Request to make a Request to Transfer.
39 Request (Opens if you clicked Request transfer on Risk page OR Request from the Patient Details page) Anytime you are on this page, you will need to re-click your Receiving Hospital; Procedure required; and Transfer Option
40 Patient Details Transfer Request completed To view the Inpatient Transfer List
41 Referring Hospital Transfer List NOTE: Status = New patient if the transfer request has not been completed Status = Transfer requested
42 Referring hospital options AFTER a Transfer Request is made from Patient Details Page (Transfer List/ Patient ID) Menu of options
43 EDIT - a Transfer Request sent There are two ways to edit/ update a Transfer Request from the Patient Details Page (Transfer List/Patient ID): EDIT option enables the Referring Hospital to edit all the Patient Transfer Request data: Referring hospital data; Clinical Assessment; Medical History, Investigations; Results. Click EDIT, edit or add data. Click SAVE always opens up the Risk-TIMI page, edit/update and click SAVE to return to the Patient Details page OR click on another page to edit/update. OTHER ACTIONS option enables specific types of edits: Edit patient details; Edit drugs; Edit request/receive data; Add further procedure; Create new transfer based on this record. Choose the option, click UPDATE when completed. Additions will be seen by the receiving hospital
44 HOLD - a Transfer Request sent/ Request Restarted The Referring hospital can: HOLD a Transfer Request to stop the IHT system clock for that patient until the request is restarted. This stops the clock for Length of Stay. ( icon will appear on the Inpatient Transfer List) This tells the receiving hospital that the transfer request is not ready to be accepted. Both referring and receiving hospitals can HOLD a patient pathway. CANCEL HOLD a Transfer Request to restart the request. RULE OF THUMB: The hospital putting the HOLD is responsible to CANCEL HOLD as appropriate.
45 HOLD - a Transfer Request sent/ Request Restarted HOLD option is available from the Inpatient Transfer List (Patient Details) page, when a record status is Transfer Requested OR Request Restarted. Click Hold, enter the reason for Holding. CANCEL HOLD option is available from the Inpatient Transfer List (Patient Details) page. Click CANCEL HOLD, enter the reason, edit Date and time as appropriate. The record status on the referring and receiving hospital Inpatient Transfer List will be Request Restarted. Referring hospital Inpatient Transfer List: All Transfer Requests put on HOLD CAN be seen with a record status of HOLD.. Receiving hospital Inpatient Transfer List: All Transfer Requests put on HOLD will NOT be seen on the receiving hospital Inpatient Transfer List. All HOLD records can be viewed by clicking on the ON HOLD Tab Filter in the Inpatient Transfer List page.
46 DELETE/CANCEL a Transfer Request The method of deleting an entry will depend on the stage of the transfer request. DELETE option is available from the Inpatient Transfer List (Patient Details) page, when a record status is New Patient, BEFORE a transfer request has been made (i.e. the Request page has not been completed and next pressed). Click Delete, choose the reason for deletion (Transfer not required; Error in data; Test; Other) REVOKE option is available from the Inpatient Transfer List (Patient Details) page only AFTER a transfer request has been made. Click Revoke, choose reason for deletion (Immediate re-referral keep on list; Make another referral remove from list; Discharge home; Patient deceased). This is used also used to remove transfer requests with TRANSFER REVOKED/ INAPPROPRIATE TRANSFER response from the Receiving hospital.
47 REVOKE reasons explained Immediate re-referral keep on the list Removes the transfer request from the Receiving hospital Transfer List but keeps it on the Referring hospital s Transfer List with the record status Transfer Revoked. Use if the transfer request has been revoked temporarily and a future re-referral is planned e.g. when patient is fit for transfer (patient details on the transfer list = a reminder) To re-start the transfer request Click Request from the Patient Details page and complete. NOTE: the admission date will remain the same as the first transfer request and cannot be amended. Make another referral later remove from list Removes the transfer request from the Receiving and the Referring hospital s Transfer List. Patient details are kept in the database and can be searched for. To create a new transfer request using the same patient details Search by Patient ID or name. Click on the patient ID, click Other Actions and follow as per SLIDE 38 Discharge Home Removes the transfer request from the Receiving and the Referring hospital s Transfer List. Patient details are kept in the database and can be searched for. Recommended for transfers revoked by the Receiving hospital, where no further tests or procedures are required. To create a new transfer request using the same patient details Follow as above Patient Deceased Removes the Transfer Request from the Receiving and the Referring hospital s Transfer List. Patient details are kept in the database and can be searched for.
48 SUPPLY INFORMATION relating to a Transfer Request Referring hospitals can send additional information to the Receiving hospital as required: SUPPLY INFORMATION option from the Inpatient Transfer List enables the Referring Hospital to send information or comments in a free text box. This is a communication option. Click SUPPLY INFORMATION, type in comments, click NEXT. The Inpatient Transfer List opens with a status of INFORMATION SUPPLIED. This is seen in the Inpatient Transfer List of both the Referring Hospital and the Receiving Hospital. To view the message, click JOURNAL from the Patient Details page, message is under the Details heading. This allows conversation between the Referring and Receiving Hospital in lieu of phoning or emailing each other.
49 Referring hospital options AFTER a Transfer Request is made from Patient Details Page (Transfer List/ Patient ID) Same as Slide 37 See next slide Same as Slide 38
50 EuroSCORE 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
51 Referring hospital options AFTER a Transfer Request has been transferred (Patient Received ): Same as Slide 37 Same as Slide 50 Same as Slide 38
52 Referring hospital options AFTER a Patient has been Returned from the Receiving hospital: If a returned patient requires further treatment (e.g. treat and return angiography), click REQUEST to start a further Request to Transfer using the same patient details.
53 Referring hospital options AFTER a Patient has been Returned from the Receiving hospital: All patients returned to the Referring Hospital from the Receiving Hospital should be DISCHARGED from the Inpatient Transfer List (Patient Details) page once the patient status becomes PATIENT RETURNED.
54 DISCHARGE a RETURNED patient This removes the patient record from the Transfer List of both the Referring and Receiving hospitals.
55 Housekeeping for Referring Hospitals The IHT system is a LIVE system and requires all data to be updated in real time 1. Referring Hospitals must ensure the Inpatient Transfer List is accurate and updated - Revoke to cancel any transfer requests (e.g. the patient has gone elsewhere/ transfer was inappropriate) to avoid wasted effort by receiving hospital staff. - Cancel Hold will un-holds any transfers on hold when appropriate to avoid delays in transfer and lets the receiving hospital know the IHT clock has started. - Discharge all patients returned from the Receiving hospital or request for further treatment as appropriate. 2. Referring Hospitals must regularly check the Inpatient Transfer List for any updates/information from the receiving hospital indicated by Information Supplied status (Remember this is a communication tool for all transfers!)
56 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.
57 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.
58 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!
59 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.
60 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!
61 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
62 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.]
63 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.
64 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 who will liaise with clinical nurse specialists, bed managers etc.
65 For further advice About a referral you have made Please contact the receiving 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