clinical neurophysiology workflows - ehospital 2019 qs 1.0 clinical...clinical neurophysiology admin...

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CAD 2019 QS 1.0 Last Reviewed 22-04-2020 © 2014 Epic Systems Corporation. Confidential

Clinical Neurophysiology Admin Workflows

This Quick Start Guide shows the Neurophysiology administrative staff a general overview of Epic and runs through the workflow for updating registrations, scheduling

all patient procedures and the cancellation process.

Table of Contents

Clinical Neurophysiology Admin Workflows ................................................... 1

Introduction .................................................................................................. 2

What is the Hyperspace Toolbar? .......................................................................................... 2

What is a Workspace? .......................................................................................................... 2

What is an Activity? ............................................................................................................. 2

Looking Up a Patient............................................................................................................ 2

Orders, Referrals and Waiting Lists ................................................................... 3

Orders ............................................................................................................................... 3

Enter information from another hospital’s paper or electronic referral (not from a GP) ................. 3

How to manually select a Consultant for Results Routing .......................................................... 5

New Order ......................................................................................................................... 5

Specifying the Ordering Clinician ........................................................................................... 5

How will the letter be sent? .................................................................................................. 6

How to specify a particular address ....................................................................................... 6

What if the correct address is not listed? ................................................................................ 6

How to add a ‘CC’ recipient .................................................................................................. 6

Editing the Referral, Waiting List Information and Pathways ..................................................... 8

Clinical Neurophysiology Scheduling ............................................................... 11

Background ...................................................................................................................... 11

Registration ................................................................................................. 27

Appointment Actions ..................................................................................... 29

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Introduction

What is the Hyperspace Toolbar?

The Hyperspace Toolbar (1) is the set of buttons that appear at the top of the screen

to the right of the Epic button. Using these buttons you can quickly open other workspaces like your schedule or a patient’s chart.

What is a Workspace?

A workspace is the area where you work in Epic, such as a patient chart or the department schedule. Workspaces appear as tabs across the top of the screen (2). To

view a workspace, select its corresponding tab. You can have more than one workspace open at the same time, but you can view only one at a time.

What is an Activity?

An activity (3) is a feature in Epic that supports a specific task, such as entering paper orders or scheduling appointments. Activities are similar to tabs on a paper

chart. Activity toolbars (4) appear towards the top of most activities and include buttons specific to the tasks you frequently do in the activity.

You can access activities from the tabs on the left side of a workspace, as shown.

Some of your frequently used activities are also available on the Hyperspace Toolbar.

Looking Up a Patient

When you need to open a patient’s record and he/she is not on your schedule, you’ll have to look them up.

Click on the ‘Appts’ button in the Hyperspace Toolbar

When the ‘Patient Lookup’ window appears, enter at least four identifiers:

Surname, Forename, Sex and Birth date or search for a patient by entering his/her medical record number (MRN) or NHS number

1

2

3 4

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Press ‘Enter’. The ‘Patient Select’ window appears with the patient or patients listed that match the search criteria. Double click the correct patient in the list.

The ‘Patient specific’ activity opens. Review the ‘Patient Select’ window carefully to be sure you choose the correct patient

If no patient is found the PDS tab will appear, you will need to use your Smart Card to query the Patient Demographic Spine. (See Tip Sheet CAD 2011)

Orders, Referrals and Waiting Lists

Orders

If a patient’s order is on paper, you need to copy the information from the paper

order into the system so that all information related to the patient’s care is recorded in one place.

To place an order into the system, you use the Ancillary Orders activity. The top portion of the activity shows any orders that are already in the system for this

patient. By identifying orders that are already in the system, you can prevent duplicates from being created.

Enter information from another hospital’s paper or electronic referral (not from a GP)

Click ‘Anc Orders’ on the main toolbar. The ‘Patient Lookup’ window appears

Use the information from the paper order to find a select the patient. The ‘Ancillary Orders’ activity opens

Click ‘New Order’

Use the information from the paper order to enter the correct ordering provider

and department. After you enter this information other fields become available

Enter the procedure in the ‘Proc’ field. The ‘Priority’ and ‘Class’ fields are filled

out for you based on the procedure you enter

You can also look up a procedure by its synonym e.g. EEG – a list will appear of

all the available EEG tests. Select the appropriate one

Enter a diagnosis or ‘Diagnosis Unknown’ if there isn’t a clear diagnosis

On the right hand side of the screen answer the relevant questions which will be specific to the chosen procedure

Enter the reason for the referral: free text e.g. ‘see scanned referral’ and answer any required questions

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Appointment Type: This should be completed from the available list e.g. Next

available or Planned for Specific date

NHS or Private patient?: Enter the patient’s status

Referral Location: Where the referral was received from e.g. Peterborough City Hospital

Referral Received Date: Enter the date the referral was received by CUH (this could be a past date)

New Admin Pathway: This will default to ‘Yes’ and should be left. Do not change

Referral Source: Choose the appropriate option from the list e.g. Other

Consultant – Not Accident and Emergency (Internal or External)

Referral Medium: This should be completed from the list e.g. letter

Decision to refer date: This is the date typed on the referral letter

Enter any additional notes in the ‘Comments’ field

Click ‘Accept’

The provider’s routing window will open if there is more than one Hospital listed for the Consultant – choose where you would like the result sent to

The order will now show at the top of the screen with a detailed report displaying for the highlighted one

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How to manually select a Consultant for Results Routing

This workflow should only be used when the lead consultant from the external hospital is not available within the pick list in Epic. This pick list is updated weekly

from the national ODS files and these files only include consultants.

If the external order is from a Registrar, Clinical Fellow etc. this group of staff will

never be available in Epic. You should use the lead consultant as the ‘Clin’; and then record the name of the Reg etc. within the referral questionnaire.

New Order

When entering an order you have the option of finding an ordering clinician that has a

record in Epic, adding additional CC recipients that have records in Epic or entering an ad hoc recipient when not available from the National Files within Epic.

This document will show you how to correctly do all of the above and what to do if you can’t find one of these recipients.

Specifying the Ordering Clinician

When placing the order in ‘Anc Orders’ you are prompted to enter the ordering

clinician.

Enter part of the name in the search box and press ‘Enter’

o If your search returns no results, the section at the end of this document

‘Ad Hoc Recipients’ shows you how to add a recipient

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How will the letter be sent?

Once the clinician has been entered, you can find out how the letter will be sent by hovering your mouse over the envelope button to the right of the name.

How to specify a particular address

If you click the envelope button, an information box opens containing all the

clinician’s known addresses and how letters will be sent to that particular address.

To change addresses, simply tick the address you wish to use

What if the correct address is not listed?

If the correct address isn’t listed, the section at the end of this document ‘Ad Hoc

Recipients’ shows you how to add an address.

How to add a ‘CC’ recipient

If you need to send the results to more than one recipient you can use the ‘CC’ box at the bottom left hand side to add recipients (you may need to ‘Expand’ to open the

search box).

You can search in this box just like the ordering clinician box, when you find

your clinician you will be given the option for sending results

You can confirm the address by hovering over the cogs to the right

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If you click the cogs you will get a popup window allowing you to pick one of

multiple addresses

Ad Hoc Recipients

If you cannot find an ordering clinician or their secondary work address is not listed then you can use the CC recipients to enter the ordering clinician details.

To do this put a ‘*’ in the CC box and hit the ‘Enter’ key

You will see the following box appear which will allow you to input the details of the ordering clinician

Once you have done this select ‘Accept’ and the select a ‘Method’ you will be given the option for sending results

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Editing the Referral, Waiting List Information and Pathways

Once you have entered the order into the system, you need to complete the referral, waiting list information and check the relevant pathways.

Still within ‘Ancillary Orders’, click ‘Appt Desk’ for the relevant patient

The ‘Appointment Desk’ activity will open, here you can see information about

the patient including

o Demographics

o Future Appointments

o Outstanding Orders

o Referrals

o Waiting Lists

To access the Referral, click the ‘Referrals’ tab

Locate the referral required

Select the referral and click ‘Edit’

There are 10 fields on this form to check (the answers should have been auto-populated by the order)

o Received on date: The date the referral was received by CUH

o Class: Incoming

o Source: e.g. Other Consultant – Not Accident and Emergency (Internal or

External)

o Medium: Letter, Fax etc.

o Priority: e.g. Routing, Urgent or Cancer Pathway

o Elective Admission Type: For Neurophysiology this will be either:

Elective Wait: Patient will be added to the waiting list for an appointment

Elective Planned: This is where the referrer has requested a specific date in 6 months for clinical reasons etc. a field will become

available for planned due date

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o Administrative Category: This will be either NHS or Private, the other

categories will have to be decided by paying patients

o Decision to Refer Date: This needs to be set to the date on the letter

o Status: Once you completed all fields, change this to ‘Authorised’

Click ‘Next’ to access the Questionnaire

Complete the ‘Referred by Specialty’ field from the option list. These fields must be completed for charging purposes

Use free text to type in the ‘Referred by Clinician’ name

Click ‘Next’ to access the Linked Records form

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The last thing to do is check the ‘Waiting List Information’. Click on the blue

hyperlink number under the ‘Waiting List ID’ column

There are several fields to check here:

o Priority

o Type: This should always be first for diagnostic appointments unless

clearly stated

o Date on waiting list: Date of the order

o Admin Category: NHS or Private

o Elective Adm Type: Wait or planned as per referral

o First or Follow up: This should always be first for diagnostic appointments unless clearly stated

o Specialty: Always Clinical Neurophysiology for this service

When the ‘Finish’ button is clicked this will return the screen to the Referral – check the status is ‘Authorised’

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On the linked records form you will also see that a pathway has been

automatically created for a 6 week wait pathway for Neurophysiology

Press the ‘Accept’ key at the bottom of the screen to save any changes

Clinical Neurophysiology Scheduling

Background

Clinical Neurophysiology is an order based area; each patient appointment should be

generated from an order; the order is needed to allow the necessary clinical tools to work.

External Referrals; you will record these referrals using the Ancillary workflow. This workflow will create the referral, waiting list and the order

Internal Orders; Clinicians will place orders internally and these orders will automatically create the outpatient waiting list entry (no waiting list is created

for an inpatient)

The orders will appear on the Front Desk view in the top section of the screen. This is

your list of patients and you should use this as your primary source of patients needing to have an appointment booked. You should always access the patient Appt

Desk from the Front Desk view and book the appointment from the waiting list. As

there maybe occasions where a waiting list has been created independently from an order you will always need to check the Outpatient Neuroscience PTL as well.

Orders must only be booked if they have been protocolled this will show in the Front Desk under the ‘Pr’ column with a green tick.

A room and a human resource are always involved when scheduling appointments in Clinical Neurophysiology (except when booking the IOM). Each appointment needs

the appropriate clinic code and consultant for billing and a room resource to allow clinical tools to work. As a result, all of the appointments will be scheduled as ‘Joint

appointments’. Joint appointments are where one appointment can have two or more resources tied to it. For all these appointments, the person must be selected first and

the room selected second to make sure this activity is reported correctly.

We have placed blocks on both the person and room schedules to save that time for

particular visit types (i.e. EMG, SSEP, etc.)

Her are all the visit types used within the department along with their associated

orders. Note that the visit types for EMG Inpatient, SSEP Inpatient, EEG Portable and

IOM are used exclusively for current inpatients (either for the inpatients to be seen in Clinical Neurophysiology or for a Clinician to perform the test at the patient bedside).

When you select a visit type, the appropriate pool of resources will pull in to be scheduled against.

Visit Type Name Order in Epic

Amb EEG Fit/Remove 24 hr NEU32

Natural Sleep EEG, Melatonin Sleep EEG NEU15

EEG 60 and EEG PIU NEU4

EEG Portable NEU16

VEP, VEP PIU NEU10

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EMG/NCS 30, EMG Urgent, EMG Papworth, EMG Private Patient, EMG

Inpatient, EMG PIU

NEU6

Somatosensory Evoked Potential and SSEP Inpatient NEU28

Thermal Threshold NEU1010

EMG/NS 30, EMG/NGS 45, EMG Inpatient, EMG Papworth, EMG Private Patient, EMG Urgent

EMG5

IOM NEU1004

When you use the Auto Search facility in Epic, this will automatically try to find the

next available appointment for you based on your selected providers. Providers (both people and rooms) are grouped into a pool. A ‘Pool’ is a list of providers that we

search across. You can see several resources in a pool.

If however you know the patient needs to be seen with a specific consultant, you can

eliminate the other resources from the pool easily by right clicking on the consultant’s name and selecting ‘Use Selected Provider’.

Below is the workflow from start to finish for scheduling a patient for a normal

appointment in Clinical Neurophysiology, followed by booking an ambulatory EEG,

booking a patient for Intra Operative Monitoring (IOM), EEG Portable and finally how to book a test done at the bedside for a current inpatient.

Scheduling a Standard Neurophysiology Appointment for either inpatient or

outpatient visit

From the ‘Front Desk’ activity toolbar, click the ‘Appt Desk’ button

The ‘Appointment Desk’ activity opens

Navigate to the ‘Waiting List’ tab, highlight the waiting list you wish to schedule

and click ‘Book’

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Occasionally there will be multiple visit types that apply to the order. You should select the appropriate visit type for the patient and click ‘Accept’

If registration launches, fill in as much registration information as you can. PDS Split Screen will fire before any Registration workflow if there are discrepancies

between the Local record and the Spine. See tip sheet CAD 2011 for further guidance. Click ‘Continue’ when finished

You will be brought to the ‘Make Appointment’ activity. Notice that much of the critical information has already defaulted for you. This information came from

the order and Waiting List that you chose to book. The visit types linked to the order will show be default, select the appropriate person and room from the

offered provider pools

Note: If you are booking an appointment into any of the ADD NEUROPHYS consultant

clinic codes, you must always select the NEUROPHYS VER ROOM [117700] room provider. Consultants and the Registrar will always use the VER room while the

Technicians can be booked to either Pink, Grey or VER rooms.

Remember, you can pick and choose the resources from the Provider field by

right clicking on the specific consultant or room and selecting ‘Use Selected

Provider’

Remember you must select the person provider first to make sure the activity is

coded correctly

Once you have selected both providers, you must then confirm that Auto

Search needs to look across ‘Any Centre’ and ‘Any Department’. Do this by clicking on the 3 dots next to ‘ADD NEUROPHY’

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Then go on to select ‘Any Centre’ and remove the tick from ‘Same department’ fields

This will then allow you to search over all of the clinics correctly. Click ‘OK’ and then click on the ‘Search’ button in the bottom right corner of the screen

In the ‘Recommended Solution’ window, you will see both the clinician and the room you are booking against. You are scheduling one appointment for the

patient, but will end up blocking both the room and the person’s time

If you don’t find any opening with auto search and need to urgently see a patient, you can book the patient in by selecting ‘Manual’

Within the yellow section at the bottom of the screen, select the appropriate date, person and time first, followed by the date, room and time second

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When booking manually, it is important that you remember to book the person

and the room at the same time. Remember to select the person first

Note: When booking a joint appointment manually, double click on the start time for

the person first followed by the room. You may see a warning about booking into a slot that is not a normal slot for this patient. However, you have the security to

override these warnings.

Click ‘Schedule’ and continue through the warning below (if this appears)

Continue through scheduling. In the ‘Appointment Review’ screen, you will need

to select either ‘Inpatient’ or ‘Outpatient’ radio buttons to confirm what type of patient this appointment is for

Gather any declined dates if appropriate on the bottom of the appointment

window. Click ‘Accept’ to finalise the appointment

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You will not be asked to choose either Inpatient or Outpatient when booking

with the SSEP Inpatient [36409] or EEG Inpatient [35423] as these are already defaulted to Inpatient

You will be jumped to Registration. If you want an appointment letter to be printed centrally, enter ‘Yes’ in the ‘Printer Letter?’ field. If Dot Codes apply to

this appointment select the appropriate one from the list to pull in specific patient instructions. Select ‘No’ here if you are printing a local booking letter

You must also select the Admin category (if not already completed) before you can finish making the appointment

Click ‘Finish’

The booked appointment will show in the Future section of the appointment

desk like this

Scheduling a prolonged EEG Neurophysiology Appointment for either inpatient or outpatient visit

The normal EED [NEU4] procedure can be done as prolonged in order to capture

specific patient events. Example, the patient has intermittent seizures and the clinician/tech wants to capture the spike.

The decision to make the appointment a prolonged EEG happens in 3 situations:

During Scheduling: This happens when the tech adds a protocol comments

saying ‘Book as prolonged appointment’

o After the tech protocolled the order, the scheduler can see on the Front

Desk that the order has a protocol comments of ‘book to prolonged’

o When the scheduler schedules the order, a visit type selection will appear. Select ‘Prolonged EEG’

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o Then follow the normal scheduling workflow

Patient arrives for normal EEG: The technician may give a verbal instruction to the front desk that the patient should be booked to a prolonged EEG

appointment. Usually this happens after the front desk has already checked in the patient

o Select the patient and click ‘Appt Desk’

o Within ‘Appt Desk’ ensure you are on the ‘Future’ tab and select the appointment with a status of ‘Arrived’. Click ‘Change’

o Within the ‘Change Appt’ activity, change the visit type to ‘Prolonged EEG’

and the length column to ‘120’. Add an appropriate ‘Change Reason’

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During the Procedure: This happens when the patient is already having the normal EEG and the tech noticed an event that they want to capture so they

decide to change the normal EEG appointment into a prolonged one

o The tech can change the appointment via the Snapboard by right clicking

the appointment and going to ‘Appt Desk’

o When the tech has already clicked ‘End Exam’, they can still change the

appointment via ‘Verify Order’

o Both will open the ‘Appt Desk’ activity. Here you can change the visit type

and the length (see above for the steps on how to do this)

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Scheduling an Ambulatory EEG Appointment

This procedure needs the patient to have the monitoring equipment fitted on one day and removed on the next day and these appointments must be 24 hours apart. Epic

uses a panel of visit types to allow these to be grouped and scheduled together.

From the Hyperspace Toolbar, click the ‘Appts’ button

The Appointment Desk activity opens

Navigate to the ‘Waiting List’ tab, highlight the Waiting List you wish to

schedule and click ‘Book’

Note: You can also book these Waiting List entries from your Waiting List Reporting

Workbench. To access these, click ‘OP Waiting Lists’ from the User Toolbar and select ‘OP Neuroscience Waiting List’ to schedule from. Find the Waiting List entry you want

to book and click ‘Book’ from the Activity toolbar.

The registration screen launches, fill in as much registration information as you

can. Click ‘Continue’ when finished. If there are any discrepancies with the spine the PDS split screen will display (please see tip sheet CAD 2011 for more

information)

You will be brought to the ‘Make Appointment’ activity. Notice the information that has defaulted for you looks different than the normal neurophysiology

appointment you just scheduled. This type of appointment is called a panel. A panel is a way to group appointments and schedule them together as one item

instead of scheduling the appointments separately

In our example, the visit type is ‘Ambulatory EEG Fit/Remove 24HR’, which contains

two different visit types – Ambulatory EEG Fit and Ambulatory EEG Remove.

As you can see in the instructions, the system is configured to find two

openings for these appointments at least 24 hours apart. If you need to modify this, you can use the manual process for booking (last section)

You do not need to select any providers here as these will be pulled in automatically for you

Remember to confirm that ‘Any Centre’ is selected and that ‘Any department’ is unticked in the search

When you have completed scheduling, you should have two separate

appointments for the patient – one for the Ambulatory EEG fitting, and a second to have the Ambulatory EEG removed. Remember that you will need to select

either the Inpatient or Outpatient radio button to confirm what type of patient this appointment is for

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Gather any declined dates if appropriate on the bottom of the appointment window. In the ‘Appointment Review’ screen, you will need to select either

Inpatient or Outpatient radio buttons for both the appointments to confirm what type of patient this appointment is for. Click ‘Accept’ to finalise the appointment

You will be jumped to ‘Registration’. If you want an appointment letter to be printed centrally, enter ‘Yes’ in the ‘Print Letter?’ field. If Dot Codes apply to this

appointment select the appropriate one from the list to pull in specific patient instructions. Select ‘No’ here if you are printing a local booking letter

You must also select the Admin category before you can complete the appointment

Click ‘Finish’ to complete this booking

The patient appointment desk will look like this. The ‘S’ indicates that these

appointments have been scheduled together and form part of a series

Scheduling an Appointment for Intraoperative Monitoring (IOM) procedure –

carried out in a theatre

The clinician will place an order for Intra Operative Monitoring and should confirm the date that the patient will be in theatre. The IOM appointment is made to show when a

clinician is in theatre so will not be available in Clinical Neurophysiology department for a whole day.

Note: When an inpatient order is placed a waiting list is not created; you will need to book the appointment from the Order instead.

This procedure is generally used for existing inpatients so the IOM visit type is defaulted as Inpatient – you will not be asked to choose this when making the

appointment. The IOM visit type is the only visit type that is booked with a single resource.

Highlight the order from the Front Desk view and the click the ‘Appt desk’ button on the Toolbar

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Navigate to the ‘Orders’ tab, highlight the Order you wish to schedule and click ‘Schedule’. As this is an inpatient order, a waiting list will not be created. For

this procedure you should book from the Order

Patient registration details will display for confirmation or amendment if

necessary, smart card rules apply

For the IOM visit type, the ‘NEUROPHYS SPINALS’ pool will default to the ‘Make

Appointment’ screen

Select the appropriate provider and then click ‘Search’; you do not need to change ‘ADD NEUROPHY’ from the ‘Schedule at’ box as this visit type is only

ever booked to ‘ADD NEUROPHYS’ department click ‘Search’

In the ‘Recommended Solution’ screen, click ‘Schedule’. In the appointment

review screen, you will not need to select either Inpatient or Outpatient. Click ‘Accept’ to finalise the appointment

You will be returned to the patient appointment desk as no letter will need to be sent for this appointment

This patient will now appear on the Snapboard on the requested date in the

relevant column for IOM Neurophys

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Scheduling an Appointment for EEG Portable procedure – carried out on the

ward

The clinician will place an order for EEG Portable and should confirm the date that the

patient is to be seen on the ward. The EEG Portable appointment is made to show when the equipment and a technician are out of the department. This procedure is

generally used for existing inpatients so the EEG Portable visit type is defaulted as Inpatient – you will not be asked to choose this when making the appointment.

Highlight the order from the Front Desk view and then click the ‘Appts’ button on the Toolbar


Navigate to the ‘Order’ tab. Open the Orders tab, highlight the Order you wish

to schedule and click ‘Schedule’

The EEG Portable visit type will default in; select the appropriate technician and

machine from the provider pools

Click ‘Search’; you do not need to change ‘ADD NEUROPHY’ from the ‘Schedule at’ box as this visit type is only ever booked to ‘ADD NEUROPHYS’ department

In the ‘Recommended Solution’ screen, click ‘Schedule’. In the appointment

review screen, you will not need to select either Inpatient or Outpatient. Click ‘Accept’ to finalise the appointment

You will be returned to the patient Appointment desk as no letter will need to be sent for this appointment

The patient will now appear on the Snapboard on the requested date in the ‘EEG Portable Neurophys’ column

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Scheduling any appointment for an existing inpatient where clinician goes to

the ward

Current inpatients may require any of the Neurophysiology tests but either EMG or

Somatosensory Evoked Potential tests are the most common. As these are the most common procedures, specific inpatient versions of these visit types have been

created. These visit types have a default type of ‘inpatient’ so you will not have to choose this during scheduling. Usually a Consultant or Registrar will undertake the

EMG tests and technicians will perform the SSEP.

The clinician must place an order for the test needed by the inpatient.

For a SSEP test on a current inpatient:

Highlight the order from the Front Desk view and then click the ‘Appts’ button

on the toolbar


Navigate to the ‘Orders’ tab, highlight the order you wish to schedule and click ‘Schedule’

To select ‘SSEP Inpatient [36049]’ visit type you will need to delete any other

visit types that have defaulted in

Choose the appropriate technician from the pool in the option box

There is another pool called ‘On the Ward’ with a single provider of ‘WARD ROOM’; as this is the only room provider, you do not have to select this.

Remove the tick from ‘Auto Search’ and book this appointment manually

You do not need to change ‘ADD NEUROPHY’ from the ‘Schedule at’ box as this

visit type is only ever booked to ‘ADD NEUROPHYS’ department

o Within the yellow section at the bottom of the screen, select the

appropriate date, person and time first, followed by the date, room and time second

o When booking manually, it is important that you remember to book the person and the room at the same time. Remember to select the person

first

Click ‘Schedule’ and continue through the warning below (if this appears). In

the ‘Appointment Review’ screen, you will not need to select either Inpatient or

Outpatient. Click ‘Accept’ to finalise the appointment

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You will be returned to the patient ‘Appointment Desk’ as no letter will need to be sent for this appointment

Manual scheduling for a current inpatient for any other procedure on the

ward

For any other test that might need to be booked for a current inpatient you will need

to book this manually. You should already know the clinician that will be undertaking this procedure on the ward so you will need to book this test to the appropriate ‘ADD

NEUROPHYS’ clinic code

The clinician must place an order for the test needed by the inpatient and this order

should specify when the test is to take place and which clinician is to undertake the test.

Highlight the order from the Front Desk view and then click the ‘Appt Desk’ button on the activity toolbar

The Appointment Desk activity opens

Navigate to the ‘Orders’ tab, highlight the order you wish to schedule and click

‘Schedule’. Depending on the test requested you may need to select from an

option box

The registration screen will open for confirmation or amendment. Smart card

will link to the spine if any mismatch. Click on ‘Continue’ when complete

The ‘Make Appointment’ screen opens and will default the visit type from the

order – you will be offered the pool of providers linked to this visit type. Make sure the relevant providers are displayed or add the providers if necessary

o To add a provider click in the ‘Provider’ box and type part of the clinician’s last name

o Press ‘Enter’ or click on the magnifying glass, the selection window will display all clinician’s with names that match your partial name

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o Untick ‘Show all’ box to only see the Neurophysiology staff. Select the relevant option and this consultant will now appear in the pool

Select the appropriate clinician by highlighting the name and right clicking and choosing ‘Use Selected Provider’

From the pool of room providers select ‘Ward Room’ if this appears. If Ward Room is not in the pool click on the pool and type ‘Ward’ into the empty

provider box and the Ward Room provider will appear in the room pool. Select this provider by right clicking

Remove the tick from ‘Auto Search’ to book this appointment manually. Click ‘Search’

The Provider Schedule window will open; in the yellow section at the bottom of this screen, enter the specified date, select the clinician first followed by the

time. Continue through the warning shown below if this is displayed. Secondly, enter the date, room provider of ‘WARD ROOM’ and time and continue through

the warning below if displayed

Click ‘Schedule’ and the ‘Appointment Review’ screen opens

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Select the Inpatient radio button on the ‘Appointment Review’ screen and then

click ‘Accept’ to finalise the appointment

You will be returned to the patient appointment desk as no letter will need to be

sent for this appointment

Cancel or reschedule an appointment

You can cancel and reschedule appointments from the Appointment Desk or the Front Desk activity. If you reschedule appointments together, they are rescheduled

following the scheduling rules for that series.

Note: If an appointment is linked to an order and that appointment is cancelled and

not rescheduled, the order returns to the Front Desk orders list.

Cancel/Reschedule from the Appointment Desk

Open the patient’s Appointment Desk and select the appointment

Click ‘Can/Rsch’ on the toolbar at the bottom of the activity. The Cancel

Appointments form appears

Select the check boxes for appointments that should be cancelled

In the ‘Cancel reason’ field, select the cancellation reason. You can also enter a

comment in the ‘Comments’ field. Your initials are automatically entered on the form

Click ‘Cancel Appts’. A ‘C’ appears next to the selected appointments, indicating that they were cancelled

Or if you wish to reschedule click on that button instead – you do not need to click on the ‘Cancel Appts’ button as you are going to reschedule the

appointment immediately

Cancel/Reschedule from the Front Desk activity

Select the appointment in the Appointments pane

Click ‘Cancel’. The Cancel Appts form appears

Select the check boxes for appointments that should be rescheduled

In the ‘Cancel Reason’ field, select the cancellation reason. You can also enter a

comment in the ‘Comments’ field. Your initials are automatically entered on the form

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Click ‘Reschedule’ and schedule the appointment as usual. If a letter is required

this must be sent manually – by either using the communications tool ‘Send Letter’ or for the standard ‘Cancel’ or ‘Resched letters’ use the ‘Appt Info’ button

from the bottom of the appointment desk screen (when you are highlighting a cancelled appointment)

Or if you wish to permanently cancel the appointment click the ‘Cancel Appts’ button and remove the patient from the waiting list

Registration

Review and verify patient registration information

The Interactive Face Sheet appears when you schedule or check in patients. The PDS

will be queried every time as you have a smart card inserted. See tip sheet (CAD 2011) for more information.

If required information is missing, those errors are listed under the link so you know

what to fix. You must update this information before it can be verified.

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Review patient demographic information from Appt Desk

On the toolbar click ‘Appts’. The patient Lookup window appears

Enter the patient’s name in the ‘Name/MRN’ field and press ‘Enter’. The patient’s Appointment Desk opens

Review the patient’s demographics in the Patient Summary in the top panel of the screen

To amend or access full patient demographic information from Appt Desk

From the Activity Bar select the ‘Reg’ button

For help with updating the details see the tip sheet from the eHospital library ‘CAD 2011 Patient Registration’

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Find the patient’s future appointments

Future appointments can be found in the Front Desk activity or on the patient’s

appointment desk. In the front desk activity, scheduled appointments appear in the ‘Appointments’ report in the bottom pane. On the Appointment Desk, scheduled

appointments appear on the ‘Future’ tab.

Appointment Actions

Check In

Checking in a patient allows the appropriate staff to know that the patient has arrived and is ready to be seen.

How to Check in a Patient

In the appointments pane of the Front Desk activity, select the appointment

you want to check in

Click ‘Check In’ on the activity toolbar. The Check In activity opens

Complete the ‘Encounter Info’ and click ‘Check In’

The patient’s status changes to ‘Arrived’, which is indicated by the check in icon

on the Appointments report in the Front Desk activity

Check Out

Checking out a patient allows the appropriate staff to know that the patient has left

How to Check out a Patient

In the appointments pane of the Front Desk activity, select the appointment you want to check out

Click ‘Check Out’ on the activity toolbar. The check-out activity opens

Complete the Check Out screen and click ‘Accept’

The patient’s status changes to ‘Comp’, which is indicated by the check-out icon on the Appointments report in the Front Desk activity

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Recording a DNA Status using Front Desk

When a patient does not attend their appointment, we need to document in Epic that this occurred for three reasons:

To update their pathway to indicate if further appointments are necessary

To re-book from the original order

To send out letters to patient or referring team

Patient has not attended but requires another appointment

From the Front Desk activity select the patient appointment in the ‘Appointment’ report at the bottom of the page

In the Local toolbar click on the ‘DNA RTT Status’ button

Select ‘DNA-further appt required’ and then close the screen to return to the Front Desk activity. In the activity toolbar click on the ‘EOD’ button

Enter the status as ‘Did Not Attend’

Click ‘Accept’. This updates the status column in the appt report

Note: The following steps cannot be performed until the next day

From the Front Desk activity select the patient appointment in the

‘Appointment’ report again

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In the local toolbar click on the ‘Rebook DNA’ button, the ‘Cancel Appts’ screen

will open

Enter the cancel reason as ‘Did Not Attend’ and then reschedule the

appointment as per normal workflow

Open the patient’s ‘Appointment Desk’ from the Hyperspace toolbar and

navigate to the ‘Past’ tab

Select the cancelled appointment and click on ‘Edit Stats’ at the bottom of the

page

Enter the status as ‘Did Not Attend

Click ‘Accept’. The appointment’s status should now be displayed as ‘DNA’

Patient has not attended and does not require another appointment

From the ‘Front Desk activity select the patient’s appointment in the

‘Appointment’ report at the bottom of the page

In the local toolbar click on the ‘DNA RTT Status’ button

Select ‘DNA-no further appt required’ and then close the screen to return to the

Front Desk activity

In the local toolbar click on the ‘EOD’ button

Enter the status as ‘Did Not Attend’

Click ‘Accept’. This updates the status column in the ‘Appointment’ report

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