To standardise procedures for outpatient clinics. To provide a point of reference for management, clinic co-ordinators and clinic staff.

Procedure 1 Scope Trust-wide clinics and all outpatient locations. 2 Purpose 3 Definitions To standardise procedures for outpatient clinics. To provide a point of reference for management, clinic co-ordinators and clinic staff. Please refer to: general HISS documents (article ID 12779); in particular o the standard glossary of terms (media ID 8990) o HISS codes (media ID 9362) 3.1 Abbreviations used Appt CRN GDP GP HISS JCIS QAS PTL SOS appointment case record number ( hospital number ) general practitioner (or HISS code) hospital information support system joint clinical investigation system quick address system 4 Introduction These procedures have been written with the help of clinic co-ordinators and other staff closely involved in the running of clinics in order to assist you in continuing to provide a high quality and consistent service to our patients. There are many areas of good administrative and procedural practice in individual clinics and this manual will ensure that such high standards are seen throughout the Trust. Cambridge University Hospitals NHS Foundation Trust Page 1 of 71

5 How to use this document This manual has been designed to follow the patient path through outpatients from referral to outcome, broken down into six sections: patient registration and referral outpatient clinic set-up outpatient waiting list outpatient partial booking making appointments cancelling appointments patient arrival at clinic patient disposal/ outcome at appointment When accessing this manual from Connect you can use the hyperlinked contents page to navigate around the document. We have also hyperlinked specific words within the document to quickly take you to relevant information. Some links will take you to the Connect policy and procedure pages. From there you will be able to find the policy and procedure you need to consult. 6 Responsibilities The post holder is responsible for data quality and complying with the policies, procedures and accountability arrangements throughout the Trust for maintaining accuracy and probity in the recording of the Trust s activities. You are legally responsible for all records that you gather, create or use as part of your work within the Trust (including patient health, financial, personal and administrative), whether paper based or on computer. All such records are considered public records, and you have a legal duty of confidence to service users (even after an employee has left the Trust). All staff that have access to or transfers any data are responsible for those data, it must be kept secure and they must comply with the requirements of the Data Protection Act 1998 and the common law on confidentiality. All data must be kept in line with the Trust s policies and procedures. Data includes all types of data ie patient, employee, financial, electronic, hard copies of printed data or handwritten data etc. Cambridge University Hospitals NHS Foundation Trust Page 2 of 71

Contents 1 Scope 1 2 Purpose 1 3 Definitions... 1 4 Introduction... 1 5 How to use this document... 2 6 Responsibilities... 2 7 Patient registration... 5 8 Waiting list accuracy... 5 9 Outpatient clinic set-up on HISS... 7 10 Outpatient waiting list entry... 15 11 Suspending or deferring a patient from the waiting list... 18 12 Removing a patient from the waiting list... 19 13 Reinstating a patient on the waiting list... 21 14 Fast track referrals for suspected cancer... 21 15 Cancer pathway procedure... 23 16 Fast track referrals for rapid access chest pain... 23 17 PTRANS for UNSP patients/ change of consultant... 24 18 Partial booking process (new referrals)... 26 19 Long term follow-up or specific procedure waiting list... 27 20 Booking rules... 36 21 New appointments... 37 22 Overbooking/forcing a booking into clinics... 38 23 Walk-in patients - extras... 40 24 Follow-up appointment... 40 25 Ward follow-up appointments... 41 26 Could not attend (CNA) a new appointment... 43 27 Cancelled by patient (CP)... 45 28 Clinic cancellation procedure... 46 29 Front of house policy... 53 30 HISS downtime procedure (manual procedure)... 53 31 Patient arrival... 54 32 Post session recording (PSR)... 57 33 Discharge procedure... 61 34 Did not attend... 61 35 HISS transport ordering... 62 36 Monitoring compliance with and the effectiveness of the document... 68 37 References... 68 38 Associated documents... 68 Cambridge University Hospitals NHS Foundation Trust Page 3 of 71

Patient registration and referral Cambridge University Hospitals NHS Foundation Trust Page 4 of 71

7 Patient registration Patients must have a hospital number and be placed on the appropriate outpatient waiting list. 7.1 Procedure 1. To enter the registration screen either type REG or use the F8 function button. 2. Complete the relevant searches. The minimum requirement is NHS number search, name search and/or date of birth search. Press either F4 name search or F5 date of birth search from the CRN field. 3. For full instruction on complete a full and accurate registration please refer to the online HISS support lessons. 4. If after completing the QAS address search you are unable to locate the patients address/ postcode please complete the online postcode request form or ring the support desk on extension 2757 giving the full address and postcode. 5. If you are unable to find the GP then please use the online GP update request tool. 8 Waiting list accuracy 8.1 Referral letters 1. Staff entering outpatient referrals onto the outpatient waiting list should record the referral received date as per the date stamp on the referral letter. In the event of the referral not being date-stamped, the referral received date would be the date the patient was referred by their GP or other referrer, and the letter written. 2. Standardising this procedure will ensure that patients' waiting times are kept to a minimum and that no patient will be disadvantaged through recording errors. 3. To ensure accurate recording, the Trust must ensure that all referral letters are date-stamped with the date they are received by the Trust. Just to confirm, this is not the date opened or the date actioned but the date the letter is received into the Trust. Therefore it is vital that all referral letters are dealt with on a daily basis, recorded (where appropriate), and date-stamped. 8.2 Inter organisation referrals 1. All tertiary referrals to and from other organisations should contain the nationally mandated 18 week minimum data set. 2. All secretarial staff should ensure that any letters from/to other hospitals are copied to the 18 week information office so that 18 week pathways can be tracked by Trust and the tertiary centres. Cambridge University Hospitals NHS Foundation Trust Page 5 of 71

Outpatient clinic set-up Cambridge University Hospitals NHS Foundation Trust Page 6 of 71

9 Outpatient clinic set-up on HISS 9.1 Approval process 1. Any requests for a new or change of service are made by email to the Commissioning department using using a 'change of methodology of recording' form. See appendix 2 for flowchart. 2. Commissioning, clinical income and information management validate the request, and if appropriate, the request will be authorised and information management will assign the relevant new codes and send the requestor a confirmation email and memo. 3. Once the new code is issued the following actions must be taken. 9.2 Clinic profile entry 1. Step one is to create a clinic profile. From a menu type CLINPROF or navigate through the menus to OPREF and then select Clinic Profile Entry. 2. This screen is used to create and update a profile for each clinic. The profile sets the parameters for the clinic. The confirmation email from information management will confirm some of required data. The fields are described in the table below. Cambridge University Hospitals NHS Foundation Trust Page 7 of 71

Field No. Field Description Data 01 Clinic Enter the clinic code 02 Consultant Enter the consultant code 03 Specialty Enter the specialty code 04 Pers.Refs.Only <Y> indicates that the consultant will see new appointments that have been personally referred to the clinic. <N> indicates that the consultant will see new appointments however they have been referred to the clinic. The default for this is <N>. 05 Hospital Code This is always ADD 06 Location Enter the location code for the clinic. (See Memo) 07 MRT Loc This must always be left blank 08 Clinic Purpose Enter the specific purpose of the clinic, eg hepatitis, etc. Advance appointments limits - 09 Days This is always set to 10 10 Weeks This is always set to 12 11 Months This is always set to 18 12 Years This is always set to 2 13 Search Ahead Limit This is always set to 10 14 Outcome Prompt This is always set to Y 15 Clinic Lists Split <Y> will split the lists, <N> will print one list. This is normally set to Y 16 Exclude from ALL pulling lists 17 No. of copies This is set to 5 If casenotes are required this is set to <N> if casenotes are not required set to <Y> 18 Notes Pull.Order This is set to TD (Terminal Digit) 19 Departmental No This is left blank 20 KH09 or ISDS1 (enter N if to be excluded This determines if the activity is submitted against these two national returns enter <Y> if the clinic is consultant led or enter <N> if the clinic is nurse or non-consultant led Consultant led is a service where a consultant retains overall clinical responsibility for the service, care professional team or treatment. The consultant will not necessarily be physically present for each clinic but remains clinically responsible for each patient s care. 21 SMRO (Y/N) This is left blank as it is only relevant in Scotland. Cambridge University Hospitals NHS Foundation Trust Page 8 of 71

9.3 Clinic template entry 1. Step two is to create a clinic profile. From a menu type CLINTEMP or navigate through the menus to OPREF and then select Clinic Template Entry. 2. This screen is used to create and update a template for each clinic. The template sets the appointment types and times for the clinic. The fields are described in the table below. Cambridge University Hospitals NHS Foundation Trust Page 9 of 71

Field No. Field Description Data 01 Clinic Enter the clinic code 02 Consultant Enter the consultant code 03 Template Number For any clinic and consultant combination there may be many templates created. The template number is automatically generated as you return through the field. Where a previous template exists these are displayed in the window in the lower part of the screen once they are filed. 04 Start Time Enter the time that the clinic is due to begin (first patient to arrive). 05 Finish Time Enter the time that the clinic is due to finish (last patient to leave). 06 Total Appts As fields 10 to 14 are completed this field calculates the number of appointments in the clinic. 07 Area for Postcode Restriction 08 Ambulance Transport Earliest Appt. This is to be left blank This is to be left blank 09 - Latest Appt. This is to be left blank 10 SMR Appt. Time Type This is left blank as it is only relevant in Scotland. The following fields are used to create the appointment structure for the clinic 11 Time Enter the appointment time 12 Type Enter the appointment type (CABR, CABU, CRET, etc). 13 Minutes Enter the number of minutes between this appointment and the next appointment. 14 App ts Enter the number of appointments for this time and type Complete these fields as many times as necessary and then <F> File the template entry Cambridge University Hospitals NHS Foundation Trust Page 10 of 71

9.4 Clinic schedules entry 1. Step three is to create a clinic schedule. From a menu type CLINSCHED or navigate through the menus to OPREF and then select Clinic Schedule Entry. 2. This screen is used to create and update schedules for each clinic. This data will be used to confirm the dates and days that the clinic will run. The fields are described in the table below. Cambridge University Hospitals NHS Foundation Trust Page 11 of 71

Field No. Field Description Data 01 Clinic Enter the clinic code 02 Consultant Enter the consultant code 03 Day of the week Enter the day of the week on which the clinic is to be held. Mon, Tue, Wed, Thu, Fri, Sat or Sun are valid. If the clinic will run on more that one day then you will need to repeat this process for each day. 04 Room This is to be left blank 05 Effective Date Enter the date from which the clinic will run. The date must be later or equal to the present date 06 Multiple Template If this is the first of a multiple template clinic enter <1> here and then subsequent numbers for the other parts of the multiple template. This would be used if there were a different template for different weeks of the month. 07 Template Enter the template number for the clinic you are scheduling 08 Special Conditions The normal scheduling for a clinic is for it to be held on the same day of the week, on a weekly basis. However, some clinics run to a different schedule. They may be held monthly, etc. Within this field you must enter the week numbers within the month on which the clinic will run, eg Weekly [1,2,3,4,5] Week one only monthly [1 ] Weeks 2 and 4 Monthly [2,4 ] You must enter the correct week numbers. 09 Interval This is the interval between clinics such as 01M for monthly or 02W for every two weeks. 10 Regular Holidays This field is used to indicate whether the clinic will be held on regular public holidays. <Y> indicates that the holidays will be observed, ie it will NOT run on bank hols etc. <N> indicated that the holidays are not observed, ie it WILL run on bank hols, etc. 11 Comments/Narration Enter any comments in free text for this schedule. 12 GP Update Enter <Y> if a GP user is allowed to book appointments on this schedule Cambridge University Hospitals NHS Foundation Trust Page 12 of 71

9.5 Setting up partial booking letters 1. Every patient must be offered the opportunity to negotiate their appointment either verbally or by receiving an invitation to phone letter. 2. The invitation to phone letter contains the details for contacting the relevant booking office. These data come from the HISS ADDWAIT screen, shown below, and are entered by the information management team from detail supplied with the clinic code request form. 3. An entry should be created in ADDWAIT for U (urgent) and R (routine) as a minimum for all clinics and if the clinic will see urgent suspected cancer referrals these also need to be set-up. Cambridge University Hospitals NHS Foundation Trust Page 13 of 71

Outpatient waiting list Cambridge University Hospitals NHS Foundation Trust Page 14 of 71

10 Outpatient waiting list entry All new referrals will have a hospital number and be placed on the appropriate outpatient waiting list. This section should be read in conjunction with the waiting list access policy. 10.1 Waiting list entry 1. To access the outpatient waiting list type OPWAIT and select patient. Always ensure that you have the correct patient on screen before continuing. 2. Where a patient has already been entered on one or more outpatient waiting lists and not yet treated, the details of these are summarised immediately above the control line. It is important that this summary is checked to ensure that the referral has not already been recorded. The format of the summary of incomplete entries is as follows: On list for [N; XX, YY, AA] where: N is the waiting list entry number XX is the specialty code, YY is the consultant code, and AA is the outpatient waiting list type code 3. To display previous incomplete entries on a waiting list (ie when a patient has been booked and removed from the outpatient waiting list) you need to know the waiting list entry number. Starting with 1 enter the entry numbers in chronological order until the entry you require is displayed. 4. If the entry shown at the control line is not relevant press return through to carry on and create an entry. The fields are described in the table below. Using the help function F2 or? in any field will display a list of options. Field No. Field Description Data 01 CRN Enter the patients CRN and check the correct patient is on screen before continuing Cambridge University Hospitals NHS Foundation Trust Page 15 of 71

Field No. Field Description Data 02 Entry No. Each time a patient is placed on a waiting list, an entry number is given. These numbers are allocated sequentially as a default when you press enter (return) 03 Hospital This is always ADD and will default. 04 Category The field records the treatment category for the patient. For example, NHS or Private. 05 Specialty Enter the specialty within which the patient is to be treated 06 Consultant Enter the code of the consultant who is to treat the patient 07 Urgency Enter the code relevant to the urgency. If the patient has already negotiated a date select one of the BAP codes. If the patient is a cancer referral please see cancer referral procedure. 08 Referral Source Enter the code that describes the source of the patient s referral. For example, GP for general practitioner. 09 Referral Reason Enter the appropriate referral reason. If the patient is attending for an OP procedure you must select specific procedure. 10 Short Notice This field records whether or not the patient will accept a request to attend at short notice. Enter <Y> or <N>. The default is <N> 11 W/L Type This field records with type of waiting list. EW Elective Wait at the time of entering the patient on the list they haven t been allocated an appt date EB Elective Booked at the time of entering the patient on the list they have already negotiated an appt date EP Elective Planned the patient is planned to attend at a specific date in the future for clinical reasons. The use of EP is restricted and must be agreed with the head of information management on a patient by patient basis. EP is used for all ward follow-up appointments. 12 OSV This field records whether the patient is to pay any fees as a result of being on overseas visitor. The default is NA (not applicable). 13 Referral received Record the referral received date as per the date stamp on the referral letter. In the event of the referral not being date-stamped, the referral received date would be the date the patient was referred by their GP, and the letter written. See waiting list accuracy section for full details. 14 Date on Waiting List Enter the date, in a valid format, when the patient was placed on the waiting list. Use <T> for today. Cambridge University Hospitals NHS Foundation Trust Page 16 of 71

Field No. Field Description Data 15 Referring GP For GP referrals enter the code of the referring GP. Search facility is available using the first three letters of the surname and first four of part of the address eg CORHAVE for Dr Cornish of Haverhill. 16 GP Address This will be automatically populated based on what was entered in field 15 17 GP Partnership This will be automatically populated based on what was entered in field 15 18 Decision to refer This is left blank or is completed by the 18 week information office or the cancer trackers to record the 18 week or cancer target start date. 19 Cancer Ref Type This field is used when an urgent referral for suspected cancer is received. Please see cancer referral procedure for the list and guidance on usage. 20 Provisional Diagnosis Enter details on the reason for referral in this field or leave blank if unknown 21 Transport This field records details of how the patient will arrive to clinic. Completing this field will not order transport. 22 Preferred Clinic Enter the clinic code that you will book the patient into. This will be used to generate the phone number in the invitation to phone letter. 23 Acknowledgement Letter The system will generate a message asking which acknowledgement letter you wish to send. See screen shot below. If you wish to send an Invitation to Phone letter at this time then Select the required letter code, in this case SURGI or if no letter is to be sent at the moment type END or press F1. For the letter to be correctly worded you MUST have both a preferred clinic and request an invitation to phone letter. Cambridge University Hospitals NHS Foundation Trust Page 17 of 71

Acknowledgement Letter (cont/..) If you defer sending the letter and now wish to send it then open the relevant waiting list entry, ensure the preferred clinic is completed, and then either move to field 23 and select the required letter or type FREVIEW and select the required letter. See screen shot below. 24 Response Received Enter the date the response was received. 25 Comment Enter any relevant comments 26 GP Ref No If the appointment is to be negotiated with the patient enter PART. If the appointment is not negotiated then leave this blank. 5. Once all the fields are correct F file the waiting list entry. Reminders: always do a thorough search to ensure you have the correct patient make sure you accurately complete all the fields use the help facility? or F2 to display all the available options 11 Suspending or deferring a patient from the waiting list 11.1 Deferring a patient from the waiting list Defer a patient on a waiting list including details of when the patient is unable to attend the outpatient appointment. All patients who are unable to attend should have details of the period of unavailability recorded on HISS. 1. This should be read in conjunction with the waiting list access policy. 2. The waiting list deferment entry screen, OPDEFER, is used for recording and changing these periods of suspension or deferment. 3. Enter the patient s hospital number (CRN) and select the correct waiting list entry. See screen shot below. Cambridge University Hospitals NHS Foundation Trust Page 18 of 71

4. To enter data into this screen use I to insert, R to replace and D to delete. For R and D you will need to enter the line number if the data to be updated or deleted, eg R1 or D1. Enter the data as per the following table. Field No. Field Description Data 03 Reason for Deferment Category Enter the correct reason for the patients unavailability. 04 Date from Enter the date from which the deferment begins. This date must not be in the past. If you wish to enter a past date please email data quality the details. 05 Date to Enter the date when the patient will become available again. All periods of deferral must have a beginning and end date. Reminders: always do a thorough search to ensure you have the correct patient the patient must be on the waiting list to be deferred make sure you accurately complete all the fields use the help facility? or F2 to display all the available options email data quality if you need to enter a retrospective start date 12 Removing a patient from the waiting list 12.1 Removing a patient from the waiting list If patients no longer require an appointment or review or have declines multiple offers of appointments (see waiting list access policy) they should be removed from the waiting list. All waiting list removals should be emailed to the 18 week information office. Cambridge University Hospitals NHS Foundation Trust Page 19 of 71

12.2 Procedure 1. The waiting list entry screen, OPWAIT, is used when removing patients from the waiting list. 2. Enter the patients hospital number (CRN) and select the correct waiting list entry. See screen shot below. 3. Entering REMOVE at the control line initiates the process of making the waiting list entry non-operational. See screen shot below. 4. The system will ask you to confirm that you wish to remove the patient from the waiting list. Enter Y to continue. 5. You will be prompted to enter a removal reason code: use the F2 help facility to choose the correct reason. 6. After entering a valid reason code, you are then prompted for the date of removal. Enter the date of the decision to remove from the waiting list. If you do not enter a date the system defaults to today. 7. In the case of patients who have not responded to their invitation to phone letter, a letter should then be sent to the patient s GP or referrer informing them that they have been removed from the waiting list. 8. If the removal is done in error the waiting list entry can be revived by selecting the entry number as above and typing REVIVE at the control line. This process should only be used in the case of an entry being erroneously removed otherwise see reinstating a patient on the waiting list below. Cambridge University Hospitals NHS Foundation Trust Page 20 of 71

13 Reinstating a patient on the waiting list 13.1 Outpatients Each reinstatement should be judged on its own merit and where good reasons exist for the patient to have not responded, no deferment should be added to the waiting list entry. However, reinstatements in these circumstances should only be made with the agreement of the directorate support manager or equivalent grade. Please see waiting list access policy for the full detail on reinstatements. 14 Fast track referrals for suspected cancer 14.1 Background The cancer two week standard guarantees: a maximum two week wait for urgent GP or GDP referrals for suspected cancer to date first seen for all suspected cancers a maximum two week wait from referral of any patient with breast symptoms to first hospital assessment Prior to referral patients should have been given the appropriate information about why they are being referred, the reason for being seen quickly and the importance of keeping appointments by the person referring them as per site specific referral proforma on the GP website. Patients categorised as fasttrack by the GP cannot be down graded by the Trust. See reminders below. 14.2 Clock start The 14 day guarantee starts on the original referral request received date or for choose and book referrals the UBRN conversion date. For choose and book appointments the two week slots should not allow the patient to book outside the two week wait window. 14.3 Clock stop The stop date is the date first seen or first hospital assessment. 14.4 Recording a suspected cancer referral on HISS 1. Using OPWAIT, enter the patients hospital number (CRN) and select the correct waiting list entry. 2. With the exception of the fields listed below follow the process for entering a patient on the waiting list above. Cambridge University Hospitals NHS Foundation Trust Page 21 of 71

Field No. Field Description Data 07 Urgency The urgency code for all suspected cancer referrals is FT or BAPFT. BAPFT is used if the appointment is negotiated within one working day. 08 Referral Source For cancer tracking to work effectively the referral source must be recorded accurately. 19 Cancer referral type This should be the suspected type of cancer, eg breast, upper GI etc. Use help functionality (F2) to view the full list of suspected cancer sites. For CAB referrals the suspected cancer site must be entered onto OPWAIT immediately the referral is received. Failure to do this will result in incorrect tracking against the cancer targets. 3. If the patient cancels their appointment any future offered appointment must be within the original 14 days. The waiting time for these patients will still be calculated from the referral request received date (clock start) to the date of the attended appointment with no adjustment for the cancelled appointment. Under no circumstances should you remove the patient from the waiting list due to their unavailability. 4. If the patient does not attend (DNA) their first appointment they cannot be referred back to the GP. All attempts should be made to contact the patient to rearrange the appointment. An adjustment is allowed for period between the original referral received date to the rebook date (not the appointment date) and this is recorded in JCIS. Reminders: Patients should not be referred back to the GP because they are unable to accept an appointment within two weeks, ie once a referral has been received by secondary care it should not be returned due to patient unavailability. Two week wait referrals can only be downgraded by the GP - if a consultant thinks the two week wait referral is inappropriate this should be discussed with the GP and the GP asked to withdraw the two week wait referral status a GP should not be asked to downgrade a patient (or withdraw the referral) simply because the patient is unable to accept an appointment within two weeks. Patients should not be referred back to their GP after first DNA (Did Not Attend) of their first appointment. Patients can be referred back to their GP after multiple (two or more) DNAs if this is the agreed local policy and the clinical team agree. Patients must not be referred back to their GP after a single appointment cancellation. Patients should not be referred back to their GP after multiple (two or more) appointment cancellations unless this has been agreed with the patient by cancelling an appointment a patient has shown a willingness to engage with the NHS. Cambridge University Hospitals NHS Foundation Trust Page 22 of 71

15 Cancer pathway procedure 15.1 Background All patients who are on a suspected or confirmed cancer pathway must be prospectively tracked through the system to a first appointment, first or subsequent treatment. Benefits of this will be that radiology, pathology and endoscopy etc will be able to identify cancer patients and prioritise their investigations appropriately. To improve our tracking of patients the cancer board has agreed the following process which will allow us to flag cancer patients to the diagnostic teams. 15.2 Process for identifying patients on a cancer pathway The cancer board agreed that the term cancer pathway or CP should be used to identify cancer patients who are on the pathway. This should be used on all requests including radiology, pathology, endoscopy and waiting list entry requests. 1. If requested using OCS, the requesting clinician should use the PRIORITY FIELD and prioritise the request as CP. 2. If requested using a handwritten request forms cancer pathway or CP should be written/ identified alongside the reason for request or clinical details. 16 Fast track referrals for rapid access chest pain 16.1 Definition A letter is received from a GP/Consultant requesting their patient be seen in a rapid access chest pain clinic (RACPC) using the agreed referral proforma. Patients will be seen within 14 days of the GP's decision to refer for treatment (decision to refer is day zero). 1. At the main menu screen type OPWAIT and press enter, this will take you to the outpatient waiting list entry screen. 2. Enter the patients hospital number (CRN) into field 1. 3. With the exception of the fields listed below follow the process for entering a patient on the waiting list above. Field Field Description Data No. 07 Urgency The urgency code for all RACP referrals is FT or BAPFT. BAPFT is used if the appointment is negotiated within one working day. 20 Provisional diagnosis RACP should be recorded on this line. Cambridge University Hospitals NHS Foundation Trust Page 23 of 71

Reminders: If the patient cancels or does not attend their appointment, any future offered appointment must be within 14 days of the cancelled or DNA'd appointment date. 17 PTRANS for UNSP patients/ change of consultant All patients who are entered onto OPWAIT with UNSP as the consultant code must be PTRANS d to the relevant consultant before the appointment is booked. 1. To do this, go into OPWAIT and select the waiting list entry. Type PTRANS at the control line The following screen will appear: 2. Enter the consultant who the patient will be seeing in field 3 and the specialty must be entered in field 4. Using the F2 function key will pull up the list of reasons (field 5) and select appropriate reason. File the information in the usual way. Go back into OPWAIT and check the waiting list entry, you will see that the desired consultant has now replaced UNSP in field 6. Cambridge University Hospitals NHS Foundation Trust Page 24 of 71

Outpatient partial booking Cambridge University Hospitals NHS Foundation Trust Page 25 of 71

18 Partial booking process (new referrals) Cambridge University Hospitals NHS Foundation Trust Page 26 of 71

18.1 Partial booking letter Invitation to phone (SURGI) Example: Dear MARY SMITH We are contacting you to arrange an appointment with a member of our dermatology clinic team. You may be asked to attend Addenbrooke's or one of our clinics held at another hospital. Please call us on 01223 245151 within seven days of receiving this letter, so we can arrange a convenient date and time for your appointment. You can call our appointment staff, Monday to Friday 9.00am to 5.00pm, except on bank holidays. They will ask you for your name, hospital number and daytime contact number. At busy times you may have to leave these details on our message service. If you no longer need an appointment it is important for you to let us know as soon as possible, so we can take you off our waiting list and update our records. Please be aware that if you do not call us within seven days we will transfer your care back to your GP or referring organisation that requested this appointment. Yours sincerely Clinic Co-ordinator Dermatology 19 Long term follow-up or specific procedure waiting list 19.1 Background When patients are to be listed for an outpatient procedure on a future date or booked as a long term follow-up the following process should be followed. Long term follow-ups are for patients that have been seen in clinic and require a further appointment more than six weeks in the future. Patients should not be given long term follow-up appointments of over one year unless there is a strong clinical need. (Note: You may have a local policy to work to a different timescale please contact your service manager). Only specific procedures within specific clinics that have been identified, can the process be used for. Cambridge University Hospitals NHS Foundation Trust Page 27 of 71

19.2 Rules If patient is a direct referral to a new service: complete outpatient waiting list entry complete outpatient follow-up waiting list entry. If patient is referred as part of follow-up: complete outpatient follow-up entry Do not double book ie if procedure is undertaken during normal clinic session (where decision for procedure is made), coding sheet should be completed to reflect this action. If patient returns to another appointment in a procedure clinic, then outpatient follow-up waiting list entry created and appointment booked in relevant clinic. 19.3 SPF or LTF waiting list entry 1. Type SPF from a main HISS menu to display follow-up waiting list menu Short Codes to access 2 options: Follow-up Waiting List entry SPFWAIT Follow-up Waiting List Errors SPFWL 2. Select Option 1 or type short code SPFWAIT and Enter valid CRN for patient. Patient details display and any existing FUWL entries would be visible. Please note: Search facilities eg: Name/ DOB are not available and L Last is also not available. 3. Press Enter to continue and auto number generate the next FUWL number. 4. Field details: Fields 03 to 08 and 12 are the same as on OPWAIT and should be completed accurately. Cambridge University Hospitals NHS Foundation Trust Page 28 of 71

Field 6 Waiting List Type If using elective planned (EP) this will activate Field 14 estimated date to be mandatory and date of planned procedure must be recorded. Field 7 Urgency Enter relevant urgency code. However, if any of the following codes are used CP/FT/BAPCP or BAPFT, then Field 12 Cancer Ref Type then becomes mandatory. Field 9 Referral Code Field 09 is either SP specific procedure or LTF long term follow-up. Use F2 to display codes If SP is selected then field 10 procedure code is mandatory and must be accurately completed. Use F2 to display codes If LTF is selected then field 10 is non mandatory but field 13 estimated date becomes mandatory. Field 11 Preferred Clinic Field 11 preferred clinic is mandatory and MUST be the clinic the patient will be booked into (this is exactly the same as on OPWAIT). The invitation to phone letter, if selected, will use the detail from this clinic to add in telephone contact numbers. PLEASE NOTE: If at booking the patient is to be listed on another clinic then this field must be changed prior to the appointment being booked. Field 12 Cancer Ref Type This field becomes mandatory when CP/FT/BAPCP or BAPFT Urgency codes (Field 7) are entered. Use F2 to display full list of types to select. Field 13 Decision to Treat Date Enter date same process as for Wait Field 14 Estimated Date This will only become mandatory when using the Long Term Follow-Up procedure or Elective Planned (EP) and a date must then be entered which is an estimated date of next attendance. Field 15 16 Enter data the same as we would for OpWait remember to ensure the correct match from Field 08 Source. Cambridge University Hospitals NHS Foundation Trust Page 29 of 71

Field 17 Revised Date on List (Rev d DoL) Non mandatory - This field allows adjustment to the waiting time start date if the patient CNA s an appointment. This field warns if a future date is entered or if the date is more than one month in the past. The date cannot be before the decided to treat date or greater than the estimated date. Field 19 Status This will display current status as the patient moves through from NULL not booked to B booked, etc. This field would be used to cancel, remove or delete the waiting list entry (once any appointments are cancelled). File Entry 19.4 Cancelling entry Please note: If any entry has appointments booked these must be cancelled before any of these functions are used. 1. Select Follow-up Waiting List entry from Menu SPF or use short code SPFWAIT 2. Enter valid CRN and select relevant Follow-up Waiting List entry. 3. With the FUWL selected, type 19 at control to move cursor Message displays with options type C to Cancel. Field 18 must be completed with reason for cancellation before Filing. Move cursor to field 18, free text reason. File Entry Note: When displaying entry, status will show as cancelled (Field 19) Cambridge University Hospitals NHS Foundation Trust Page 30 of 71

19.5 Reversing a cancellation 1. Enter CRN - open FUWL entry 2. Type 19 to access Field 19 from control line. 3. If reinstating press enter to clear data and Field 18 will need to be updated File entry Entry will be visible again and cancelled status removed. 19.6 Removing FUWL Entry 1. Same process but using R emove in field 19 and will be prompted to use a valid code for the removal use F2 to display and select relevant option. 2. Comments must be recorded in Field 18 and File entry. 19.7 Reinstating FUWL Entry 3. Type R at Control Line and follow message; File when completed. 19.8 Booking appointments 1. Use the OPAPP screen in the normal way to book and cancel appointments. 2. FUWL entries will not be displayed on this screen to link to even if the appointment is CNEW; OPWAIT entries will display. 3. Bookings must match the FUWL entry in respect of: Preferred clinic change on FUWL if necessary before booking appointment Consultant change on FUWL if necessary before booking appointment Referral Reason must record SP specific procedure or LTF Cambridge University Hospitals NHS Foundation Trust Page 31 of 71

19.9 Matching process 1. The matching process must be run at least once a day to ensure that any booked appointments are matched to the waiting list entry and any cancelled appointments are removed and the waiting list entry updated. 2. Either navigate to SPF Menu and select Follow-Up WL Errors or type from a HISS main menu the shortcode SPFWL. 3. The matching process is automatically launched when the screen is opened. HISS will process the data for the next few minutes. During this time the cursor will be static in the top left corner of the HISS window. Please note: after a weekend this can take up to 5 minutes to process. 4. Any matches will be completed and the waiting list status will be updated. The criteria used to match is: preferred clinic consultant referral reason 19.10 Correcting errors When running the matching process any errors will appear on screen when the process is complete. You will see all the errors and not just your own. If no errors are found a message will appear on screen to confirm this and you can exit the screen. You must correct any errors for your service. Errors will occur where more than one possible match is found or SP or LTF is used and no waiting list exists for the patient. Matching process complete with no errors. Cambridge University Hospitals NHS Foundation Trust Page 32 of 71

Matching process showing errors 1. Select the error record by entering the line number. 2. If the message No possible FWL matches found is displayed then the appointment booked and the waiting list entry don t match or the patient is not on the waiting list. 3. Correct the waiting list or appointment (whichever is incorrect), or create a follow-up waiting list entry. 4. Once the error has been identified and corrected, a manual process for matching needs to take place. 5. Go back to the SPFWL match option from the menu and the records previously displayed with the errors will still be visible although you have made the relevant corrections. 6. Select the error record by entering the line number and press Enter. 7. A summary waiting list entry will be displayed. Select relevant record number again and press Enter; this will run a manual matching process. Cambridge University Hospitals NHS Foundation Trust Page 33 of 71

8. File the page to ensure the details are updated. This record will no longer appear on the error screen. Cambridge University Hospitals NHS Foundation Trust Page 34 of 71

Making appointments Cambridge University Hospitals NHS Foundation Trust Page 35 of 71

20 Booking rules It is expected that each clinic will develop booking rules to ensure the smooth running of the clinic. These should include: The clinic co-ordinator should review where necessary the appropriateness of the clinic templates. Any changes which increase or change activity should be notified to the commissioning department before any changes are made using the change of methodology of recording process. See appendix 2. Future acancy tables should be available to doctors before each clinic to help them assess availability of future slots if the consultant requires them. There should be clear local guidelines showing under what circumstances over booking and forced booking may take place. There should be local guidelines stating where extras can be fitted into the clinic. Local standards should be agreed for categorising patients as urgent and routine. Where clinics are cancelled, the clinic co-ordinator should endeavour to make use of the spare capacity. Cambridge University Hospitals NHS Foundation Trust Page 36 of 71

21 New appointments 21.1 Definition A letter is received from a GP or other referrer consultant requesting their patient is seen for a clinical problem they cannot deal with. One referral should generate only one new appointment. A new appointment should be booked if: the patient has not seen this consultant team before or the patient has previously been discharged by the consultant. Some clinics are organised so that a patient may be seen by a different consultant team (within the same specialty and for the same course of treatment) on subsequent follow-up visits. Where this is the case, these are follow-up visits. Reminders: Please see the medical director s letter regarding consultant to consultant referrals. If the referral is outside the agreed pathways for consultant to consultant referrals the patient should return to their GP to request a referral. 21.2 Procedure When a patient responds to their invitation to phone letter an appointment date must be negotiated with the patient. 1. At the main menu screen type OPAPP and press enter, this will take you to the appointment entry screen. Alternatively, type OPWAIT and select the waiting list entry and type BOOK. 2. Check RTTVIEW or JCIS to ascertain the various target dates for the patient. 3. Enter the clinic code and select an appointment date. 4. Enter patient hospital number ensuring that correct patient details are displayed before commencing. 5. Select type of appointment to be booked. Note: All NEW appointments must have an outpatient waiting list, (OPWAIT) entry. When a NEW appointment type is selected a list of waiting list entries will be displayed. Ensure the correct entry is selected and proceed with the booking. Cambridge University Hospitals NHS Foundation Trust Page 37 of 71

Note: If none of the listed waiting list entries are relevant then using F1 will take you back to the main screen. 6. Complete the appointment entry screen using the normal booking procedure. Ensure you choose the correct referral reason in field 11. 7. Type B at the control to book the appointment. 8. Select letter to be sent to patient. 9. Extra information may be added to the appointment letter by using the F2 function key. 22 Overbooking/forcing a booking into clinics Sometimes it may be necessary to overbook a clinic or force and appointment into a different type or slot. For example, a new appointment can be forced into a follow-up slot. Force Booking:Booking a new patient into a return patients slot. Over Booking: Booking more than one patient in any one slot of the same type. Cambridge University Hospitals NHS Foundation Trust Page 38 of 71

22.1 Procedure Overbooking 1. If necessary, the appointment slot for a particular appointment type can be overbooked. 2. Entry of these patients details are through the OPAPP entry screen. 3. Fields 1 to 7 of this screen should be completed normally. 4. When the system offers to search for a vacant appointment enter N and the cursor will move to field 8 (time). 5. Enter the required time, which will generate a message. Press enter at the field. Instead of a time being displayed, you will be asked for your overbooking authority. 6. Enter your password. Provided you have sufficient authority a time is now automatically displayed in field 8 appropriate for the appointment type that is being overbooked. 7. The remainder of the fields on the screen are completed as normal. 8. On completion of the fields enter B to confirm the booking. 9. Over bookings are shown in reports with an asterisk ( * ). Force booking 1. If necessary, an appointment slot type can be forced into the time of a different slot type. 2. Entry of these patients details are through the OPAPP entry screen. 3. Field 1 to 7 of this screen should be completed normally. 4. When you are asked if you want to search for a vacancy, enter N. 5. The cursor will move to field 8 (time). If you enter a time for an appointment reserved for a different appointment type, you will be asked if you want to force this into another type. 6. Answering Y will prompt you for your password. Provided you have sufficient authority the system accepts the time you entered into field 8. 7. The remainder of the fields on the screen are completed as normal. 8. On completion of the fields, enter B to confirm the booking. You will be prompted to close any clinic slots. Press N. 9. Forced bookings are shown in reports with an f. Cambridge University Hospitals NHS Foundation Trust Page 39 of 71

23 Walk-in patients - extras Patients who attend at clinic where no pre-booked appointment is recorded on HISS. 23.1 Procedure 1. At the main menu screen type OPAPP and press enter, this will take you to the appointment entry screen. 2. Enter clinic details and select date. 3. Enter patient hospital number and check correct patient details are displayed. The patient s demographics must be checked and corrected if necessary. 4. Select type of appointment to be booked. 5. Fields 1 to 7 of this screen are completed normally. When the cursor moves to time, field 8, enter EXT to indicate that this is an extra booking. 6. If the clinic is fully booked, the system will inform you that there are no appointments of this type available and offers to search for a vacancy. Enter N to continue. 7. The remainder of the fields on the screen are completed normally. 8. At the control line you enter EXTRA as the booking command. Reminders: Introducing extras to a clinic can only be done either on the day the clinic runs or retrospectively. 24 Follow-up appointment Having been seen in a clinic a patient requires a further appointment. Patients should negotiate their follow-up appointment before leaving the clinic. 24.1 Procedure 1. Book follow-up appointment using standard booking procedures. 2. Follow up appointments negotiated with patients on leaving clinic are classified as direct or full bookings and coded BAP. 3. If Reminder letter; selection is displayed select relevant letter code. Cambridge University Hospitals NHS Foundation Trust Page 40 of 71

25 Ward follow-up appointments Patients requiring a ward follow-up appointment fall into the following categories: 1. Patient has been admitted to hospital as an emergency under the consultant team but is not a current Addenbrooke s patient, e.g never been seen at Addenbrooke s or at an Addenbrooke s outreach clinic or has been previously discharged. In this scenario the follow-up appointment should be booked as appointment type WFN (ward follow-up new). 2. Patient has been admitted to hospital under an admitting specialty and has been seen on the ward by a different visiting consultant team. The visiting team require a follow-up appointment with the patient. The patient has never been seen by consultant team clinic at Addenbrooke s or at an Addenbrooke s outreach clinic or previously discharged. In this scenario the follow-up appointment should be booked as appointment type WFN (ward follow-up new). 3. Patient has been admitted to hospital and an outpatient follow-up appointment is requested. Patient is a current patient of the consultant team. The appointment should be booked as appointment type WFU (ward follow-up). Reminders: All ward follow-up new appointments are booked as elective planned (EP). Cambridge University Hospitals NHS Foundation Trust Page 41 of 71

Cancelling and rebooking appointments and clinics Cambridge University Hospitals NHS Foundation Trust Page 42 of 71

26 Could not attend (CNA) a new appointment Patients who have negotiated an outpatient appointment date and who later contact the clinic to advise they are unable to attend but still want an appointment. This should be read in conjunction with the waiting list access policy. 26.1 Procedure Rebook and time of cancellation 1. At the main menu screen type OPAPP and press enter, this will take you to the appointment entry screen. Select the correct patient and appointment. 2. Ent Enter reason for cancellation in remarks field by typing 12 at control line (field number 12), this will take you to remarks field, enter details and press enter, this will take you back to the control line. 3. Enter CNA code at control line (see below) 4. Select Y if rebooking at time of cancellation. The rebook screen will appear. If you are re-booking at a later time select N but do not remove from the waiting list when prompted. Cambridge University Hospitals NHS Foundation Trust Page 43 of 71

5. Type B followed by the number of the appointment you wish to choose, e.g. B7 and then B to book the appointment. Send a rebook letter only if the patient requests it. 26.2 Procedure Rebook appointment later 1. At the main menu screen type OPAPP and press enter, this will take you to the appointment entry screen. Select the cancelled appointment and then type RR (remove and refresh) at the control line. This will remove the CNA status. 2. Re-enter the CNA' and select Y to rebook another appointment. Cambridge University Hospitals NHS Foundation Trust Page 44 of 71

3. The rebook screen will appear. 4. Type B followed by the number of the appointment you wish to choose, e.g. B7 and then B to book the appointment. Send a rebook letter only if the patient requests it. 27 Cancelled by patient (CP) Patients who have been informed of their outpatient appointment date and who contact the clinic to cancel the appointment and do not want to re-book. 27.1 Procedure On receipt of patient cancellation request clinic staff will make enquiries as to the reason for cancellation, advise the patient they will have to go back to their GP should they require a referral in the future. 1. At the main menu screen type OPAPP and press enter, this will take you to the appointment entry screen. Select the correct patient and appointment. 2. Enter reason for cancellation in remarks field by typing 12 at control line (field number 12), this will take you to remarks field, enter details and press enter, this will take you back to the control line. Cambridge University Hospitals NHS Foundation Trust Page 45 of 71

3. Enter CP code at control line (see below) and type N when asked if you want to rebook another appointment. 4. If the appointment being cancelled is a NEW appointment the following prompt will appear - Remove from waiting list Y/N. Type Y. 5. Message displayed enter removal reason code F2 (help) will display list of codes to select from. Choose correct removal code. 6. Message prompt for cancellation letter Y (yes)/n (no) only send letter if patient requests. Reminders: Email the 18 week office if a patient is cancelled as CP and requires no further appointments. 28 Clinic cancellation procedure A request is made to cancel a clinic session. Requests should not be actioned without approval of DSM or equivalent authority. Patients can either be individually cancelled and rebooked or the whole clinic cancelled and rebooked. Cambridge University Hospitals NHS Foundation Trust Page 46 of 71

28.1 Procedure individually cancelled Before commencing ensure that the clinic list is printed. Follow the processes outlined in section 24 but use CC as the cancellation code. If rebooking appointments later then follow details in section 24.2 ensuring that CC is used. 1. Select appointment to be cancelled. 2. Enter CC cancellation code at control line. 3. Rebook appointment using rebooking procedure see section 24. 4. Send rebook letters if required. 28.2 Procedure Cancel whole clinic Before commencing ensure that the clinic list is printed. 1. At the main menu screen type OPDATA and then select Reschedule with Cancel. 2. Enter the clinic code, consultant code, date and day for the clinic to be cancelled and F File. 3. Any patients cancelled with appear on screen to be rebooked. Cambridge University Hospitals NHS Foundation Trust Page 47 of 71

4. The patients will stay in this hold file until they are rebooked. 5. The appointment hold file can be accessed by typing OPICK at the control line. 6. To rebook the patients type B followed by the number next to the patient you wish to rebook, eg B1 7. The rebook screen will appear. 8. Type B followed by the number of the appointment you wish to choose, e.g. B7 and then B to book the appointment. Send a rebook letter only if required. 9. Book the appointment as normal. You will be returned to the hold file. Continue this process until all the patients are rebooked. Cambridge University Hospitals NHS Foundation Trust Page 48 of 71

28.3 Rebook clinic with AUTO (clinics with the same date/ time/ specialty) Please contact the HISS trainers on extension 2820 to update training skills. To rebook/move patients into another clinic of the same specialty on the same date and time. 1. The clinic must have been cancelled using the Reschedule with cancel see cancelling whole clinic. 2. The appointment hold file can be accessed by typing OPICK at the control line. 3. Type AUTO on the code line. The following screen will be displayed 4. Change the destination area to the new clinic and consultant codes and F File the screen. This would be used if a new consultant started but had the same template and schedule as the predecessor. 5. When the above screen is filed and password inserted, all appointments that match the criteria will automatically be rebooked onto the destination clinic on their original date and time. 6. The screen will return to the display and selection, listing any patients who could not be rebooked ie if the slot times don t match the new clinic. These need to be rebooked individually. See section 26.1. Cambridge University Hospitals NHS Foundation Trust Page 49 of 71

28.4 Rebook clinic using MASS (clinics with different date) Please contact the HISS trainers on extension 2820 to update training skills. 1. The clinic must have been cancelled using the Reschedule with cancel see cancelling whole clinic. 2. The appointment hold file can be accessed by typing OPICK at the control line. 3. Type MASS on the code line. 4. Enter the clinic date to be rescheduled in field 04 and the start date to look for slots field 5 and then F file. 5. Message displayed with new first appointment date selected, press return to accept. 6. This takes you to another screen with all the appointments rescheduled. Cambridge University Hospitals NHS Foundation Trust Page 50 of 71

7. Enter Y to confirm appointment(s) and file. If the appointment is not appropriate then N and rebook manually from the hold file see section 26.2. 8. Select rebook letter only if required. 9. All rebooked appointments can now be viewed via the OPAPP screen. Cambridge University Hospitals NHS Foundation Trust Page 51 of 71

Patient arrival at clinic Cambridge University Hospitals NHS Foundation Trust Page 52 of 71

29 Front of house policy Patients will be welcomed to clinic in a courteous and pleasant manner, and dealt with efficiently. 29.1 Procedure Patients will be welcomed to clinic and efficiently processed in conjunction with agreed Trust and local procedures. Confidentiality must be maintained when dealing with any patients or patient information in line with Trust policy. Staff will endeavour to respond to all patient concerns directly, without passing them between different departments. Access for disabled patients will be addressed locally eg hearing disability, stretcher access, wheelchair access, sight impairment etc. If patients or visitors demonstrate aggressive behaviour, support and back up are available from security (extension 3333). All patient alerts should be reviewed and necessary actions taken. 30 HISS downtime procedure (manual procedure) It is extremely unlikely that the system will become unavailable but should there be a period where it is unavailable then the following rules apply. The outcome of all attendances at clinic should be recorded on the appropriate clinic sheet and entered onto the system as soon as it becomes available. The time of the patients arrival, the time they were seen and the time they left the clinic should be recorded on the appropriate clinic sheet and entered onto the system as soon as it becomes available. Any patient needing to book a further appointment should be asked to leave their appointment slip and informed that they will be notified of their further appointment by post within the next two working days. Any special requests should be added to the appointment slip. Any walk-in patients or GP requested urgent appointments should be recorded on the appropriate clinic sheet and entered onto the system as soon as it becomes available. It is imperative that an accurate record be kept of all manually allocated appointments in order that the system can be updated when it is available. Where outpatient data is collected manually and entered onto HISS at a later date the above procedure should be followed to ensure that data entered onto HISS is accurate. Manual data entry should be completed within one working day of the system becoming available. Cambridge University Hospitals NHS Foundation Trust Page 53 of 71

31 Patient arrival When attending an outpatient clinic, all patients and patient information should be dealt with efficiently and consistently in conjunction with agreed Trust and local procedures. 1 31.1 On arrival 31.2 Subsequently Clear signs must be in place to ensure that patients are advised to report to the reception desk on arrival, to check in. Staff will ensure they capture arrival in real-time on HISS, and enter correct details on HISS. All relevant patient details must be clarified on registration screen, ensuring both the notes and computer held information are correct (see the collection of patient demographics section, below). If amendments are required, the front sheet of the notes should be updated, new addressograph labels and front sheet should be printed and old ones destroyed. All patients should be asked the following questions as they arrive for an appointment: Q: Have you lived in this country for the past 12 months? A: Yes or No If yes, no action required other than to record that the question was asked. This is done on the front sheet printout. If no, or admin ALERT on HISS shows OVSEA contact paying patients extension 2999/ 2565/ 6965 or bleep 151-661 Patients who arrive as extra to the clinic must be advised that they will be fitted into the clinic where possible, and informed that there may be some delay before they see their practitioner. All patients should be seen within 30 minutes of their appointment time. Any clinic delays will be advised to patients by means of a regularly updated whiteboard, plasma screen, or individually, as appropriate. All patient notes must be tracked correctly on HISS on the patient s arrival/ check in. Local procedures must be put into place concerning pre-test, x-rays etc, and any time delays fully explained to the patient. In accordance with medical records policy, local procedures must be in place for locating missing case notes and/or collecting a recent history for the practitioner to work with. For further information on medical records policies contact the patient records manager on extension 56274. All clinic lists must be updated with relevant DNA, CNA details etc and retained by the appropriate member of staff for 13 months. Cambridge University Hospitals NHS Foundation Trust Page 54 of 71

31.3 Collection of patient demographics All patients should be asked to confirm their: date of birth current address telephone number named GP and practice name and address If any details have changed then make the necessary amendments on HISS. The old patient labels and front sheet should be placed in the confidential waste and a new front sheet and a set of labels should be printed and placed securely in the notes. Cambridge University Hospitals NHS Foundation Trust Page 55 of 71

Patient disposal/ outcome at appointment Cambridge University Hospitals NHS Foundation Trust Page 56 of 71

32 Post session recording (PSR) All patients attending an outpatient appointment should have an arrival time, seen time, seen by, left time and/or discharge time and both a national and 18 week outcome recorded on HISS within 24 hours of the end of the clinic. To ensure that PSR is complete regular checks should be made using OPREC. 32.1 Recording clinic actual times Cambridge University Hospitals NHS Foundation Trust Page 57 of 71

Cambridge University Hospitals NHS Foundation Trust Page 58 of 71

32.2 Recording patient attendance details OPREC HISS Procedure Guidance Recording Patient Attendance OutPatient Reception Screen Field 1 Record patient Arrival time following normal procedures Field 2 Record patient Seen time Please note: It is mandatory to collect this information Recording who the patient was Seen By End Field 3: Enter the relevant code Consultant Code or Grade of Staff Code the patient was seen by. Available Codes: If lead consultant press Enter and accept the consultant default code. UNSP = Junior medic e.g. SpR, Reg, SHO, FY1, FY2 etc NURSE = Specialist Nurse, Nurse Consultant MWIFE = Midwife TECHN = Orthotist, Prothetist, Clinical Scientist AHP = Physiotherapist, Occupational Therapist, Speech & Language Therapist For Associate Consultant e.g. 2 consultants working from the clinic code or covering for the absent consultant, enter HISS code for that consultant. Reminder: If multi-professional/multidisciplinary don t forget to tick the coding box on Outpatient Sheet Cambridge University Hospitals NHS Foundation Trust Page 59 of 71

HISS Procedure Guidance Recording Patient Attendance OutPatient Reception Screen Field 4 Time Left: Record the time the patient was seen (this information will be available on the Patient Clinic Outcome sheet) Field 5 Discharged: Enter Y/N to identify whether the patient is to be discharged from clinic Recording the appointment outcome and next stage of the patient pathway End Field 6 Outcome: Enter the relevant code as indicated on the Patient Clinic Outcome sheet use F2 (Help) to display available codes and select if required. Note: If outcome code relates to discharge, Field 5 must indicate this otherwise mismatch will occur. Field 7 Attendance Status: Enter the relevant code identified on the Patient Clinic Outcome sheet - use F2 (Help) to display available codes and select if required. Add additional information in Remarks Field 08 and File The OPREC screen can be used to carry out PSR the next working day. It can also be used as a checking tool to ensure all PSR has been completed. Cambridge University Hospitals NHS Foundation Trust Page 60 of 71

33 Discharge procedure 33.1 Definition 33.2 Policy Patients who have attended an outpatient clinic and are subsequently discharged. The Trust will work in partnership with GPs to ensure appropriate discharge from the clinic. Patients will be made aware and given information on SOS contact details as appropriate. 34 Did not attend 34.1 Definition 34.2 Policy Patients who have been informed of their outpatient appointment date and who, without informing the Trust, did not attend the appointment The Trust will only re-book if there is a clinical decision to do so. The patient should be contacted in writing to explain the reason for removal/or new appointment date. No DNA should be re-booked without indicative clinical need. The GP/referrer should be informed of their removal and the patient re-referred at the GP/referrer discretion. 1. Type in number of relevant appointment. 2. Enter DNA in remarks field by typing 12 at control line (field number 12), this will take you to remarks field, enter details and press enter, this will take you back to the control line. 3. Enter DNA code (did not attend) at control line. 4. If clinically indicated, rebook appointment using rebooking procedure. Cambridge University Hospitals NHS Foundation Trust Page 61 of 71

35 HISS transport ordering Please refer to HISS transport (media ID 12033). 35.1 Procedure 35.1.1 Recording a DNA when NO further appointment is to be booked Recording a DNA via the OPAPP screen Select relevant appointment, enter DNA in remarks field by typing 12 at control line (field number 12), this will take you to remarks field, enter details and press enter, this will take you back to the control line. Enter DNA Enter N to identify no rebook required. Cambridge University Hospitals NHS Foundation Trust Page 62 of 71

Outcome prompt will be displayed Use F2 to display list of outcome codes Select DAD DNA no further appointment given Cambridge University Hospitals NHS Foundation Trust Page 63 of 71

35.1.2 Recording DNA when FURTHER appointment to be booked Recording a DNA via the OPAPP screen Select relevant appointment and enter DNA Enter Y to identify rebook required Continue with standard rebooking procedures Cambridge University Hospitals NHS Foundation Trust Page 64 of 71

When confirming rebooking by entering B to book prompt will be displayed to enter relevant Outcome Code. Use F2 to display list of outcome codes Select DDA DNA further appointment given 35.1.3 Changing DNA Outcome When a DNA has been recorded with an Outcome of No Further Appointment required (DAD), it is essential to follow the correct procedure for changing the outcome ie DDA. Cambridge University Hospitals NHS Foundation Trust Page 65 of 71

Display the DNA appointment Enter RR in the command line this action will remove the DNA, remove the original outcome code entered and refresh the current screen Cambridge University Hospitals NHS Foundation Trust Page 66 of 71

The appointment has now returned to Booked status allowing the DNA to be re-entered utilising the changed outcome status and code. Continue recording DNA as per standard procedures. 35.1.4 Recording a DNA via the OPREC screen Access Outpatient Reception screen by typing OPREC from a menu screen Display patient details and relevant outpatient appointment Use F1 to access the Code Line and type DNA OPREC screen continues with normal process for recording DNA and will prompt for Outcome Code to be entered. Cambridge University Hospitals NHS Foundation Trust Page 67 of 71