Inter Trust Transfer Policy (ITTP) Supporting Inter Provider Transfers

Transcription

1 Inter Trust Transfer Plicy (ITTP) Supprting Inter Prvider Transfers Versin: VERSION 1.11 Name f authr/jb title: Mairéad Lyns, Directr Integrated Cancer, UCLPartners Lndn Cancer Fergus Brwne Operatins Manager Onclgy, Ryal Free NHS Fundatin Trust Date issued: 04 June 2015 Dcument Review Date : 01 Nvember 2015 Target audience: Clinicians and Managers acrss Lndn Cancer Lndn Cancer Inter Trust Referral Plicy Versin June

2 VERSION CONTROL SCHEDULE Versin number Issue / Review Date Amendments frm previus issue 1 13 Nv 2014 ML and FB first draft 2 17 Nv 2014 Small edits t frnt page and t images, ML 3 20 Nv 2014 Insert flw chart diagrams and crrectin f sectin headings, fnt, frmat and page numbering ML 4 15 Jan 2015 Infrmatin requirements fr transfer frms ML 5 09 Feb 2015 Edits fllwing ITT wrkshp n 03 Feb 2015 ML 6 10 Feb 2015 Clarificatins n minimum dataset 62 day CWT ML 7 13 Feb 2015 Minr edits and frmats fllwing feedback ML 8 17 Feb 2015 Appendices and frmatting pst feedback ML 9 03 March 2015 Escalatin diagram tidied and inserts t clinical referral infrmatin requirements May 2015 Cntact details added fr Trusts PA 11 4 June 2015 Renal pathway added t appendices Lndn Cancer Inter Trust Referral Plicy Versin June

3 CONTENTS Page 1 Intrductin 4 2. Objectives 4 3. Scpe 4 4. Why infrmatin needs t be cmmunicated 4 5. Wh is respnsible fr cmmunicating the infrmatin 4-6 Scenaris ne and tw Breach cncerns Hw the infrmatin shuld be cmmunicated When the infrmatin shuld be cmmunicated Inter Trust Transfer (ITT) escalatin prcess ITTP feedback and mnitring prcess 12 Appendices Example f lcal applicatin f ITTP a. Inter Trust Transfer fr Oesphaggastric Pathway b. Inter Trust Transfer fr Urlgy Pathway c. Inter Trust Transfer fr Renal Pathway d. Trust cntact details Lndn Cancer Inter Trust Referral Plicy Versin June

4 1. Intrductin This dcument details the prcesses fr the cmmunicatin f infrmatin in relatin t suspected and/r cnfirmed cancer patients whse care is transferred frm ne prvider t anther within the Lndn Cancer integrated cancer system. 2. Objectives This dcument aims t underpin effective and timely cmmunicatin t ensure efficient transfer f patients between rganisatins invlved in cancer pathways. This dcument describes the escalatin prcess within tertiary centres acrss Lndn Cancer shuld referring rganisatins have any cncerns r queries regarding the pathway management f tertiary referrals. This dcument will address the fllwing peratinal principles: Sectin 4 Why infrmatin needs t be cmmunicated Sectin 5 Wh is respnsible fr cmmunicating the infrmatin Sectin 5 What data items need t be cmmunicated Sectin 4 Hw the infrmatin shuld be cmmunicated Sectin 6 Breach management Sectin 8 The pint in the pathway that the infrmatin needs t be cmmunicated Sectin 9 Escalatin prcess when delays in inter trust transfer (ITTP) pathway ccur Sectin 10 ITTP feedback and mnitring prcess Appendices 3. Scpe This plicy is applicable t clinical, managerial and administrative staff invlved in the referral f patients and related t this the infrmatin prvisin and perfrmance mnitring f cancer pathways acrss Lndn Cancer. 4. Why infrmatin needs t be cmmunicated 4.1 Patient delays are avided: T ensure that patients are treated quickly, they must be referred within timelines that supprt achieving the cancer waiting times (CWT) targets fr the trusts invlved in the patient s care. Perfrmance against the CWT targets is mnitred using the Natinal Cancer Waiting Times Database (Open Exeter); 5. Wh is respnsible fr cmmunicating the infrmatin needed t refer the patient? 5.1 Respnsibility fr recrding and cmmunicating accurate infrmatin in a timely manner needed fr patient referral lies with fur key grups: Lndn Cancer Inter Trust Referral Plicy Versin June

5 The clinicians invlved in the Multidisciplinary teams are respnsible fr the care f the patient and shuld ensure that infrmatin is made available t allw it t be recrded prspectively and electrnically. The respnsible clinicians, MDT c-rdinatrs and cancer pathway c-rdinatrs shuld ensure that the infrmatin is transferred within the timescale specified(ne wrking day), and shuld establish rbust lines f cmmunicatin with their clleagues in ther Lndn Cancer rganisatins. The trust executive leads and cancer managers shuld ensure that ITTP prcess is adhered t fr all patients transferred ut f their rganizatin s that patients are treated as quickly as pssible. Treating patients as quickly as pssible will ensure that cancer waiting times are met at all levels thrughut each trust. Patients must be transferred by day 31 if mre investigatins are required r by day 38 if treatment is decided and further diagnstic investigatins are nt necessary. 5.2 What data items need t be cmmunicated, Minimum Dataset? Infrmatin required fr referral regardless f the type f frm: Patient NHS number Referring hspital, name and cntact details f referring clinician Receiving hspital name and wh is receiving the referral Cancer type, pathway indicated Patient full name, age, gender, cntact details, next f kin GP name and cntact details Date f referral; t tertiary r ther prvider Specify urgency and 62 day clck start e.g. 2WW, cnsultant upgrade, 62day pathway, and day number Clinical infrmatin and diagnsis, decisin t treat made when (date) Ntify breach risk/date Date first seen and by whm Delays, if any and why Patient is infrmed and aware f referral and prcess All infrmatin required t treat prvided e.g. radilgy, pathlgy, medical histry 5.3 Respnsibility f cmmunicating infrmatin frm Specialist MDTs Sme scenaris are prvided belw t illustrate the critical pints fr cmmunicatin in an inter trust transfer. Scenari 1: Patient is referred frm Trust A t a Specialist MDT (SMDT) at Trust B fr discussin and decisin n a treatment plan. The fllwing infrmatin is required t enable an efficient and effective referral t be cmpleted by MDT c-rdinatr and sent t MDT c-rdinatr: Outcme f lcal MDT Referral letter OR relevant clinical infrmatin Lndn Cancer Inter Trust Referral Plicy Versin June

6 Patient demgraphics Any available radilgy, histpathlgy slides and reprts Imaging scans (details f scans available, the lcatin taken, sent n IEP) Cancer waiting times ptential fr breach if applicable Cnfirmatin that the patient has been tld that they are being referred t the SMDT at anther trust fr pinin n treatment plan The utcme f the MDT discussin is that the patient shuld be treated in Trust B Trust B MDT C-rdinatr (the hst trust f the SMDT) will cmmunicate the SMDT utcmes t Trust A within ne wrking day f the MDT. Outcmes must be clear, recmmendatins must be actinable and timescales must be prvided. Trust A must prvide an appintment t infrm the patient f the decisin frm the SMDT fr nward referral and care. At this pint it must be explained t the patient that their fllw up care will cntinue at Trust A nce the specialist care has been delivered in Trust B. It is then the respnsibility f Trust A t frmally refer the patient details t Trust B if this is the utcme f SMDT. An inter trust transfer frm must then be cmpleted by the MDT c-rdinatr and sent t the SMDT c-rdinatr within ne wrking day. Lndn Cancer Inter Trust Referral Plicy Versin June

7 Scenari 1 TRUST A Decisin t refer t SMDT at Trust B fr discussin and treatment decisin. A prvisinal referral frm is cmpleted with all necessary clinical infrmatin t supprt SMDT discussin and sent t Trust B Patient is infrmed that their case will be cnsidered at anther trust in a specialist MDT t cnfirm the treatment plan. They will be given an appintment t discuss the utcme f the SMDT TRUST B (SMDT hst) Patient is discussed at SMDT at Trust B; Outcme is decisin t treat at Trust B Nte if yu are nt referring t an SMDT but are making a direct transfer t anther hspital please cntinue frm this pint. Infrm the patient and cmplete a transfer frm prviding all the necessary clinical and patient infrmatin required TRUST B (SMDT hst) Must cmmunicate utcme f SMDT t Trust A within ne wrking day TRUST A Infrms patient f decisin frm SMDT and explains the need t refer them Trust B fr specialist care and that they will return t Trust A fr fllw up care. Trust A prvides the next appintment date at Trust B Trust A Cmpletes an inter trust transfer/referral frm and sends t Trust B. This frm is the riginal referral frm with decisin f SMDT and any ther infrmatin required TRUST B Receives referral frm and required infrmatin frm Trust A. Trust B cntacts the patient t cnfirm next appintment A clinician referral letter is nt required t initiate the arrangements fr the transfer and future appintments at Trust B nce the decisin is recrded at SMDT. This may vary by pathway but is agreed in principle by peratinal leads in Lndn Cancer Lndn Cancer Inter Trust Referral Plicy Versin June

8 Scenari 2: Patient is referred frm Trust A t a Specialist MDT (SMDT) at Trust B fr discussin and decisin. The fllwing infrmatin is required t enable an efficient and effective referral t be cmpleted by MDT c-rdinatr and sent t SMDT c-rdinatr: Outcme f lcal MDT Referral letter OR relevant clinical infrmatin Patient demgraphics Any available radilgy, histpathlgy slides and reprts Imaging scans (details f scans available, the lcatin taken, sent n IEP) Cancer waiting times ptential fr breach if applicable Cnfirmatin that the patient has been tld that they are being referred t the SMDT at anther trust fr pinin n treatment plan The utcme f the MDT discussin is that the patient shuld be seen at Trust B. Trust B (the hst trust f the SMDT) will cmmunicate the SMDT utcmes t Trust A. Trust A must infrm the patient f the decisin fr nward referral. It is then the respnsibility f Trust A t cmplete the frmal referral prcess as set ut abve t Trust B. After being seen at Trust B the decisin is that the patient shuld receive treatment at Trust C. Example where raditherapy is nt available in Trust A r is gegraphically / travel clser fr the patient in Trust C Trust B shuld then discuss the ptins with the patient as t where they can receive the prpsed treatment. Trust B shuld cmplete a frmal referral f the patient t Trust C fllwing prcess utlined abve and ntify Trust A f the date f referral. Cancer waiting times infrmatin shuld be cmmunicated at this pint als s that patient des nt breach. Lndn Cancer Inter Trust Referral Plicy Versin June

9 TRUST A Decisin t refer patient t SMDT at Trust B fr discussin and treatment decisin TRUST B (SMDT hst) Discussed at SMDT at Trust B; Outcme is decisin t treat at Trust B TRUST B (SMDT hst) Must cmmunicate utcme f SMDT t Trust A within ne wrking day Patient is infrmed that their case will be cnsidered at anther trust in a specialist MDT t cnfirm the treatment plan. They will be given an appintment t discuss the utcme f the SMDT TRUST B Cmpletes referral frm and sends t Trust C. Trust B infrms the patient f nward referral and where apprpriate prvides chice f prvider TRUST B Patient is seen at Trust B. Outcme is decisin t refer t Trust C fr treatment. TRUST A Infrms patient f decisin frm SMDT and explains the need t refer them Trust B fr specialist care and that they will return t Trust A fr fllw up care. Trust A prvides the next appintment date at Trust B t the patient Trust A Cmpletes an inter trust transfer/referral frm and sends t Trust B. This frm is the riginal referral frm with decisin f SMDT and any ther infrmatin required TRUST B Sends cpy f referral t Trust A (the first seen Trust) TRUST C Receives referral frm Trust B and prvides treatment t patient. Trust C infrms Trust A when treatment starts s CWT and breach risk is managed A clinician referral letter is nt required t initiate the arrangements fr the transfer and future appintments at Trust B nce the decisin is recrded at SMDT. This may vary by pathway but is agreed in principle by peratinal leads in Lndn Cancer Patient returns t Trust A fr lcal fllw up Lndn Cancer Inter Trust Referral Plicy Versin June

10 6. Breach cncerns Any missing infrmatin has t be identified back t the MDT c-rdinatr at pint and time f receipt. This infrmatin shuld be prvided back t the receiving trust within ne wrking day. Any subsequent delays in receiving this infrmatin must be escalated t the respnsible manager and clinician if nt received within 48 hurs. Breach risk shuld be ntified and number f days n the 62 day pathway shuld be made clear. 7. Hw the infrmatin shuld be cmmunicated It is the recmmendatin f Lndn Cancer that MDT c-rdinatrs are the key respnsible psitins fr cmmunicating the patient infrmatin fr discussin/decisin at SMDT and fr referral. Regardless f trust mechanisms fr receiving transfers e.g. centralised ffice fr referrals, accuntability fr the transfer f the patient must remain with the MDT c-rdinatr. 7.1 Paper Infrmatin Each trust has previusly signed up t the Lndn Cancer Infrmatin Sharing Agreement (data transfer plicy) and is expected t bserve best practice Infrmatin Gvernance. Electrnic referral is desired and n handwritten frms will be accepted. Paper based referral shuld be avided where pssible. 7.2 Verbal Infrmatin Rbust lines f cmmunicatin shuld be established between all peple wh cllect Cancer Waiting Times data acrss Lndn Cancer. Queries and anmalies, in particular ptential breaches, shuld be highlighted and reslved as quickly as pssible Infrmatin Patient identifiable, cnfidential and r sensitive infrmatin shuld nly be transferred using NHS.net accunts r ther secure electrnic transfer such as the inter trust referral prtal. The latter is run by IG Spectrum and thse wishing t avail f it will need t make arrangements with IGSpectrum supprt@igspectrum.cm. It is recmmended that each rganisatin shuld establish ne central address (nn persn reliant) fr receipt and referral f the infrmatin. This accunt shuld then be accessible t all relevant and apprpriate persnnel within each tumur specific team and cancer perfrmance mnitring team. It shuld be nted that this methd f transfer is nly secure when the infrmatin is being sent t and received by anther NHS.net accunt. 8. When the infrmatin shuld be cmmunicated 8.2 Infrmatin transferred frm Treating Trust t First Seen Trust First definitive treatment Lndn Cancer Inter Trust Referral Plicy Versin June

11 The infrmatin shuld be transferred frm the Treating Trust t the First Seen Trust within 7wrking days f the First Definitive Treatment. This is critical fr the First Seen Trust s they can agree t clse ff the referral and stp tracking the patient as part f the CWT prcess ITTP feedback and mnitring prcess / general updates If a patient n a 62 day pathway / upgrade pathway is referred t anther prvider fr treatment, the treating trust will prvide a weekly infrmatin update t the referring Trust. Updates will be sent ut electrnically in a standardised frmat t an NHS.net r ther secure accunt, n a weekly basis. 9. ITTP escalatin prcess As a principle, the diagnstic / treating Trust will make every effrt t ensure that patients are managed in accrdance with the clinical pririty, in chrnlgical rder and breach date. Hwever if after receiving the weekly update, the referring Trust has any issues r cncerns regarding a patient pathway the fllwing escalatin steps shuld be fllwed in an attempt t reslve the situatin. a) Reslutin via Cancer Tracker / C-rdinatrs The Cancer Tracker / C-rdinatr at the diagnstic / treating Trust will lk t initially reslve any prblems r delays that may arise as requested. b) Reslutin by the Cancer Manager / Perfrmance Manager Where a delay cannt be reslved by the Cancer Tracker / C-rdinatr, this will be escalated by the referring Trust in accrdance with the prcess utlined belw. Lndn Cancer Inter Trust Referral Plicy Versin June

12 Please refer t Appendix B fr the cntact details fr the relevant individuals within each rganisatin acrss GMCCN. 10. ITTP feedback and mnitring prcess: It is recmmended that MDT c-rdinatrs and cancer managers within trusts have weekly meetings with the relevant clinicians t track prgress f the patient transfer and identify areas fr imprvement and/r fr escalatin. It is recmmended that cancer managers acrss Lndn Cancer Trusts have regular(weekly) telephne cntact between key trusts s that patient tracking in relatin t CWT breach is managed, prblems in transfer prcesses identified and reslved quickly thereby reducing need fr escalatin. It is recmmended that a frum is held twice per year with MDT c-rdinatrs, cancer managers and peratinal leads t review transfer pathways and prcesses and make amendments t this plicy if required. Lndn Cancer Inter Trust Referral Plicy Versin June

13 Appendix A Examples f lcal pathway applicatin f ITTP Oesphaggastric cancer Lndn Cancer Inter Trust Referral Plicy Versin June

14 Lndn Cancer Inter Trust Referral Plicy Versin June

15 Appendix B Urlgy Patient Pathway required Infrmatin flws and respnsibilities Urlgical cancer Suspected MDT c-rdinatr Designated Cns. MDT c-rdinatr Tracker MDT c-rdinatr Designated Cns. Cnsultant sec. Navigatr / tracker MDT c-rdinatr Cnsultant sec. Navigatr / tracker MDT c-rdinatr Cnsultant sec. Navigatr / tracker MDT c-rdinatr Cnsultant sec. Navigatr / tracker MDT c-rdinatr Cnsultant sec. Navigatr / tracker MDT c-rdinatr Referring Trust: xxx smdt referral frm **CaB nly All relevant clinical crrespndence All relevant Imaging (IEP'd t UCLH) SMDT prfrma ed within 24 hurs with Actin Summary List **CaB nly Patient cntacted and given clinic appt by UCLH Updated respnse t actin summary list within 3 days Each actin list utcme t be sent t UCLH as sn as available Inter Trust Transfer frm Clinical crrespndence ed within 5 wrking days f smdt clinic appt Discharge Summary and peratin nte ed within 24 hurs Pathlgy smdt review ed with f/up recmmendatins within 24 hurs First fllw up clinic letter ed within 5 wrking days Patient is repatriated xxx BAUS frm t be cmpleted at each further fllw up Cpy f clinic letter and blds sent t UCLH Specialist xxx Cancer Centre: UCLH UCLH navigatr / SMDT c-rdinatr smdt c-rdinatr smdt c-rdinatr UCLH navigatr UCLH navigatr smdt c-rdinatr UCLH navigatr smdt c-rdinatr Pre-sMDT meeting smdt meeting / vide-cnference smdt clinic Interventin / treatment smdt review First Fllw up* 2nd and subsequent fllw ups* Max 2 weeks Max 4 weeks Key Stage f patient jurney Infrmatin required by Respnsible fr prviding infrmatin Descriptin f infrmatin required and directin f flw Lndn Cancer Inter Trust Referral Plicy Versin June

16 Fllwing discharge frm smdt clinic, 2 nd and subsequent fllw ups t take place at referring hspital. A BAUS frm is t be cmpleted at each fllw up visit and a cpy f the clinic letter and bld results (U&Es) is t be frwarded t UCLH as part f the nging Quality Perfrmance Indicatr (QPIs) fr urlgical cancer patient utcme mnitring. Cntacts agreed: Hspital Designated clinician CNS MDT C-rdinatr Generic urlgy cancer address Navigatr / Patient Tracker Cnsultant secretary BHRUT Mr Sandy Gujral Angela Lee Angela.lee@bhrhspitals.nhs.uk Nancy Harris Nancy Harris Tricia Wding UCLH Prf Jhn Kelly j.d.kelly@ucl.ac.uk Hilary Baker/Gillian Basnett Gillian.Basnett@uclh.nhs.uk Hilary.Baker@uclh.nhs.uk Jack Redhead (t Feb 2015) Sally Hwe (frm Feb 2015) urlgymdtcrdinatr@uclh.nhs.uk ucl-tr.ur-ca-ctr@nhs.net ucl-tr.cancertransfers@nhs.net Rebecca Dennett/Sam Arthur Rebecca.Dennett@uclh.nhs.uk Sam.Arthur@uclh.nhs.uk Kristy Webb Kristy.Webb@uclh.nhs.uk Escalatin Plicy. This plicy will be enacted if there appear t be significant delays in the patient pathway because f breakdwn in flws and respnses as utlined in this dcument. Cntact 1 st line as detailed belw and cntinue up line t Medical Directr (3rd line) if required. Hspital First line Secnd line Third line BHRUT Julia Bell, General Manager Julia.bell@bhrhspitals.nhs.uk Jacky Fultn Service Manager Jacqueline.Fultn@bhrhspitals.nhs.uk Dip Mukherjee CD Dipankar.Mukherjee@bhrhspitals.nhs.uk UCLH Sufi Husain, General Manager Sufi.Husain@uclh.nhs.uk Kate Farrw, Assistant General Manager, Ur Onclgy Kate.Farrw@uclh.nhs.uk Lis Rberts, Divisinal Manager lis.rberts@uclh.nhs.uk Geff Bellingham Medical Directr geff.bellingan@uclh.nhs.uk Lndn Cancer Inter Trust Referral Plicy Versin June

17 Appendix C Renal Patient Pathway required Infrmatin flws and respnsibilities Lndn Cancer Inter Trust Referral Plicy Versin June

18 Appendix D Trust Cntact Details First name Surname Psitin Barts Health Helen Mnahan Operatinal Lead helen.mnahan@bartshealth.nhs.uk Barts Health Anthny Sullivan Operatinal Lead anthny.sullivan@bartshealth.nhs.uk Barts Health Emma Stack Operatinal Lead Emma.Stack@bartshealth.nhs.uk Barts Health Angela Wng Clinical Lead angela.wng@bartshealth.nhs.uk Barts Health Sarah Slater Clinical Lead sarah.slater@bartshealth.nhs.uk BHRUT Lucy Gladman Operatinal Lead lucy.gladman@bhrhspitals.nhs.uk BHRUT Jane Stevens Clinical Lead Jane.Stevens@bhrhspitals.nhs.uk GOSH Carla Hbart Operatinal Lead carla.hbart@gsh.nhs.uk GOSH Cathy Cale Clinical Lead CALEC@gsh.nhs.uk Hmertn Lesley Dawn Hlland Operatinal Lead Lesley.Dawn@hmertn.nhs.uk Hmertn Ben Stevens Operatinal Lead ben.stevens@hmertn.nhs.uk Hmertn Carline Bwring Operatinal Lead carline.bwring@hmertn.nhs.uk Hmertn David Feuer Clinical Lead David.feuer@hmertn.nhs.uk Mrfields Antinette Flynn Operatinal Lead antinette.flynn@mrfields.nhs.uk Nrth Middx Shareen Pavaday Operatinal Lead s.pavaday@nhs.net Nrth Middx Sian Davies Clinical Lead siandavies6@nhs.net Nrth Middx David Stker Clinical Lead dstker@nhs.net PAH Bernadette Rach Operatinal Lead Bernadette.rach@pah.nhs.uk PAH Wade Nrctt Operatinal Lead wade.nrctt@pah.nhs.uk PAH Sridhar Redla Clinical Lead Sridhar.Redla@pah.nhs.uk RNOH Stephanie Jhnsn Operatinal Lead stephanie.jhnsn@rnh.nhs.uk RNOH Tim Briggs Clinical Lead Tim.Briggs@rnh.nhs.uk RFL - B/CF Fergus Brwne Operatinal Lead fergusbrwne@nhs.net RFL Julie Savage Operatinal Lead julie.savage2@nhs.net RFL Nigel Andrews Operatinal Lead nigel.andrews@nhs.net RFL - B/CF Astrid Mayer Clinical Lead astrid.mayer@ucl.ac.uk RFL - B/CF Marilyn Treacy Clinical Lead marilyn.treacy@nhs.net UCLH Geff Bellingan Clinical Lead geff.bellingan@uclh.nhs.uk UCLH Nick Kirby Operatinal Lead nick.kirby@uclh.nhs.uk UCLH Praveen Chitrapu Operatinal Lead Praveen.chitrapu@uclh.nhs.uk UCLH Sandra Arnld Operatinal Lead Sandra.Arnld@uclh.nhs.uk UCLH - NHNN Lesley Terry Operatinal Lead Lesley.Terry@uclh.nhs.uk Whittingtn Fina Isacssn Operatinal Lead finaisacssn@nhs.net Whittingtn Nick Harper Operatinal Lead nick.harper@nhs.net Whittingtn Mark Rse Operatinal Lead mark.rse2@nhs.net Whittingtn Maureen Blunden Operatinal Lead m.blunden@nhs.net Whittingtn Pat Rubin Operatinal Lead Pat.Rubin@bartshealth.nhs.uk Whittingtn Pauline Lenard Clinical Lead p.lenard@nhs.net Lndn Cancer Inter Trust Referral Plicy Versin June