CareFlow Referrals Standard Operating Procedure

Document Control
Title
CareFlow Referrals Standard Operating Procedure
Author Author’s job title
Consultant Microbiologist
Directorate Department Team/Specialty
Unscheduled Care All Various
Date
Version Status Comment / Changes / Approval
Issued
0.1 16/04/20 Draft Initial version for consultation
0.2 22/04/20 Draft Changes made to section 6.3 & 6.4
0.3 05/05/20 Draft Changes by A.Moody and comment by L.Burrows
0.4 06/05/20 Draft Changes by A.Moody with comments from L.Burrows and
T.Lewis
1.0 06/05/20 Issued Changed by L.Burrows – Agreed by T.Lewis & A.Moody
Main Contact
Consultant Microbiologist Tel: Direct Dial –
North Devon District Hospital Tel: Internal –
Raleigh Park Email:
Barnstaple, EX31 4JB
Lead Director
Director of Operations
Document Class Target Audience
Standard Operating Procedure Doctors
Distribution List Distribution Method
All Doctors Trust’s internal website
Superseded Documents
CareFlowMicrobiologyReferralsSOP V1.0
Issue Date Review Date Review Cycle
06/05/2020 06/05/2023 Three years
Consulted with the following Contact responsible for implementation
stakeholders: (list all) and monitoring compliance:
 Junior doctors Tom Lewis
Education/ training will be provided by:
None required
Approval and Review Process
CareFlow Group: Tom Lewis, Alison Moody, Luke Burrows
Local Archive Reference
G:\CAREFLOW ADMIN\Resources\SOP
Local Path
BOB Policies Page
Policy categories for Trust’s internal Tags for Trust’s internal website (Bob)
website (Bob) CareFlow

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CareFlow Referrals Standard Operating Procedure

CONTENTS
Document Control ............................................................................................................... 1
1. Background .................................................................................................................. 3
2. Purpose ........................................................................................................................ 3
3. Scope ............................................................................................................................ 3
4. Location ........................................................................................................................ 3
5. Equipment .................................................................................................................... 3
6. Procedure ..................................................................................................................... 3

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CareFlow Referrals Standard Operating Procedure

1. Background
1.1. To improve working practises and increase resilience of the Trusts medical and
surgical teams, CareFlow will be utilized for non-urgent referrals between teams and
specialties.

2. Purpose
2.1. The Standard Operating Procedure (SOP) has been written to:

 Improve the referral process between teams

 Improve the way in which referrals to different teams and specialities are
delivered, managed and responded
 Reduce the amount of non-urgent bleeps
 Improve the quality of referrals
 Increase resilience of offsite working
 Utilize the CareFlow application for the above

3. Scope
3.1. This Standard Operating Procedure (SOP) relates to the following staff groups who
may be involved in patient referral.

 All Doctors
 All Surgeon’s
 Clinical Site Mangers

4. Location
4.1. This Standard Operating Procedure can be implemented in all clinical areas where
competent staff are available to undertake this role.

4.2. Staff undertaking this procedure must be able to demonstrate continued competence
as per the organisations policy on assessing and maintaining competence.

5. Equipment
5.1. Desktop or mobile phone access to the CareFlow application

6. Procedure
NOTE: CareFlow should simply be used as an electronic record of patients requiring
query or referral. Clinical information recorded in CareFlow does not get recorded in
the patient’s medical notes (paper or TrakCare).

6.1. When to use CareFlow to refer patients:

 The various ward and speciality teams will use the referral functionality within
CareFlow to refer patients to other teams in non-urgent circumstance
 Push alerts will be sent to teams based on above interactions

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CareFlow Referrals Standard Operating Procedure

 CareFlow can be used for inpatient referrals at all times, including out of routine
hours. You will be able to see when the message has been received and
acknowledged by the receiving team. If you do not see this acknowledgement and
urgent advice is required, then the responsible clinician/team should be contacted
either by bleep or through switchboard.

6.2. Teams and patient lists

 All Clinicians should be within the correct team in CareFlow

 Any new teams required will be created by admin support
 It is possible to easily switch between teams if doctors are moved to ensure continuity of
care
 Each team will have access to an auto-populated patient list – if they have in-patients..
This is based on TrakCare integration utilizing Smart lists in CareFlow
 Patients not on the list, that should be, can be manually added at any time either by
adding manually in CareFlow (entering the NHS number is the quickest way to do this),
or correctly ensuring the patient is under the right Consultant of care in TrakCare
 Any reviews of patients should be recorded in the medical notes as happens now. If
there is no action required then it is not necessary to record this in the patient’s notes

6.3. How to refer patients to other teams

 To use Careflow for non-urgent referral of a patient, the clinicians within a team who
wish to receive updates should go “on duty”
 The clinician making the referral should find the patient of interest within CareFlow,
either from their teams patient list, or by entering the details into the search function
 The clinician should then use the ‘Referral conversation’ feature against the patient,
this will start the referral conversation between two teams, an SBAR referral form will
present
 The clinician should ensure the appropriate ‘Referral conversation from’ and ‘Referral
conversation to’ fields are correctly filled in
 The SBAR details should be filled in as appropriate. Alternatively you can copy a
handover content and edit as appropriate
 When the referral is sent, this will send a push notification to the clinicians on duty in
the receiving team
 You will be able to see when this has been actioned
 The whole on duty referring team will receive a push notification when the referral is
responded to
 If a response is not received before the team go off- duty they should either:
o bleep the team for a response if it needs a same day action
o hand the patient over to the on call team – if appropriate e.g. for Microbiology
referrals
 All clinicians should mark themselves “off-duty” within the application when
completing their shift to ensure notifications are stopped

6.4. How to Accept, Decline and respond to referrals

 It is both the referring and receiving teams responsibility to ensure referrals are
managed and responded to
 Within the Referrals tab of each team, you are able to view the list of referrals with
following filters:
o Sent referrals
o Received referrals
o Sent & Received referrals

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CareFlow Referrals Standard Operating Procedure

 A secondary filter is available for the various referral statuses:

o All statuses
o Accepted
o Decline
o Pending
o Cancelled
 NOTE: Filters may already be applied when viewing this page, please ensure you
have the correct filters set to show the desired status
 NOTE: When using the mobile version of CareFlow, some of the more advanced
filtering options are not available, and you see an entire list of all referralsNew
referrals with show in the status of ‘Pending’
 Teams managing referrals should use the following status and populate the
comments field as required, based on the below:

Change When:
Status to:
Pending When the referral has been sent and the referral team has not yet accepted the
referral
Or when the receiving team has asked for more clarification before seeing the
patient e.g. further blood test or scan

This is also the default original status the referral will be created in.
Accepted When a clinician in the receiving team has acknowledged and agreed they will
come and see the patient. They may want to add a comment on when this is
likely to be e.g. ‘this afternoon after clinic’

The referral comments can still be added too, even once accepted.
Declined When the referral is inappropriate or has been sent to the wrong team.
A comment to explain this decision should be used to allow the referring team
to send appropriate referral if needed
The referral comments can still be added too, even once declined.
Cancelled When the referral is no-longer required or an error has been made.

 NOTE: The patient will stay on the referring team’s patient list in both cases, whether
the receiving team accept or decline a patient referral
 By accepting the referral the patient automatically also goes on to the receiving
team’s patient list (visible to all in the team). However, this does not mean that the
team has taken over the care of the patient
 The Comments box within the referral should be used for further discussion of the
referral between teams, recording any actions or queries
 If a patient moves wards e.g.from MAU to Cardiology, the Cardiology team will still be
able to see the referral has been made by looking at the patient’s profile in their list
 In order to print off a referral (e.g. for an OP appointment) currently ‘Print screen’ is
the only option

6.5. Post an update feature - Discussing a patient (within a team)

 It is possible to discuss a patient within CareFlow rather than bleeping. The “Post an
update” feature should be used with the correct patient and relevant team selected.
The comment will go to all Clinicians within the team and they will receive an
automatic notification. It is not seen by any other team who will not therefore receive
any push notifications.

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CareFlow Referrals Standard Operating Procedure

 It is not part of the referral process per se but could be used within a team. For
example if a clinician has agreed to see a referral but gets held up they can post an
update to the team asking someone else to attend
 To use Careflow for non-urgent communications the clinicians within a team who
wish to receive updates should go “on duty”
 All clinicians should mark themselves “off-duty” within the application when
completing their shift to ensure notifications are stopped
 Only the relevant Clinician should respond.
 It should not be used for urgent communication requests
 This should help reduce the number of bleeps each team member receives

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