Application version: v3 v3.4 End User Guide v1.0...NORSE v3.4 user guide last updated: 01/05/2015 Document uncontrolled after 23/06/2015 if printed v1.0 Page 1 of 59 NORSE End user

NORSE v3.4 user guide last updated: 01/05/2015

Document uncontrolled after 23/06/2015 if printed v1.0 Page 1 of 59

NORSE End user guide

Application version: v3.4

Network of On-call Referral Services

Version: v1.0

Network of On-call Referral Services



The latest version of the document can be found in \\uhb\userdata\IT Projects\P11004 Norse for use in other Specialties\Stage 2 - Design, Build and Test\Management Products\IT Support Materials\User Guide\Norse v3.4 End User Guide v1.0.docx

Revision History Revision date

Version Summary of Changes Changes marked

13/03/13 0.1 First draft 13/03/13 No

20/05/13 0.2 2nd

Draft 20/05/13 No

30/07/13 0.3 30/07/13 - add changes re. waiting list and liver med tabs

No

18/10/13 0.4 30/07/13 - add further changes re. waiting list and liver med tabs

No

10/02/14 0.5 Introduction of Self Registration and Sharing features

No

21/03/14 0.6 Rewrite of User roles section and review of status ordering on active referral grids

No

14/04/14 0.7 Rewrite of User roles section and review of status ordering on active referral grids

No

23/12/14 0.8 Update following changes to style and enhancements introduced following system testing

No

20/2/15 0.9 Update following changes to style and enhancements introduced following system testing

No

06/03/15 1.0 Upgrade to v3.4.4. Functional changes to match v3.4 Norse and other cosmetic updates.

No

Author/IT PM: Steve Ryan/Farina Chaudhri/Sue Sheahan

Owner: IT Application Support

Authorized by: Farina Chaudhri

Document No (v): 1.0

System Owner Mark Garrick Neurosurgery - Graham Flint Renal - Peter Hewins Liver Medicine - Dhiraj Tripathi Liver Surgery – Robert Sutcliffe

Technical lead: Jim Williams/Maxwell Dobbs



THE NORSE URGENT AND EMERGENCY REFERRALS APPLICATION 5

ABOUT NORSE (NATIONAL ON-CALL REFERRAL SERVICE) 5 SECURITY 5 NORSE PROCESS OVERVIEW 6 A TYPICAL NORSE PROCESS – REFERRAL LOGGED FOR QEHB HUB 6 TYPICAL NORSE USER PROCESS STEPS FOR A REFERRER (EXTERNAL HOSPITAL) 6 TYPICAL USER PROCESS STEPS FOR A NORSE HUB ON-CALL CLINICIAN 7

SET UP AND ACCESS 8

ABOUT SET UP AND ACCESS 8 UHB HUB USERS 8 EXTERNAL NHS TRUST REFERRER USERS 8 THE NORSE NATIONAL LANDING PAGE 8

NORSE USER ROLES 9

NORSE HUB USER ROLES: 9 NORSE REFERRER USER ROLES: 9

REGISTERING AS A NORSE REFERRER 10

REGISTER AND REFER 10 UPDATING YOUR ACCOUNT 13 USERS WHO WORK AT MORE THAN ONE TRUST 14 INACTIVE NORSE ACCOUNTS AND CHANGING YOUR PASSWORD 15 FORGOT YOUR PASSWORD 15 CHANGING YOUR PASSWORD 15

REFERRAL GRIDS 16

REFERRAL GRID DISPLAYED TO HUB USERS 16 ACTIONS AVAILABLE FROM THE HUB REFERRAL GRID 16 REFERRAL GRID DISPLAYED TO REFERRER USERS 18 ACTIONS AVAILABLE FROM THE REFERRERS REFERRAL GRID 19 REFERRAL LIST – HOW IS IT ORDERED? PRIORITY AND STATUS EXPLAINED 20 REFERRAL LIST ORDER 20 HOW THE SYSTEM ORDERS BY STATUS: 21 MESSAGE ICONS EXPLAINED 21

NORSE AUTOMATED NOTIFICATIONS 22

ABOUT ‘MESSAGE’ NOTIFICATIONS 22 MESSAGES THAT NOTIFY THE HUB SPECIALTY GLOBAL ON-CALL EMAIL AND MOBILE: 22 MESSAGES THAT NOTIFY THE REFERRER CONTACT EMAIL: 23



ADD NEW REFERRAL 23

USERS WHO CAN LOG NEW REFERRALS 23 SUBMIT A NEW REFERRAL REQUEST 23

ATTACHMENT RULES AND RESTRICTIONS 27

SPECIALTY SPECIFIC PANELS 27

LIVER MEDICINE - CLINICAL STATUS TAB 28 LIVER MEDICINE - BLOODS TAB 31 LIVER SURGERY - CLINICAL STATUS 32 NEUROSURGERY – GCS 33 NEUROSURGERY - MUSCLE POWER (GUIDELINES ONLY) 33 NEUROSURGERY - WAITING LIST PANEL – REFER TO SEPARATE WAITING LIST SECTION 34 RENAL - CLINICAL STATUS 35 RENAL BLOODS TAB 36 OPEN REFERRAL – WHICH ROLES HAVE ACCESS TO WHICH TABS 38 THE ‘ALL MESSAGES’ TAB 40 UPDATE DETAILS TAB 40 LIVER – UPDATE DETAILS TAB 40 NEUROSURGERY – UPDATE DETAILS TAB 41 RENAL – UPDATE DETAILS TAB 41 SEND MESSAGE TAB (EXTERNAL) 42 ADD INTERNAL NOTE TAB (INTERNAL) 42 MANAGEMENT PLAN TAB 43 CLOSE REFERRAL TAB 44 ATTACHMENTS TAB 45 SPECIALTY SPECIFIC TABS 46 LIVER MEDICINE - BLOODS TAB 47 LIVER SURGERY - CLINICAL STATUS TAB 48 NEUROSURGERY – GCS TAB 49 WAITING LIST TAB – REFER TO SEPARATE WAITING LIST SECTION 50 RENAL - CLINICAL STATUS 51 RENAL BLOODS TAB 52 ABOUT THE NORSE WAITING LIST 53 ACCESS TO WAITING LIST FUNCTIONALITY 54 UPDATING A NORSE WAITING LIST ENTRY 54 CLOSING/REMOVING FROM NORSE WAITING LIST 55 USER STEPS - CLOSING/REMOVING FROM NORSE WAITING LIST: 55 USER STEPS - CLOSING A NORSE REFERRAL WHICH HAS AN ACTIVE WAITING LIST ENTRY: 56

WAITING LIST GRID - TO DISPLAY ALL WAITING LIST ENTRIES 56

REFERRAL SEARCH 58

HANDOVER REPORT 59

PDF FACILITY 59



The NORSE urgent and emergency referrals application

About NORSE (Network of On-Call Referral Services) Many medical staff make urgent or emergency referrals to specialist centres in other NHS hospitals by telephone. Unfortunately, this often requires the caller to wait for the receiver to locate the specialist doctor who may be busy on another call or preoccupied with another task. It is also difficult to make accurate and sufficient records about the call, in particular about the clinical findings and management plans. NORSE offers a web based referral system as an alternative to the telephone. The referring doctor completes an online form with the patient details and a brief summary of the clinical problem and investigation findings to date, then sends the message to the receiving unit before returning to other duties. The receiving centre is notified immediately by email and/or text who respond as soon as the relevant member of staff is free. Text message dialogue then structures a management plan and all exchanges are recorded for reference by both parties. It is also clear, at all times, who has entered any comments and, once logged, these items cannot be deleted or altered. This ensures little scope for confusion or disagreement on the information communicated between both parties. Telephone conversations, if necessary, especially with more urgent cases will still be possible between both parties. NORSE is a highly secure system with access limited to NHS staff on the N3 network. To access the system NHS staff must also register a username and password before accessing NORSE. NORSE offers the following benefits:

1. NORSE allows the referrer and the specialist unit to engage in two-way dialogue until a definitive management plan is concluded.

2. All request and advice information is recorded with a clear audit trail as to what is requested and advised.

3. Referring clinicians receive instant acknowledgement their request has been logged. 4. Referring clinicians providing an email address or mobile phone number when logging a

referral request will receive an email notification whenever the referral details are updated with a new message or management plan.

5. Specialist clinicians at on-call centres receive instant email notification of new requests and will respond appropriately.

6. NORSE does not replace phone calls but supports them, however it can replace the need to use the phone if desired

Security

NORSE is only available on the N3 network – N3 is a private data network designed to ensure confidentiality, integrity and availability

SSL certification is applied to NORSE traffic across N3 to encrypt the data to HSCIC standards and comply with the Data Protection Act and Caldicott principles

NORSE should only be accessed using supported browsers due to security and encryption methods. Currently, these are IE8, Chrome and Firefox.

Data is held on NHS servers at the specialist hub.

Users can only view referrals they have logged or have been shared with them by a registered NORSE user.



NORSE process overview

A typical NORSE process – referral logged for QEHB hub

Typical NORSE user process steps for a referrer (external hospital)

1. Register as a NORSE user

2. Log a referral request to a hub (e.g. UHB)

3. View and respond to messages

4. View and respond to a management plan

5. Request referral closure

9. External Hospital

– receives message (Management plan)

5. External Hospital –

receives message

1. Patient admitted

at external hospital.


ask QEHB for advice [Add Request on NORSe]

3. QEHB – Receive

request on NORSe

4.QEHB – Request

more information (Send message)

6. External

Hospital replies to message

7. QEHB – receives

Message

8. QEHB – Issues

Management Plan


Acts on Management plan

11. External

Hospital requests closure of referral on NORSe

12 UHB then Close

Referral

Referrer A referral request is logged on NORSe either by:

- a clinician at another trust or

- by a clinician at a NORSe hub on behalf of a clinician at another trust.

Hub (UHB specialist service) A clinician in the on-call team for a specialty at a NORSe hub responds to a referral request and ultimately provides a management plan.



Note: Sharing referrals with other clinicians at their trust. If the clinician who originally submitted the referral is handing over to a colleague then they can use the ‘Share’ tab to enter their colleague’s NHS email address so they too can view and update the referral details. If their colleague already has a NORSE account then they will simply need to log in as normal, if they don’t already have a NORSE account then they will need to register online in the normal way before they can access the details. It is also possible for a hub registrar or consultant to share a particular referral with another clinician at the referring hospital. E.g. if the clinician who originally submitted the referral has forgotten to share the details with their colleague then the hub registrar dealing with the referral can use the ‘Share’ tab as described above. Note: In addition NORSE provides:

- a search facility - a NORSE ‘waiting list’ (see Waiting List section of this document)

Typical user process steps for a NORSE Hub on-call clinician 1) When a referral request is submitted on NORSE the on-call Blackberry receives a notification

alert

2) The on-call clinician views the referral details on NORSE

3) The on-call clinician updates the referral details:

a) The on-call clinician sets who the receiving consultant and registrar are (these can be updated at a later time if required).

b) The on-call clinician inputs an external message back to the referrer

c) The on-call clinician inputs an internal message so that their colleagues are kept up to date, perhaps as part of a handover

d) The on-call clinician updates any specialty specific details

e) The on-call clinician issues a management plan (Diagnosis, Investigation, Advice)

4) The referral is closed Note: Prior to a referral being closed a management plan must be submitted and the on-call clinician or specialty administrator validates/looks up UHB Patient ID

a) Once the referral has been closed, all details are captured as a pdf and exported to the Clinical Portal

Note: Sharing referrals with other clinicians at the referring trust. If the clinician who originally submitted the referral is handing over to a colleague then they can use the ‘Share’ tab to enter their colleague’s NHS email address so they too, can view and update the referral details. If their colleague already has a NORSE account then they will simply need to log in as normal, if they don’t already have a NORSE account then they will need to register online in the normal way before they can access the details. Note: In addition NORSE provides:

- a search facility - a handover report – this presents a view of all current referrals with enough details on

display to be used in a handover meeting. - a NORSE ‘waiting list’ – this allows the hub to monitor all patients referred on NORSE that

need to be admitted to the specialist centre (UHB) and repatriated back to the referring hospital.



Set up and Access

About Set up and Access NORSE is a web application, and therefore once users have been set up with the correct access and role it can be opened by simply visiting the correct web address. (I.e. it does not require any installation) It is compatible with IE7,IE8, Chrome and Firefox. Users located at the UHB hub can access the application via an internally available application server (http://ceto/norse) and users outside of the UHB hub location can only access the application via the N3 NORSE domain https://nww.norse.uhb.nhs.uk

UHB Hub Users On request from an authorising manager to the IT service desk (2199) UHB users are set up with a username and password linked to their network Active Directory account. To gain access they must:

1) Be added to the NORSE GL Active Directory group. The NORSE shortcut icon will

then appear on their desktop the next time they log in. 2) Be added as a user with the appropriate role in the NORSE application’s admin tool

– see the NORSE Admin guide ‘Maintain Users’ They can then access NORSE by either using the desktop icon or visiting http://ceto/NORSE

External NHS Trust Referrer Users Users external to UHB can access NORSE via the N3 network by visiting https://nww.norse.uhb.nhs.uk Most external users will self-register using their NHS email address. By doing this they will be able to log referrals and view any referrals that they have logged, or have been shared with them.

The NORSE National Landing Page

http://ceto/norse

https://nww.norse.uhb.nhs.uk/

http://ceto/norse




NORSE user roles There are two groups of front end users: Hub users and Referrer users. Hub users are those people who work for a specialty at a trust that receive referral requests. Referrer users are those people who use NORSE to log referral requests to specialist services at a NORSE hub.

In addition there is a system administrator role. (Please refer to the NORSE Admin User Guide).

NORSE hub user roles: Consultant – full access to add and update referral details. Also have access to Referral

Search, the Handover page and if appropriate for their specialty the NORSE waiting list page. These users appear in the consultant drop down lists.

Registrar – full access to add and update referral details. Also have access to Referral Search, the Handover page and if appropriate for their specialty the NORSE waiting list page. These users appear in the registrar drop down lists.

Specialty Admin – have access to the NORSE referrals for their hub and specialty so that they can help to validate Patient IDs and close referrals.

Read Only - have access to the NORSE referrals for their hub and specialty, but are not able to add or update referrals.

Hub Admin – have access to some of the admin functions for their hub and specialty, enabling them to configure the referral form, the management plan form (including diagnosis codes) and the notification messages for their hub specialty.

NORSE referrer user roles: All NORSE users are provided with referrer roles for every hub specialty that is active on that NORSE instance. However,

- When users initially self-register as a user on the system, they will only be able to view/amend the referrals that they have logged, or that their colleagues have specifically shared with them.

- A referring trust can nominate a system administrator, who can amend users at their trust access, so that they can see all referrals logged by their Trust. Note: - System administrators at referring Trusts can only be set up by the System administrators at the Hub. This would be subject to the referring hospital engaging with the NORSE hub operational leads and agreeing who the nominated System Administrator is.



Registering as a NORSE Referrer

Register and Refer NORSE has been designed to allow busy clinicians to submit a referral request to a specialist service. Users can register online with an NHS email address and are able to submit referral requests immediately.

To register on NORSE click on Create

Account

Complete the registration form:

Your name: The name recorded here is the name that will be displayed in the system when you post messages. It should be the name that you are known by professionally.

NORSE only accepts valid NHS email addresses E.g .nhs.net / .nhs.uk The email address recorded here is used as your NORSE username. In addition the system will email a notification to this address everytime a referral is logged (or has been shared with you) or updated. If you change the email address here the new address will become your username and the system will send all update notifications to the new email address.

Contact numbers: It is recommended that you provide a mobile number here. This number will appear on your contact details should a clinician in the specialised service need to contact you.

Please provide your GMC code or other professional registration number here. If it is not known at the time of registration please enter ‘unknown’ and update as soon as you can



Your Trust, Hospital, Position and Department are needed so that the service you are contacting has your complete contact details. If the hospital is not listed please choose ‘Other’ Note: If you work at more than one trust you can use this area to change the trust you are at when required. When you log in to NORSE you will only be able to view your referrals for the trust you have currently selected here.

Please provide a password. When updating your account details this can be your current password or you can choose to enter a new one. Passwords MUST be at least 8 characters long and include letters, numbers and symbols (!, ", £, $, %, ^, &, *, etc.)

You must accept the Terms and Conditions to use NORSE. These are a legal agreement between you and the specialist services at University Hospitals Birmingham NHS Foundation Trust (UHB) for the NORSE web application software and the data supplied with the software.

Once the form is complete click on the ‘Sign Up’ button

The following instructions and confirmation message will be displayed:

Once you have successfully registered you will be able to log a referral immediately by clicking on

the ‘Submit a referral request now’ link. However you will need to activate your NORSE

account from your email in order to view any replies.



If you proceed to submit a referral request now, you must choose the hub specialty you want to refer to:

The submit referral form for the hub specialty selected opens

Complete the referral form and submit the referral request

Confirmation screen appears. o You will see a message advising you that your referral request has been submitted

and that you will shortly receive an activation email

Note: At this point the referrer can still submit further referral requests, but they will not be able to log onto the system and view the referrals they have logged or any replies they may receive until they have activated their NORSE account by clicking on the activation link in the registration email sent to them.



Note: Properties of NORSE Referrer Account

The system creates the user a NORSE referrer account: o NORSE role(s): Referrer role to all hub specialties available on the NORSE

instance they are visiting o User Trust: as entered on registration form o Username: NHS email address as entered on form o Password: the password entered on the registration form o Expiry date is set to now (and will remain expired until the user has clicked on

the link in their activation email at which point it will be set to 70 days in the future)

The system sends an email to the user’s NHS email address (as entered on form) with an

activation link

The user activates their NORSE account by clicking the link. The system updates the user’s NORSE account expiry date to 70 days from now.

User logs in with their email address and the password they entered when registering. User can now access NORSE, but can only view the referrals that they have submitted or have been shared with them.

Updating your account To update your account details you need to log in and go to the Your Current Role dropdown

box and select Manage - My Account

You can use this form to change any of your details. To submit the updates you will need to

provide a password.

Note: When completing the form click in any of the boxes on the form to display tooltip/further information.

The ‘Manage Account’ area allows you to:

a. Change your email address (which is also their username) b. Change your password c. Change your contact phone number d. Change your mobile phone number e. Change your Prof Reg no. f. Change your trust (e.g. doctors on rotation) – if you change your trust you will not be

able to see any referrals from your previous trust, unless you change your trust back again.

g. Change your Department h. Change your Position



Note: If a user tries to create a new account or update their existing account with an email address that is already registered, then they will be asked to follow the reset password and/or amend their account details – see Reset Password and Manage Account Sections

Users who work at more than one trust You can only log and review referral requests for the trust that your NORSE account is

currently assigned to, however you can change your account details to swap between trusts as required:

o If you work at more than one trust you will need to update your account to specify which trust you are working at today. This will enable you to see all referral requests that you have logged (or have been shared with you) at that trust.

o To view referrals that you logged (or have been shared with you) at other trusts you would need to update your account to swap back to the other trust. You can change trusts as often as you need to.

To change your trust you need to go to the ‘Your Current Role’ drop-down box and select ‘Manage-My Account’.

Then select the ‘Trust’ drop-down box and choose the appropriate trust, this can be changed as often as needed.



Inactive NORSE accounts and changing your password You can change your NORSE password whenever you want. However please note that after a period of 70 days of inactivity your NORSE account will expire. To reactivate your account you will need to reset your password:

Forgot your password

From the login page select Forgot password

Enter the NHS email address that you registered with and click on Send New Password

Half of your password will be displayed on the screen; make a note of it

NORSE will email the other half to your registered NHS email address. Note: the passwords include punctuation characters; make sure you include these even if they are the last character in the password. E.g. $ When you next log in, you can follow the steps below to change your password

Changing your password

Select ‘Manage-My Account’ from the ‘Your Current Role’ dropdown box

Type your chosen password into the ‘password’ field and again for the ‘confirm password’ field. Note: Passwords MUST be at least 8 characters long and include letters, numbers and symbols (!, ", £, $, %, ^, &, *, etc.)

Once you have entered your password click Update.



Referral Grids

Referral Grid displayed to Hub Users

When a hub user has logged in, the active referral grid is displayed (Note: this is not the case for Hub Admin users as they only have access to the admin tools). All active referrals are listed here, ordered according to message status (i.e. whether the last message was posted by the hub or the referrer) and date. Tip: To see the most recent referral select the Referral date header and double click.

Actions available from the Hub Referral grid

View the referral list. By default the active referrals are listed according to message

status (i.e. whether the last message was posted by the hub or the referrer) and date of last update. However users can:

o Click on any column heading to sort the list in order o Use the two available ‘quick filter’ boxes to filter the list either by referral ID or

patient name. Press Enter. o For specialties that have been set up with sub specialties like Liver (Liver Medicine

and Liver Surgery) an additional drop down box is available at the top of the grid for users to choose to view all specialty referrals or to filter by individual sub specialties



o Tick the ‘Show Completed’ tick box to list all referrals that have been closed in the last 30 days.

Add a new referral. This enables a user to log a referral request to their own hub specialty, e.g. on behalf of a non-NORSE user who makes a phone call from another trust. Refer to the Add New Referral section for more details

Open a referral. This enables a user to view more details and add updates to a referral Refer to the Open Referral section for more details

o Clicking on the magnifying glass, view button, will open a referral displaying the ‘All’ tab

o Clicking on the Management Plan cross or tick will open the ‘Management Plan’ tab

o Clicking on the square red cross icon will open the ‘Close’ tab

o Click on the envelope message icon to open the ‘Input external message’ tab

Open the Referral Search window. This enables a user to carry out detailed searches to find particular referrals or groups of referrals. refer to the Referral Search section for more details

Open the Handover Report. This enables users to bring up a list of active referrals that have been logged or had active updates in the last n hours (by default n is set to 24 hours but can be changed by the user). Specifically this is designed to facilitate handover between on-call clinicians at a hub specialty. refer to the Handover report section for more details

Open the Waiting list. This enables users to bring up a list of any patients where the latest action entered on their management plan is to add them to a waiting list with the intention of transferring/admitting them to the NORSE hub.

refer to the Waiting List section for more details



Referral Grid displayed to Referrer Users

This screen shot shows the referral grid for a user with 3 referrer roles. Currently they have selected their role as referrer

to Renal at UHB, and therefore only referrals logged by their trust to Liver at UHB are being displayed.

When a referrer user has logged in, the active referral grid is displayed (Note: this is not the case for Referrer Admin users as they only have access to the ‘Maintain User’ admin tool). All active referrals logged by them, or shared with them, at the trust that their NORSE account is currently assigned to are listed here. The user will need to choose the hub specialty list that they want to see from the ‘Your Current Role’ drop down menu available at the top right hand side of the NORSE page. Referrals are ordered according to message status (i.e. whether the last message was posted by the referrer or the Hub) and the date of the last update. (for more details please refer to the Referral List – How is it ordered? section later in this document)

Only referrals for the referrer’s trust will be displayed.

Note: the grid will list the referrals for the role that the user has selected at the top.

There are filter boxes available under the column headings for NORSE referral ID and Patient Name. These can be used to quickly ‘search’ by patient name or NORSE Referral ID

At the top of the grid the ‘show completed’ tick box can be used to show referrals that have

been closed in the last 30 days. Note: For referrals closed more than 30 days ago, users will need to use the referral Search button.

For Liver referrals where the specialty is set up with sub specialties Medicine and Surgery additional filter drop down boxes are available so users can choose to either see all Liver referrals or just Surgery or just Medicine.



In addition Liver can choose to update a referral to indicate whether the patient is waiting for transplant, post-transplant or not transplant; therefore there is an additional filter drop down box available to list these patients.

Actions available from the Referrers referral grid

View the referral list. By default the active referrals are listed according to message status (i.e. whether the last message was posted by the hub or the referrer) and date of last update. However users can:

o If a referrer user has multiple roles then they will need to choose the role that they want from the drop down menu available at the top right hand side of the NORSE page to bring the appropriate list up.

o Click on any column heading to sort the list in order o Use the two available ‘quick filter’ boxes to filter the list either by referral ID or

patient name. o Tick the ‘Show Completed’ tick box to list all referrals that have been closed in the

last 30 days.

Add a new referral. This enables a user to log a referral request to any hub specialties available. Refer to the Add New Referral section for more details

Open a referral. This enables a user to view more details and add updates to a referral Refer to the Open Referral section for more details

o Clicking on the magnifying glass, view button, will open a referral displaying the ‘All’ tab

o Clicking on the square red cross icon will open the ‘Close Request’ tab

o Click on the envelope message icon to open the ‘Input external message’ tab

Open the Referral Search window. This enables a user to carry out detailed searches to find particular referrals or groups of referrals. refer to the Referral Search section for more details

Open the Waiting list. This enables users to bring up list of any patients where the hub have indicated that the management plan action is to ‘transfer/admit’ the patient to the NORSE hub. This tab will show a full list so that users can see how many patients are waiting, but patient details will be anonymised for patients who have not been referred from the user’s trust. refer to the Waiting List section for more details



Referral List – How is it ordered? Priority and Status Explained The rationale for the order that referrals are listed is as follows: Referral requests that are awaiting a response are prioritised ahead of those that have been responded to, and therefore appear higher up the list; in addition to this referrals which have not yet had a management plan assigned are prioritised above those that are still waiting for a management plan. The system allocates a status to each referral to keep track of whether a response and/or management plan is required or not. Where referrals have the same status, the referral which has been waiting for a response the longest is prioritised to appear first. In the database there is a status field that is updated according to the last action that has taken place for each referral. These are:

Status Description

1 – New Status allocated when a new referral is logged on the system by an external user or by an internal user on behalf of an external user

2 – InfoRequest Status allocated when internal user submits a message for a referral that does not yet have a management plan message.

3 – InfoRespond Status allocated when an external referrer user submits a message for a referral that does not yet have a management plan message.

4 – Advised Status allocated when internal user submits a message for a referral that has a management plan message.

5 – Advise Respond Status allocated when an external referrer user submits a message for a referral that does not yet have a management plan message.

6 – Referrer Request Close (1000)

Status allocated when an external referrer user submits a message requesting that a referral be closed

7 – Hub Request Close (1001)

Status allocated when an internal user submits a message requesting that a referral be closed

8 – Completed Status allocated when an internal user completes/closes a referral – this is only done once the patient details have been validated and a UHB PAS ID number has been looked up

Referral List order In the front end the users will see the referral list applicable to them (i.e. either the referrer grid or the Hub grid), and this list is ordered according to the priority – i.e. the system will list the referrals according to the priority that they should be dealt with. There are two factors that determine the priority:

the status and the date/time of the last update.



How the system orders by status:

Hub user list Referrer’s list

Active List Active List

1 – New 2 – InfoRequest

3 – InfoRespond 4 – Advised

5 – Advise Respond 1 – New

2 – InfoRequest 3 – InfoRespond

4 – Advised 5 – Advise Respond

1000 – Referrer Request Close

Completed List Completed List

1001 – Hub Request Close 1000 & 1001 – Referrer Request Close & Hub Request Close

6 – Completed 6 – Completed

Where referrals have the same status the referrals are ordered by the earliest date/time. To understand this ordering it is important to understand the way the statuses update.

Message Icons Explained Both Hub and Referrer users view a referral list showing all active referrals. Alongside each referral is an icon which is intended to indicate whether a referral has an unread message, has been read but is yet to be actioned or has been read and actioned.

Status Icon on Internal Referral list Icon on External Referral list

1 – New

New

New

2 - InfoRequest

Actioned

or

Message unread or Read but not yet actioned

3 – InfoRespond

or


Actioned

4 – Advised

Actioned

or


5 – Advise Respond


Actioned

1000 – Request Close (referrer)

Request Close (remains on active list)

Request Close (disappears off active list)

1001 – Request Close (hub user)



6 – Completed

Completed - Green Tick (disappears off active list)

Completed - Green Tick



NORSE automated Notifications NORSE v3.4 has the capability of sending notification emails messages to both hub users and referrer users. The NORSE admin tool allows hubs to set up global on-call email addresses to receive notifications whenever a referral request is logged on the system and also when referrers make updates to an existing referral request. Provided a referrer supplies these details then NORSE will send notification emails each time a hub clinician updates the referral request that they have logged. It is also possible for referrer users to update which email address they want the notification to be sent to. The text in the notification messages is tailored depending on the status: 'A new referral, ID: ########' has been submitted' or 'A management plan has been submitted for referral ID ####' for management plan, or 'A new message has been submitted for referral ID ######' etc...

About ‘Message’ notifications Every time a ‘message’ is posted for a referral a notification will be sent to the global on call email for the hub specialty (or sub specialty if there is one) that the referral is logged for; and a notification will be sent to the most up to date notification details entered for the referrer.

Messages that notify the hub specialty global on-call email and mobile: Customisable in the administration panel for the Hub:

Notification Name Inform Consultant Inform On Call

Referral added

GCS value

New consultant added

New registrar added

External message

Internal message

Management Plan submitted

Close Request

Referral Closed

Attachment(s) added

Clinical Status

New Waiting List

Trauma Flag

Referrer Updated

Replacement

Bloods

Share

Renal Bloods

Referring Consultant Update



Messages that notify the referrer contact email: Input external message - submitted by a hub registrar or hub consultant

Input management plan - submitted by a hub registrar or hub consultant

Possibly a specialty specific tab; e.g. for Neurosurgery the option to update GCS value will be available on its own tab - submitted by a hub registrar or hub consultant

Close request - submitted by a hub registrar or hub consultant

Add new referral

Users who can log new referrals NORSE users with one or more of the following roles are able to submit new referral requests on NORSE:

- Hub Consultant - Hub Registrar - Referrer - Referrer Admin

Submit a new Referral Request

Access norse from https://nww.norse.uhb.nhs.uk

Click on the button

If the user has more than one referrer role they will be prompted to choose which hub and specialty they want to submit a referral for:

Click to choose which hub and specialty you want to submit a referral request for

The ‘Add New Referral’ window will open: Each hub specialty has the ability to configure/tailor parts of their referral form to meet their specific needs. However all referral forms have some mandated common fields and all follow the same format/layout.




Screenshot showing an example of a renal referral form for the UHB NORSE hub

The details of the user logged in will automatically populate in these boxes (if the details were

entered when the user was set up)

All boxes highlighted in yellow are mandatory.

The notes boxes that are displayed here are configured per hub specialty.

The select attachments box appears on all referral forms. See Attachment rules and restrictions section for more details.

The tick boxes displayed here are configured per hub specialty.

The panels that appear on tabs here are configured per hub specialty



Complete the referral details as necessary Note: It is possible to enter ‘unknown’ in the mandatory patient details fields if, at the time of submitting a referral request, these are not known. However it is not then possible to update the fields, and once known the patient’s details would need to be included in a future message.

o Patient Details:

Hospital number: the patient’s hospital number should be entered here. Note: it is possible to configure NORSE with a connection to a ‘Master Patient Index’ so that when a hub user or a referrer user at a trust flagged as a hub (e.g. UHB referrer) are logging referrals, a Patient ID look up button is available so that the patient details can be ‘pulled in’ when the patient’s hospital number is entered.

Forename Surname Gender Date of Birth NHS Number – this is not mandatory because it is not always known at the

time the referral request is submitted, but where possible it is expected. Ward – the ward that they are on in the referring hospital Address – first line of address Postcode

o Referrer Details:

Referring Hospital - The hospitals that appear in the drop down do so according to which role the user has; e.g. if the user is a hub user then they will see all hospitals at all trusts that have been set up to refer to their hub specialty; however if the user only has a referrer role then they will see only the hospitals that belong to their trust.

Referring consultant – enter the name of the ‘overseeing’ consultant at the referring hospital

Referring clinician - enter the name of the referring clinician at the referring hospital. By default the name of the logged in user will be displayed in this box. This can be overtyped if required.

Contact Number - enter the mobile or other contact number of the referring clinician at the referring hospital. By default, if entered when the user was set up with a NORSE log in, the number of the logged in user will be displayed in this box. This can be overtyped if required. This will be used by NORSE to send automatic notifications to the referrer each time an update is submitted for this referral.

Contact Email- enter the email address or other contact number of the referring clinician at the referring hospital. By default, if entered when the user was set up with a NORSE log in, the email address of the logged in user will be displayed in this box. This can be overtyped if required. This will be used by NORSE to send automatic notifications to the referrer each time an update is submitted for this referral.

Position – the position of the referring clinician can be entered here Department– the department/specialty of the referring clinician can be

entered here Admitting consultant – if the patient has been admitted

o If the referral form includes check boxes at the top, then tick as appropriate

o Enter appropriate descriptions in each of the available notes boxes on the left hand

side



o If the referral form includes some special panels on tabs on the right hand side, then

complete as appropriate (please refer to the appropriate parts of the Specialty Specific Panels section)

o Attach a file if required

(please refer to the ‘Attachment rules and restrictions’ section for more details)

Click on Submit to save and submit o The NORSE system will send an automatic notification to the email address and/or

the mobile phone of the on-call team at the hub specialty that the referral request has been submitted for. (See the ‘NORSE Automated Notifications’ section for more details)

o Once submitted all details together with the date/time and the name of the NORSE user who has submitted are captured in a message and displayed as part of the NORSE record. The details cannot then be changed. Some details can be revisited and updates can be submitted – please refer to the ‘Open NORSE Referral’ section for more details.



Attachment rules and restrictions

Note: all attachments will be virus scanned. The larger the document, the longer it takes for

the screen to change. Once the referral ‘submit’ button is selected, please DO NOT click on the Submit button twice.

Specialty Specific Panels There are a number of panels that are available for use in NORSE. Typically these panels have been specifically developed for a particular specialty, but once added to the ‘library’ of panels, they are available to add to any hub specialty’s referral form by using the NORSE admin tool. The panels available are:

Panel Name Specialty Description

Clinical Status Liver Medicine

Liver Medicine Specifically developed for Liver Medicine. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Bloods Liver Medicine Specifically developed for Liver Medicine. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

GCS Neurosurgery This is a tab developed for Neurosurgery, which calculates the GCS for a patient. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Muscle Power Guidelines only

Neurosurgery This is a tab developed for Neurosurgery which displays some guidelines for muscle power. This panel can be configured to appear on the Add Referral form. It is only displayed to provide referrers with information and therefore is not then required in the ‘Open Referral’ view.

Waiting list Neurosurgery Liver Surgery

Specifically developed for Neurosurgery but is open to other specialties. Unlike the other panels, this panel is not available for use on the Add New Referral form but can be configured to be available if particular actions are chosen on a hub specialty management plan. It is then also available to update from the ‘Open Referral’ view. Refer to the ‘Waiting List’ section for further details

Clinical Status Liver Surgery

Liver Surgery Specifically developed for Liver Surgery. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view,

Renal Clinical Status

Renal Specifically developed for Renal. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Renal Bloods Renal Specifically developed for Renal. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.



Liver Medicine - Clinical Status tab This tab must be displayed by default on the Liver Medicine ‘Add new referral’ proforma and includes mandatory fields to indicate which category (POD, Prev Liver Transplant, Other) that users can complete to be able to save and submit a NORSE referral to Liver Medicine: One or more of the following check boxes must be ticked:

Paracetamol Overdose (POD) – check box

Prev Liver Transplant (PLT)– check box

Other – check box The panel will display further questions depending on which boxes are ticked. The fields displayed for each category are listed below; some of the fields are common across all three categories, others are only common to PLT and Other, and some are unique to just one of the 3 categories.

If POD is selected

The following POD specific questions will be displayed if POD is ticked:

Date and time of OD (2 fields – date and time pickers)

Staggered – check box

Quantity – free text

Mixed OD – check box If yes – additional drugs: free text

Date and time of presentation to A&E

Normal prescribed drugs – free text

Past psych history – free text

Alcohol consumption– free text

Non prescribed drug use – free text

Social background – free text

Management - drop down with General ward/HDU/ITU

NAC – check box

IV fluid last 24 hrs (not including NAC) – check box

Antibiotics– check box

Antifungals– check box

Pulse – free text

BP – free text

Inotropes check box

Encephalopathy Yes/No

GCS: free text

Intubated Yes/No

Hypoglycaemia Yes/No

Dextrose support Yes/No

Urine Output – free text

Renal replacement therapy Yes/No



If Previous Liver Transplant is selected

Date of transplant

*if within last 3 months contact Liver Surgeons

Currently active on liver transplant waiting list? Check box

Date of admission

Reason for admission –Free text box.

Diagnosis - Free text box

Events since admission–Free text box

PMH–Free text box

Tacrolimus dose free text

Mycophenolate free text

Azathioprine free text

Pred Free text

Other relevant drugs Free text box Current examination

Temp free text Pulse Free text BP Free text

O2 sats free text Respiratory Rate Free text Oxygenation Free text

Ascites check box

Encephalopathy check box

GCS free text

Hypoglycaemia check box

Urine output free text Current management (on PLT and Other)

Management – drop down General ward/HDU/ITU

Total IV fluid last 24 hrs free text

Total IV Albumin last 24 hrs free text

Antibiotics free text

Antifungals free text

Hypoglycaemia - check box

Dextrose support - check box

Intubated - check box

Inotropes - check box

Renal replacement therapy check box

If Other is selected

Known to liver unit? check box

Currently active on liver transplant waiting list? - check box Acute liver injury - check box Chronic liver disease - check box Other- check box

Date of admission

Reason for admission - Free text box.

Diagnosis - Free text box.

Events since admission - Free text box.

PMH - Free text box.

Relevant prescribed drugs (including antibiotics in last 3 months) - Free text box.

Alcohol consumption - Free text box.

Non-prescribed drug use (illegal drugs/NSAIDS/over the counter/herbal) - Free text box.



Current examination (on PLT and Other)

Temp Free text Pulse Free text BP Free text

O2 sats Free text Respiratory Rate Free text Oxygenation Free text

Ascites check box

Encephalopathy - check box GCS Free text

Hypoglycaemia - check box

Urine output - Free text

Current management (on PLT and Other)

Management – drop down General ward/HDU/ITU

Total IV fluid last 24 hrs – free text

Total IV Albumin last 24 hrs – free text

Antibiotics – free text

Antifungals – free text

Dextrose support - check box

Intubated - check box

Inotropes - check box

Renal replacement therapy check box



Liver Medicine - Bloods tab This tab is specifically requested by Liver Medicine so referrers can enter blood results when submitting referrals and subsequently the referral can be updated with further blood results. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Date/Time

INR

Hb

WCC

Plts

Na

K

Urea

Creatinine

Bil

AST

ALT

Alk phos

Alb

Lactate

pH

BE

Ciclosporin trough level

Tacrolimus trough level

When submitted, the values entered are included in the message list together with the name of the user who entered them and the date and time they were entered.

Subsequently new values can be entered; these values do not overwrite the previously entered values but instead are added as another date/time stamped message.



Liver Surgery - Clinical Status This tab has been specifically developed for Liver Surgery. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the Clinical Status tab

Complete the form

When submitted the values entered are included in the message list together with the name of the user who entered them and the date and time they were entered.




Neurosurgery – GCS This is a tab developed for Neurosurgery, which calculates the Glasgow Coma Scale (GCS) – this is a neurological scale for a patient. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the GCS tab

Select the appropriate option in the three drop down lists

The system will display the calculated GCS value

When submitted the GCS value is included in the message list together with the name of the user who entered them and the date and time they were entered.

If the patient’s condition subsequently changes a new GCS value can be entered; this value does not overwrite the previously entered value but instead is added as another date/time stamped message.

Neurosurgery - Muscle Power (Guidelines only) This is a tab developed for Neurosurgery which displays some guidelines for muscle power. This panel can be configured to appear on the Add Referral form. It is only displayed to provide referrers with information and therefore is not then required in the ‘Open Referral’ view.

Click on the Muscle Power tab

The guidelines are displayed

If appropriate, users can select a portion of text with their mouse, and can then click and drag to copy the selected text into one of the clinical notes boxes on the left hand side of the add referral form.



Neurosurgery - Waiting list panel – refer to separate Waiting List section This tab has been specifically developed for Neurosurgery but is open for other specialties to use if required. Unlike the other panels, this panel is not available for use on the Add New Referral form but can be configured to be available if particular actions are chosen on a hub specialty management plan. If active then it is also available to update from the ‘Open Referral’ view. Refer to the ‘Waiting List’ section for further details



Renal - Clinical Status This tab has been specifically developed for Renal. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the Renal Clinical Status tab

Complete the form





Renal Bloods Tab This tab has been specifically developed for Renal. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the Renal bloods tab

Complete the form

When submitted the values entered are included in the message list together with the name

of the user who entered them and the date and time they were entered.



Subsequently new values can be entered; these values do not overwrite the previously entered values but instead are added as another date/time stamped message. This will also generate a customised renal bloods chart for each result type in the Bloods tab for each referral.



Open Referral – which roles have access to which tabs Tab Name Specialty Hub Roles that have

access Referrer Roles that have access

All Messages

All

Consultant

Registrar

Specialty Admin

Read Only

None

Update Details

All although different fields appear per specialty

Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Send Message

All Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Add Internal note

All Consultant

Registrar

Specialty Admin

Read Only

None

Management Plan

All Consultant

Registrar

Specialty Admin

Read Only

None

Close Referral

All Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Attachments All Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Clinical Status Liver Medicine

Liver Medicine Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

GCS Neurosurgery Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Waiting list Neurosurgery but perhaps also appropriate for

Consultant

Registrar

Specialty Admin

None



other specialties. Read Only

Clinical Status Liver Surgery

Liver Surgery Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Renal Clinical Status Renal Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Renal Bloods Renal Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User

Share All Consultant

Registrar

Specialty Admin

Read Only

Referrer

Read Only User



The ‘All messages’ tab The ‘All messages’ tab displays all messages for the referral in chronological order; this implies that users need to scroll through the messages to read all and understand the full details of the referral request. The only exception to this is that users logged on with a referrer role will not see any internal messages posted by users with hub roles.

It is important to note that the most recent messages and management plan will be listed towards the bottom of the list, i.e. the earlier posts are listed first. To help make it clear the most recent management plan is displayed in a bright blue box, whereas older, inactive management plans are displayed in a grey box.

Update Details tab This tab is only available to hub consultant, hub registrar and hub spec admin users and is configured to display different fields depending on the specialty that the referral is logged under.

Liver – Update Details tab



Select the consultant and registrar to indicate who is currently dealing with the referral

Select the sub specialty (i.e. Liver Medicine or Liver Surgery) if it needs changing.

Select to specify whether the patient is post liver transplant or Not applicable or HPB patient

Neurosurgery – Update Details tab

Click on the Update Details tab

Tick to indicate if the referral is a Major Trauma Centre Flag

Renal – Update Details tab

Click on the Update Details tab

Select the consultant and registrar to indicate who is currently dealing with the referral

Click on Update to save and submit



Send message tab (External) This tab allows referrer, hub registrar and hub consultant roles to submit a free text message for a given referral. The referral status updates according to the user role that submits the message; and the system will generate notification emails and text messages to the hub global on-call contact and the most recent referrer contact. All messages posted will be displayed in the NORSE messages list and will be stamped with the details of the user who submitted the message and the date/time.

Click on Input Send Message tab

Type in a message

Click on Update to save and submit

Add Internal note tab (Internal) This tab is only available to users with hub registrar and hub consultant roles. It allows them to submit internal free text message for a given referral. The referral status does not update and the system does not generate notification emails or text messages. All messages posted are displayed in the NORSE messages list when viewed by users with a hub role but are not displayed in the message list when viewed by users with a referrer role.

Click on Add Internal Note tab, type a message and select Update



Management Plan tab The ability to input a management plan is only available for use by users with a hub registrar or hub consultant role. Once submitted the referral status updates according to the user role that submits the message; and the system will generate notification emails to the hub global on-call contact and the most recent referrer contact where configured. All messages posted will be displayed in the NORSE messages list (all messages) and will be stamped with the details of the user who submitted the message and the date/time.

Click on the Management Plan tab

Select a Diagnosis Group

Tick a diagnosis code (more than one in a group can be ticked if necessary)

Note: Templated notes can be set up in the NORSE admin tool for particular diagnosis group and diagnosis code combinations. To make use of these, users should:

Click on the Find Standard notes button

Click on select alongside the notes they want to pull in.

The notes will then be copied into the advice free text box. They can then be amended and added to as required



Select an Action from the drop down list. Note: Some Actions are set up in the admin tool for a hub specialty to also create a NORSE waiting list. (Please refer to the waiting list section in this document).

Select a stage – this only applies to Neurosurgery referrals. This field is deliberately hidden for other specialties as they do not require it.

Click on Update to save and submit the management plan The referral status updates and the system will generate notification emails to the most recent referrer contact if details have been supplied. The details of the management plan will then be displayed in the message list. Note: If there are previous management plans then the earlier ones will be highlighted in grey and the latest one will appear active in bright blue:

Close Referral tab

A referral cannot be completely closed until both a Management Plan has been submitted and the Patient’s ID has been validated for the receiving hub specialty. This is so that the referral can be closed, locked down from receiving further updates and then exported as a pdf document to the hub’s electronic patient record.



However

a referrer can ‘close referral’ at any point by navigating to the close referral tab and adding a reason. This will generate a ‘close request’ message to the hub (All messages).

This will be viewable in the referral grid list if ‘Show completed only’ is selected. In order to export the referral to the EPR system the hub user would need to match the

patient ID on Norse in order for the referral record to be exported.

Attachments tab This tab allows referrer, hub registrar and hub consultant roles to view a list of files that have been attached to the referral. They are also able to attach more files to the referral. The referral status updates according to the user role that submits the message; and the system will generate notification emails and text messages to the hub global on-call contact and the most recent referrer contact. All messages posted will be displayed in the NORSE messages list and will be stamped with the details of the user who submitted the message and the date/time.

Click on the Attachments tab

A list of files that have already been attached is displayed. Underneath there is a Select button that allows users to attach further files.

To view a file click once on the View icon , the file will open up

To attach another file click on Select and browse to find the file you want to attach



Specialty Specific Tabs Liver Medicine - Clinical Status tab

Putting a tick in one of these tick boxes opens up the clinical status tab further for relevant information to be entered.



Liver Medicine - Bloods tab

When submitted, the values entered are included in the message list together with the name of the

user who entered them and the date and time they were entered. Subsequently new values can be entered; these values do not overwrite the previously entered values but instead are added as another date/time stamped message.



Liver Surgery - Clinical Status tab This tab has been specifically developed for Liver Surgery. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the Clinical Status tab

Complete the form





Neurosurgery – GCS tab

This is a tab developed for Neurosurgery, which calculates the Glasgow Coma Scale (GCS) – this is a neurological scale for a patient. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the GCS tab

Select the appropriate option in the three drop down lists

The system will display the calculated GCS value

When submitted the GCS value is included in the message list together with the name of the user who entered them and the date and time they were entered.

If the patient’s condition subsequently changes a new GCS value can be entered; this value does not overwrite the previously entered value but instead is added as another date/time stamped message.



Waiting list tab – refer to separate Waiting List section This tab has been specifically developed for Neurosurgery but is open for other specialties to use if required. Unlike the other panels, this panel is not available for use on the Add New Referral form. It is activated when a hub registrar or hub consultant submits a management plan with an action that has been set up in the admin tool to create a new NORSE waiting list entry. Once a waiting list has been created from the management plan tab the waiting list tab is displayed in the Open Referral window and is available to update by users with hub registrar, hub consultant or hub specialty admin roles. A patient’s NORSE waiting list entry can be updated either by:

using the add to waiting list form that opens when an action, flagged as activate waiting list, is chosen when submitting a new management plan.

or

using the waiting list tab available within the view referral window. Both of the above options should display the current/previous waiting list details already selected in the drop down lists, available for the user to change and save if required, or confirm no changes.

Note: The waiting list details are never overwritten/updated, but rather when a new set of details are submitted the ‘old’ details are left in the message list and the new details are recorded as a date/time stamped message, and it is the new details that are then listed on the waiting list grid (see Waiting List Grid section). The system keeps a record of the following date/times:

The date/time the referral was submitted

The date/time that the first ‘Add to Waiting list’ is created

The date/time that any subsequent updated waiting list entries are submitted



Renal - Clinical Status This tab has been specifically developed for Renal. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the Renal Clinical Status tab

Complete the form





Renal Bloods Tab This tab has been specifically developed for Renal. It can be configured to appear on the Add Referral form, but is then also available to update from the ‘Open Referral’ view.

Click on the Renal Bloods

Complete the form





About the NORSE Waiting List If patients referred via NORSE need to be admitted to the receiving hospital (Hub) (e.g.UHB (or visited by a hub clinician at the referring hospital), they can be added to a NORSE waiting list which can then be managed by the Hub Specialty team. Note: If hub specialties want to make use of this functionality then they need to set it up in the NORSE Admin tool by specifying which management plan actions they want to activate a waiting list; if they don’t want to use this functionality then they do not need to. When a clinician creates a management plan for patients referred via NORSE they have to choose an action. Each hub specialty can set up which actions prompt a waiting list to be created in the NORSE Admin tool. When such an action is selected, the registrar or consultant will also be required to complete a small ‘Add to Waiting List form’. When a patient is added to a waiting list they are assigned a category. The category is used to both indicate the priority of the patient and also to indicate what stage in the waiting list process they are at. This list of categories is preset in the system; i.e. no new values can be added via the admin tool. However the admin tool does allow hub specialties to specify which categories are available in the category drop down list for each management plan action they choose, when submitting a management plan. The available categories are listed below:

Category Active/Inactive

Urgent Same Day – it is anticipated that this category will only be used for emergencies.

Active

Level 1 – within 48 hours Active

Level 2 – within 5 days Active

Level 3 – within 10 days Active

Level 4 – within 72 hours In active

Awaiting tests Active

Visit patient in other hospital Active

Patient admitted Active

Ready to be repatriated Active

Repatriated to referring hospital Inactive

Patient sent home Inactive

Remove from waiting list (when this option is chosen the user should be asked to enter a reason)

Inactive

When an inactive category is chosen it is likely that the NORSE referral is ready to be closed. Therefore the system prompts the user to also close or close request the referral. Conversely if a user attempts to close a referral which has an active waiting list entry they will get a message asking them to first close the waiting list entry. Note: Because each change to a waiting list is effectively a new entry, the system will keep an audit of how long the patient has been held at each category/stage. This does imply that there is an emphasis on the users to understand how to use this drop down list and to keep the waiting list up to date. Any patients added to a NORSE waiting list with an active category will appear on the Waiting List grid in NORSE (please refer to the Waiting List Grid section). This grid is managed by the consultants, registrars and hub spec admin users, who are responsible for updating the waiting list category as the patient either changes in priority or moves through the process until they have been seen and dealt with.



Access to Waiting List functionality

- Only Hub Registrars and Hub consultants can create new waiting lists; they are the only roles that can submit management plans and creating a management plan with an appropriate action is the only way a NORSE waiting list entry can be created.

- Hub Registrars, Hub consultants and Hub spec admin users can access and update the waiting list information from the waiting list tab and the waiting list grid

Updating a NORSE waiting list entry A patient’s NORSE waiting list entry can be updated either by:

using the add to waiting list form that opens when an action, flagged as activate waiting list, is chosen when submitting a new management plan.

or

using the waiting list tab available within the view referral window. Both of the above options should display the current/previous waiting list details already selected in the drop downs, available for the user to change and save if required, or confirm no changes.

Note: The waiting list details are never overwritten/updated, but rather when a new set of details are submitted the ‘old’ details are left in the message list and the new details are recorded as a date/time stamped message, and it is the new details that are then listed on the waiting list grid (see Waiting List Grid section). The system keeps a record of the following date/times:

The date/time the referral was submitted

The date/time that the first ‘Add to Waiting list’ is created

The date/time that any subsequent updated waiting list entries are submitted



Closing/removing from NORSE waiting list The Category field is used to indicate what stage a waiting list is at.

When a patient is no longer required on the NORSE waiting list an updated waiting list entry must be submitted with one of the ‘inactive’ categories selected, e.g. ‘Remove from Waiting list’. This can either be done by a user submitting an updated waiting list entry via the management plan waiting list form or using the waiting list form available within the waiting list tab Note: When an inactive category is chosen it is likely that the NORSE referral is ready to be closed. Therefore the system prompts the user to also close or close request the referral. Conversely if a user attempts to close a referral which has an active waiting list entry they will get a message asking them to first close the waiting list entry.

User Steps - closing/removing from NORSE waiting list:

Choose one of the ‘inactive’ categories e.g. Remove from Waiting list

Add/amend the Treatment expected date/specific treatment info

Leave the removal date as today or amend

Type in some text explaining why the patient is being removed from the list

Click on Update

Should the user want to close the referral once the ‘close referral’ tickbox’ is selected a message box will be displayed for you to add further notes.

Please ensure a management plan has been submitted and that the Hub’s hospital number has been validated – see next section.



User Steps - closing a NORSE referral which has an active waiting list entry: Prior to closing a NORSE referral the user should ensure that a management plan has been submitted and that the Hub’s hospital number has been validated.

Click on the Close referral tab

Enter a reason and click Update

If the referral has an active waiting list entry then the user will see a message saying ‘ This referral has an active waiting list entry, do you wish to remove the patient from the waiting list?’ Yes or No

If yes is selected then the waiting list tab will be displayed ready for the user to choose one of the inactive categories

If No is selected then the message ‘ This referral cannot be completed until the waiting list has been changed to inactive’

Note: the ‘Close request’ message is a stage prior to the ‘referral closed’ stage.

Waiting List Grid - to display all waiting list entries All patient referrals with waiting list entries can be displayed on the Waiting List grid.

At the top of the grid there is a ‘Category’ checked drop down ‘filter box’ that defaults with only the following categories ticked:

Urgent Same Day

Level 1 – within 48 hours

Level 2 – within 5 days

Level 3 – within 10 days

Awaiting tests The category checked drop down filter box can be used to untick any of the above and/or to tick any of the following categories that are not displayed by default:



Visit patient in other hospital

Patient admitted

Note: Once an inactive category has been entered the waiting list entry will not be displayed on the waiting list grid at all. To view details of such referrals users will need to use the referral search and then view the details in the NORSE referral message log; or at UHB once the referral is closed this information will also be available in the in the Clinical Portal. (See additions to Referral Search window) The following referral and waiting list details must be displayed on the waiting list grid:

Patient Name

Age

Consultant – this is the currently allocated Hub consultant. If no consultant has been updated against the referral then no name will appear in this column.

Referring Hospital

Diagnosis description form the latest management plan

Specific Treatment description (free text displayed, culled at 20 characters)

Expected Date of treatment

Category: The list is also ordered according to category – see ‘Rules for grid order’ below.

Days on WL - Display the number of days since the patient was added to the Waiting list with any category.

Status – Green, amber and Red e.g. waiting list time exceeded on hover over. The following RAG highlighting will be displayed depending on the category of the referral

Level 1 – within 48 hours it will be displayed with a green background then > 48 hours it will change to red

Level 2 - within 5 days it will be displayed with a green background then > 5 days it will change to red

Level 3 – within 10 days it will be displayed with a green background then > 10 days it will change to red.

Days since referral: Display no. of days since the referral was first submitted.

Days on current category. Displays the cumulative time in days since a waiting list entry or series of consecutive waiting list entries with the same category was submitted. This does not apply if the category is Awaiting Tests.

Rules for grid order

1) Group by category (see table below indicating order level) 2) Then order by Days on WL

Category Display as active or inactive

Urgent Same Day Active - order number 1

Level 1 Active - order number 2



Awaiting tests Active - order number 5

Visit patient in other hospital Active - order number 6 – but not ticked to display by default

Patient admitted Active - order number 7 – but not ticked to display by default

Repatriated to referring hospital Inactive

Patient sent home Inactive

Remove from waiting list (when this option is chosen the user should be asked to enter a reason)

Inactive



Referral Search The referral search screen can be used to identify specific patient referrals or various other information based on the fields selected below. The Hub speciality will be able to export any search results to excel by selecting the excel icon.

The following roles can use referral search:

1. Hub Roles a. Hub Consultant b. Hub Registrar c. Hub Read Only

2. Referrer Roles a. Referrer b. Referrer read only

However the options they get are restricted according to what trust they belong to and what roles they have.

All above roles can only search through the referrals for hub specialties that they have been set up for. The hub specialties that they have been set up for also dictate what values will appear in the search screen drop down lists for: diagnosis group, diagnosis code, actions, trusts, hospitals etc

Referrer roles can only search for referrals logged by their trust for the hub specialties that they have been set up for.

Hub roles can only search for referrals logged to their hub specialty, but from anyone anywhere.

Read only roles can only view the referrals and the details, other roles will be able to open up a referral from the search results screen and update via one of the tabs available.



Handover Report

On clicking this button the Handover report screen is launched. This displays 2 lists to capture the activity in the last n hours (by default n is set to 24 hours, but can be changed by the user if required):

1. List 1: All referrals logged within the last n hours 2. List 2: All referrals logged more than n hours ago, but that have had messages and/or

management plans submitted within n hours.

This is available to hub users and filters according to the hub specialty for the role that the user is logged in with. Applicable to Neurosurgery only.

PDF facility At any moment in time a clinician on the Hub end can view the referral and all encounters of the referral in question. Simply click the View PDF button. Once a patient ID is validated, it is this PDF copy that is exported to the EPR record (where this is configured – applies to UHB).

Documents

Application version: v3 v3.4 End User Guide v1.0...NORSE v3.4 user guide last updated: 01/05/2015 Document uncontrolled after 23/06/2015 if printed v1.0 Page 1 of 59 NORSE End user