NHS Wales
NHS / Health Body
Action Planned
An e-referral system is being piloted, with an evaluation to follow three months after the pilot starts; however, networking issues have delayed the pilot's extension. In the interim, additional measures and email communication have been implemented to avoid delays in urgent referrals. (AI summary)
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Dear Mrs Knight,
Re: Regulation 28 Report related to the death of Mrs Glenys Button
On the 10th June 2019 you issued this report to 5 separate Health Boards and requested a collaborative single response proposing a new system of referrals into Neurology at UHW. As the issues specifically relate to the Neurosurgical Service which is commissioned by the Welsh Health Specialised Services Committee (WHSSC) the WHSS team was asked to coordinate that response. In addition, Aneurin Bevan University Health Board (UHB), which did not receive the Regulation 28 Report but who also commission Neurosurgical Services from Cardiff and Vale (C&V UHB), have been included in this process.
A meeting was held on the 18th of July chaired by the Director of Nursing at C&VUHB which included management, clinical, patient safety team and IT representatives from C&VUHB as well as representatives from the patient’s Health Board of residence and the WHSS team. This group identified what they considered were the key issues and developed an action plan which was then considered by the Medical Directors of the six affected Health Boards. The summary below and the action plan reflects the input from the Medical Directors Group.
Welsh Health Specialised Services Committee Unit G1, Main Avenue Treforest Pontypridd CF37 5YL Pwyllgor Gwasanaethau Iechyd Arbenigol Cymru Uned G1, Main Avenue, Trefforest Pontypridd CF37 5YL
Chair/Cadeirydd: Professor Vivienne Harpwood Managing Director of Specialised and Tertiary Services Commissioning/Rheolwr Gyfarwyddwr Comisiynu Gwasanaethau Arbenigol a Thrydyddol: Dr Sian Lewis
A number of key points have been agreed which inform the action plan:
1. An electronic referral system offers significant advantages in that it allows clearer and more detailed communication between referring and receiving clinicians however for very urgent cases telephone contact is still required. This is because it is not possible to provide 24 hour monitoring of email or web based referral systems.
2. Mobile phone signal in hospitals can be patchy and therefore bleeps are always required.
3. The C&VUHB IT team had already developed an in house e-referral systems which appears to have better functionality compared with the currently available commercial system.
The following action plan has been agreed for both paediatric and adult patients:
1. The current system for urgent and immediate care of patients with Emergency Neurosurgery needs will continue with the referral being made through the bleep system to the on call Neurosurgical Registrar. With effect from Monday 23rd September 2019 the referrer will be asked a question to gauge if the call is urgent or routine in nature. The urgency of the call will be communicated to the r Registrar via the bleep system which will enable them to prioritise urgent calls over less urgent tasks. If the Registrar is in theatre, there are arrangements in place to answer the bleep. Furthermore, if the Registrar cannot take the call, the referring team will be transferred back to switchboard for the on-call Neurosurgical Consultant to be contacted directly.
2. The on-call Neurosurgical Registrar will need to accept any emergency referrals and will ensure a clear plan is in place to manage the patient’s immediate care needs and to ensure effective communication with the referring team. Prior to the introduction of an e-referral system this will be followed up by an e–referral with a log of the call and the actions undertaken.
3. The new in house e-referral system will be piloted with Cwm Taf Morgannwg UHB starting at the beginning of August and a rigorous evaluation of the system built into the pilot from the outset. The evaluation will take place 3 months following the start of the pilot.
Following agreement of this action plan we have been told by C&V UHB that the pilot has identified networking issues between C&V and CTM UHB and that this
Welsh Health Specialised Services Committee Unit G1, Main Avenue Treforest Pontypridd CF37 5YL Pwyllgor Gwasanaethau Iechyd Arbenigol Cymru Uned G1, Main Avenue, Trefforest Pontypridd CF37 5YL
Chair/Cadeirydd: Professor Vivienne Harpwood Managing Director of Specialised and Tertiary Services Commissioning/Rheolwr Gyfarwyddwr Comisiynu Gwasanaethau Arbenigol a Thrydyddol: Dr Sian Lewis
has prevented extension of the pilot study and these issues will need to be resolved before this can be rolled out further. The C&V UHB IT Development Team are working hard to resolve this issue as quickly as possible.
In conclusion, whilst we had hoped to be able to confirm a date for roll out of an e-referral system this is not possible, but we have put in additional measures to avoid delays in making urgent referrals as well as an interim arrangement using email to improve communication around the referral process. In addition the team at C&V UHB are working hard to address the IT issues as soon as possible. I will forward a copy of the most up to date referral pathway when I receive it from C&V UHB.
Please let me know if you require clarification or further information regarding these arrangements.
Re: Regulation 28 Report related to the death of Mrs Glenys Button
On the 10th June 2019 you issued this report to 5 separate Health Boards and requested a collaborative single response proposing a new system of referrals into Neurology at UHW. As the issues specifically relate to the Neurosurgical Service which is commissioned by the Welsh Health Specialised Services Committee (WHSSC) the WHSS team was asked to coordinate that response. In addition, Aneurin Bevan University Health Board (UHB), which did not receive the Regulation 28 Report but who also commission Neurosurgical Services from Cardiff and Vale (C&V UHB), have been included in this process.
A meeting was held on the 18th of July chaired by the Director of Nursing at C&VUHB which included management, clinical, patient safety team and IT representatives from C&VUHB as well as representatives from the patient’s Health Board of residence and the WHSS team. This group identified what they considered were the key issues and developed an action plan which was then considered by the Medical Directors of the six affected Health Boards. The summary below and the action plan reflects the input from the Medical Directors Group.
Welsh Health Specialised Services Committee Unit G1, Main Avenue Treforest Pontypridd CF37 5YL Pwyllgor Gwasanaethau Iechyd Arbenigol Cymru Uned G1, Main Avenue, Trefforest Pontypridd CF37 5YL
Chair/Cadeirydd: Professor Vivienne Harpwood Managing Director of Specialised and Tertiary Services Commissioning/Rheolwr Gyfarwyddwr Comisiynu Gwasanaethau Arbenigol a Thrydyddol: Dr Sian Lewis
A number of key points have been agreed which inform the action plan:
1. An electronic referral system offers significant advantages in that it allows clearer and more detailed communication between referring and receiving clinicians however for very urgent cases telephone contact is still required. This is because it is not possible to provide 24 hour monitoring of email or web based referral systems.
2. Mobile phone signal in hospitals can be patchy and therefore bleeps are always required.
3. The C&VUHB IT team had already developed an in house e-referral systems which appears to have better functionality compared with the currently available commercial system.
The following action plan has been agreed for both paediatric and adult patients:
1. The current system for urgent and immediate care of patients with Emergency Neurosurgery needs will continue with the referral being made through the bleep system to the on call Neurosurgical Registrar. With effect from Monday 23rd September 2019 the referrer will be asked a question to gauge if the call is urgent or routine in nature. The urgency of the call will be communicated to the r Registrar via the bleep system which will enable them to prioritise urgent calls over less urgent tasks. If the Registrar is in theatre, there are arrangements in place to answer the bleep. Furthermore, if the Registrar cannot take the call, the referring team will be transferred back to switchboard for the on-call Neurosurgical Consultant to be contacted directly.
2. The on-call Neurosurgical Registrar will need to accept any emergency referrals and will ensure a clear plan is in place to manage the patient’s immediate care needs and to ensure effective communication with the referring team. Prior to the introduction of an e-referral system this will be followed up by an e–referral with a log of the call and the actions undertaken.
3. The new in house e-referral system will be piloted with Cwm Taf Morgannwg UHB starting at the beginning of August and a rigorous evaluation of the system built into the pilot from the outset. The evaluation will take place 3 months following the start of the pilot.
Following agreement of this action plan we have been told by C&V UHB that the pilot has identified networking issues between C&V and CTM UHB and that this
Welsh Health Specialised Services Committee Unit G1, Main Avenue Treforest Pontypridd CF37 5YL Pwyllgor Gwasanaethau Iechyd Arbenigol Cymru Uned G1, Main Avenue, Trefforest Pontypridd CF37 5YL
Chair/Cadeirydd: Professor Vivienne Harpwood Managing Director of Specialised and Tertiary Services Commissioning/Rheolwr Gyfarwyddwr Comisiynu Gwasanaethau Arbenigol a Thrydyddol: Dr Sian Lewis
has prevented extension of the pilot study and these issues will need to be resolved before this can be rolled out further. The C&V UHB IT Development Team are working hard to resolve this issue as quickly as possible.
In conclusion, whilst we had hoped to be able to confirm a date for roll out of an e-referral system this is not possible, but we have put in additional measures to avoid delays in making urgent referrals as well as an interim arrangement using email to improve communication around the referral process. In addition the team at C&V UHB are working hard to address the IT issues as soon as possible. I will forward a copy of the most up to date referral pathway when I receive it from C&V UHB.
Please let me know if you require clarification or further information regarding these arrangements.