TrakCare guidance and referral process

Short Notice Cancellation On The Same Day

Contact RMC as close to 8am as possible to start cancelling the first day of patients.

Your Team Lead should also be contacted / informed as close to your start time as possible.

RMC will contact all patients up until 10.30am as a minimum (later if capacity allows).

Local admin should assist RMC in the cancellation process as soon as possible.

Any patients that RMC or local admin are unable to contact in person will remain on the clinic list with a note left via the appointment type stating whether a message was left, call made with no answer etc.

This will allow for these appointments to be managed locally later the same day.

RMC will only support this on the 1st day of absence, any subsequent days should be managed locally.
Student’s sickness will be managed/absorbed by the individual Physio depts.

Prior to cancelling any patients the clinic must be closed down using the not available icon as normal.

If there are no 'not available' icons, as the clinic is full:-

• Untick ‘Hide Closed Slots’ box and click 'Find' to make an icon available
• Once completing the not available process the final pop up window ‘Auto Bulk Transfer’ should be closed using the 'X' and not update so that the patients remain on the work list.
• The work list will then need to be refreshed to show the not available status. Patients can then be rescheduled and as their name disappears from the work list the appointment slot will disappear so that no-one else can be booked into the work list.

NB - If leaving a message for a patient regarding cancelling their appointment, for confidentiality, the message should say:- "We are calling to cancel your appointment for X date at X time, please call ...... to reschedule".

Clinician Daily Essentials Guide

1. Setting Clinic Preferences
2. Viewing electronic referrals
3. Labels
4. End of clinic process / Outcomes
5. FTA's
6. Not Available
7. Multi-slot override
8. Schedule view
9. In Progress & Cancelled Letters
10. MAPPA Alerts
11. Adding Alerts
12. Upgrading referrals
13. Outcomes & Discharges
14. SOP For Caseload Management
15. Ambulance Patients

Appendix 1 - Missing outcomes report

Appendix 2 - Not available reasons

Appendix 3 - Multi slot override

Appendix 4 - CS review preferences

Appendix 5 - A&E telephone numbers for MAPPA folder

Appendix 6 - SOP For Caseload Management Flowchart

Canned Text Guide

View the full TrakCare guide for AHP Services

The majority of NP appointments are arranged by RMC.

Urgent Manual referrals - used for patients requiring to be appointed immediately as per local agreements e.g. for drop in appliances / walking aids.

See guide - Making TrakCare Appointments

Page 1 - Making New Appointments
Page 2 - Making Follow Up Appointments
Page 2 - Rescheduling Appointments
Page 3 - Rearranging a FTA
Page 3 - Cancelling Appointments
Page 4 - Overbooking
Page 4 - Extended Treatment
Page 4 - Interpreters

MAPPA

RMC contact Team Lead in advance if a MAPPA Alert exists on a patient they appoint (see 'Clinician To Do' box for full details).

Local arrangements have been agreed for the following services:

• RAH Fracture & STI Clinic TrakCare Pathway
• GRI Casualty Clinic TrakCare Pathway

Correcting TrakCare Errors

Deleting In Progress Letters

Adding Alerts

TrakCare Error Report Guide

Checking Waiting List For Under 14's

Running Quadrant Missing Outcome Reports

Checking WL for Inappropriate F2F & Appliance

Here are some examples of OPWL errors. Look at the blank version first and see if you can work out what the error is and how to fix it, then look at the answers sheet.

OPWL Error Examples - Blank

OPWL Error Examples - Answers

New Patients

View electronic referral via 'Clinical Record' icon and 'Documents' tab (you do not need to print a copy).
Only print labels once patient has arrived via demographics icon.

End Of Clinic Process

• Change status from 'Booked' to 'Arrived' (no patient should sit at 'Booked' at the end of the day)
• Complete single patient outcomes
  • RTT: NP - Treatment started today. Returns - Treatment previously started
  • Outcome: Add as many as are relevant to that days session e.g. Re-app & MSK-Refer Physio Gym /Class
  • Click 'Add to list' & 'Update'
• Make 'Follow up appointment' as required (see 'Making Appointments' box)
• If placing patient 'On Hold', give the patient an Open Appointment Letter
• Complete the electronic outcome measure after all new patient assessments (and at discharge) - see outcome measure instructions for guidance.

Imaging Ordering On TrakCare

Only for staff with appropriate rights to order investigations on TrakCare, and although you will see a wide range of examinations available you must only order within your scope of entitlement. See imaging ordering on TrakCare guidance.

Results Sign Off

As of 2/9/19 paper results will no longer be sent to the clinician who ordered the investigation. Results should now be checked weekly and signed off electronically following the results sign off guide.

End Of Clinic Process

• Change status from 'Booked' to 'Not Attended' (no patient should sit at 'Booked' at the end of the day)
• Untick both 'Print patient letter' and 'Print Referring Doctor Letter' boxes, then 'Update', so no letter should print.
• Complete the single patient outcome
  • RTT: DNA no further appointment
  • Outcome: Discharged FTA/Canc last session
  • Click 'Add to list' & 'Update'
• A discharge letter should be sent to the GP electronically on TrakCare using the canned text and short code \fta (see 'Patient Discharge' box for further information).
• These outcomes automatically remove the patient from the waiting list and the patient will only be re-appointed if the patient makes contact as per SOP for MSK Physio referral management.

NB. Clinician's should always view the electronic referral via 'Clinical Record' icon and 'Documents' tab (you do not need to print a copy). It is the clinicians responsibility to make contact with the patient to reschedule if they feel there is a clinical reason/concern not to discharge the patient. In this circumstance RTT: Did not attend - rebook & Outcome: Re-appt should be selected.

Patient ready for Discharge from MSK Physiotherapy:

• Completed Rx
• On Hold - no further contact
• Patient FTA
• Patient cancelled and no further treatment required or no contact after 1 week

If Discharging from FTA, Cancelled or On Hold:

Go to worklist on the day the patient last attended or FTA.

Check 'Patient Activity Pop Up' to make sure no further MSK appointments have been made.

Open single patient outcome, type 't' to change date to todays date

Select appropriate Discharge outcome; Discharged completed treatment; Discharged from on hold; Discharged FTA/Canc last treatment;Self Discharge, click 'Add To List' and 'Update'.

Write discharge letters on TrakCare via 'Generic Letter' and 'GP' tabs, see DC Letter Flow Chart for more information. Discharge letters should be written using the service agreed canned text. The canned text and how to set it up is detailed in the Canned Text Guide. Once completed, write in notes date, 'electronic D/C sent' and sign.

NB - If an error is made with a letter that is still 'In Progress' and requires to be deleted, change the 'Letter Status' to 'Cancelled' then contact your Team Lead who will delete it. If a letter has been authorised with incorrect information follow this guide - Fixing An Authorised Letter

Regularly check 'CS Review' and 'Clinician Approved' for letters 'In Progress' or 'Cancelled' that may still require action. See 'Clinician To Do' box for more information.

Always complete the electronic outcome measure when a patient is discharged - Outcome Measure Instructions

Refer to Full AHP DC Letter Guide for more detailed guidance.

Referral Sources

GP - SCI / Electronic referrals, processed by RMC.
Paper referral - e.g. Self Referral, Orthopaedic referrals, processed by local admin staff.

See guide for:

• Adding Referrals
• Back To Referrer Cover Letter

Page 1 - Adding paper referral (not vetted)

Page 3 - Adding paper referral (vetted - to be given an immediate appointment)

Page 4 - Scanning referrals in

If a TJ number is created when adding a referral, this CHI Request Form must be filled in and e-mailed to:-
NewCHI.Request@ggc.scot.nhs.uk

Patients name will disappear from worklist & will either be a blank space or filled with another patient.

To view patients who have rescheduled or cancelled look at 'Schedule View' on a daily basis & document in patient notes (see 'Clinician to do' box for more information).

Cancellations may have a message which can be viewed by clicking on the appointment type e.g. 'RMSK'. This can be done via 'Schedule View' or 'Patient Activity'. If there is no message, presume discharge after 1 week if no contact.

Reschedules - check 'Patient Activity Pop Up' to ensure next appointment is satisfactory with clinician.

If a patient is rescheduling repeatedly and you do not want them to be given another appointment due to this, add a comment via the appointment type on your work list or via patient activity so RMC know not to reschedule the patient again if they call

RMC & MSK practice is not to reschedule a patient more than 3 times.

See 'MSK SOP' box for attendance policy.

End Of Clinic Process

Change status from 'Booked' to 'Not Attended' (no patient should be sitting at 'Booked' at the end of the day). Untick both 'Print patient letter' and 'Print referring doctor letter'.

Complete single patient outcomes

• RTT: 'DNA - No Further Appointment'
• Outcome: 'Discharged FTA/Canc. last session'

Click 'Add to list' & 'Update'

Complete a discharge letter using the canned text short code \dc.

If the patient contacts within 24 hours and is rescheduled, explain to them that a DNA letter has been sent to their GP and can be disregarded.

If you have clinical concerns and feel the patient must be seen then you are responsible for contacting them to arrange a further appointment either by phone or letter. In that circumstance please select;

• RTT: 'DNA - rebook'
• Outcome: 'Re-appt' should be selected.

If the patient comes into the department or phones in after 24 hours, staff can also use their discretion and re-appoint if there is a clinical concern.

If the decision is to reappoint, a further appointment can be made using “FTA & Rebook” from their last appointment. The outcomes do not need to be changed on the appointment they did not attend and although a discharge letter will have already been sent, a further letter does not need to be sent until the patient completes their full course of treatment.

Each department should have a copy of the contingency plan along with 50 copies of the 'TrakCare Downtime' sheets printed out so they are available in case of any IT failure.

• Raise The Alert
• Implementing Contingency Plans
• Viewing Your Worklist On Clinical Portal
• Seeing Your Patient's
• TrakCare Down Time Record Sheet
• Electronic Clinical Records

Vetting guide MSK Physiotherapy

Vetting is carried out daily on a Quadrant basis via local rota's.  No referral should sit longer than 2 working days to be vetted.

Vetting priority: Urgent phone call, Urgent or Routine

Vetting outcome: e.g. New MSK (Quadrant), Back MSK (Quadrant) etc (see vetting guides below).

NB - Referrals NOT for the MSK Physiotherapy Service must be vetted only using one of the following two options (please do not select any other options, as this creates waiting list errors):-

1. SCI Referrals - X1 Back to Referrer (SCI Gateway referrals ONLY - not Internal Referral)
2. Scanned Referrals - X Scan AHP Inapprop Ref - Letter Sent / WL Removed

Vetting Letters:

These letters can be opened, amended then printed for individual patients as required.

Back To Referrer - Cover Letter

Failed To Complete Self Referral - Cover Letter

Low Back Pain <2 weeks - On Hold Letter In Various Languages

Back Pain Information Leaflet In Various Languages

Bells Palsy information leaflet and vetting letters

Occupational Health Suggestion Letter

Canned text can be used when vetting a SCI referral, to inform a GP regarding downgrading their referral from urgent to routine (\urg), that a referral is inappropriate for our service (\inap), to give them information regarding a Bells Palsy referral (\bp) and to advise then that a Vestibular Referral has been redirected (\vest) - see the Canned Text Guide for more information.

If a referral is not for our service it should be returned to the referrer with the appropriate cover letter or canned text. You can refer to the Redirection of Referrals guide to help advise the referrer where they should refer the patient.

Referral Management Centre do the following:-

• Urgent Phone Calls: Phone patients to appoint them, if no contact is achieved an opt in letter is sent.
• Urgent: Opted in daily and appointed.
• Routine: Opted in by date order according to waiting times and appointed.
• Monitor and fill unused NP slots 72 hours ahead.
• Convert unused double return, review or injection slots to a NP slot at 72 hours.
• Remove patients from waiting list who have:
  • Not replied to opt in letters (incl LBP On holds)
  • Failed to attend a NP appointment
• Reschedule or cancel patients who are unable to attend
• Reschedule patients on the first day of short notice clinic cancellations e.g. staff sickness - see 'Clinic Cancellations' box for more information.

See guide for Waiting List Management.

Page 1 - Looking up a full quadrant waiting list
Page 1 - Looking up an individual waiting list entry
Page 2 - Remove / Reinstate patients
Page 2 - Unavailability

If a patient contacts any department or RMC to enquire about where they are on the waiting list, the following guidance should be followed - Waiting List Enquiries Guidance

RMC SOP