EMIS WEB GUIDE

Delivered in collaboration with the NW London Primary Care Cancer Board, this pilot has been developed for all members of the practice team including clinicians and administrators to improve confidence to implement safety netting systems in your practice using EmisWeb in ways that are already familiar.

Intro Video

What is electronic safety netting?

Safety netting is an approach that manages diagnostic uncertainty.

This leads us to believe that it should be more sophisticated compared with the verbal and reactive approaches that are commonly used. Electronic safety netting is the method recommended that provides practices with a rigorous, robust, traceable and auditable pro-active approach to tracking patients where needed, for example suspected cancer referrals or direct access diagnostics mentioned in the NICE NG12 guidelines published in 2015.

The patient healthcare record can be utilised as part of mature proactive systems need to enable practices, and federations to proactively call / recall / track patients. It is administrator led, and offers medicolegal resilience – by simply building on a ‘business as usual’ methodology (like we do for QOF and other targets).

How to safety net with resilience?

A robust safety-netting management system in primary care should be able to manage the following ‘what ifs’:

1

The patient does not attend for urgent hospital test or appointment.

2

A result requiring urgent action is received late in the afternoon when the doctor who ordered the test has left?

3

A locum makes the referral/orders the test.

4

The doctor ordering the test is away on holiday?

5

The patient does not come back to the GP for review as requested?

CLINICIAN VIDEOS

Suspected cancer referrals

This video shows how to electronically safety net suspected cancer referrals.

1

By August 2018 all suspected cancer referrals will need to be sent via the e-Referral system.

4

Set the diary entry 1-2 weeks after the referral date to track an appointment has been received by the patient and to confirm their attendance.

2

Ensure that the patient is available within the two week time frame.

5

Please offer written information.
Available in 11 languages

3

Confirm up-to-date patient contact
information
at the time of the referral.

Primary care diagnostics

This video shows how to safety net diagnostics requested within primary care.  As more diagnostics become available in GP practices there is increasing responsibility of the GP to ensure patients have had their investigations performed and results received in a timely manner.

1

The electronic safety netting method allows you to track multiple diagnostics and update the usual or requesting GP of the progress.

3

Direct access diagnostics include imaging, pathology tests and endoscopy.

2

Common occurrence to arrange multiple diagnostics at the same time.

4

Useful for safety netting consultation activities of locum or part-time clinicians especially.

Vague or unexplained symptoms

This video shows how to safety net vague symptoms that require a review in an agreed time frame.

1

Useful for those who can not fix their follow up appointment there and then.

3

Enables healthcare record continuity if more than one clinician involved in the  patient’s care.

2

Vital for carers, vulnerable persons, those with complex co-morbidities where follow up appointments may be consumed by long-term conditions and concerning symptoms then missed or overlooked.

4

Provides an opportunity to safety net holistically.

ADMIN VIDEO

Safety Net Search File and Workbook

This video shows how easy it is to set up searches on a weekly basis for an administrator to review and complete the diary entries using a spreadsheet.

1

We recommend that the searches are performed weekly as an autoreport, however we appreciate depending on your in-house resource and practice size you may wish to review this. The system will pick up items that have expired or were not completed prior to the search date.  It is also important to set realistic time frames for the administrator to complete the diary entries. Again we recommend one week to ensure there are no delays.

3

Do not forget to complete or reset the diary entry. You will also be able to capture diary entries that perhaps were not completed or actioned – thereby offering the opportunity to catch items that may have been overlooked or missed prior.

2

Using the sort function in Excel you can see the patient’s name, EMIS number, date the diary entry was set for, the code, any associated free text with the instructions and the colleague who created the diary entry. Your practice safety netting admin lead is now able to add a final column to log their actions and track their own progress. This can also be entered into the care history section of the medical record. You can adapt this method to suit your way and style of working.

You can download and import the search file here to use or you can use the electronic safety netting tool within EMIS developed by UCLH Cancer Collaborative and Macmillan Cancer Support (available in FAQ section).

Testimonials

The safety netting system is an excellent way of offering quality service to our patients. I have great pleasure in doing the safety netting and it is also appreciated by our patients as several of them have actually thanked me for calling to remind them of appointment bookings and booking it for them and checking up on their health. It is a very satisfying part of my job. Patient care is at the top of our list and it is something we are very passionate about.

Sharon Elfrey
Admin Lead for Cervical Cytology & Safety Netting, Brent

As an individual involved with the designing and running in the process I have felt a great sense of ownership in the task especially knowing we are having a direct positive impact on our patients. As a team it is good to see admin and GPs collaborate together in such a seamless way.

Mark Nolan
IT and Admin lead, Brent

Frequently Asked Questions

1

What is the evidence for this as best practice?

Thematic analysis from Significant Event Audits of patients who present with a new diagnosis as an emergency reveals safety netting systems in practices to be poor or absent. This is further supported by the National Cancer Strategy and NICE guidelines NG12 (2015). Cancer Research UK  and Macmillan Cancer Support recommend safety netting. This project is part of a wider programme to improve early diagnosis across NW London. The NW London Primary Care Cancer Board will be evaluating the level of engagement, and its links with early diagnosis. If you are a practice participating in this pilot you will be asked to complete a pre and post-training assessment to inform the wider learning and next steps.

2

Is there a template version available?

EmisWeb has recently published a template that is cancer safety netting specific and builds on the principles seen in this video. Here is a link to the video and information on how to activate this in your system. https://www.youtube.com/watch?v=U4byHZwOZv8&feature=youtu.be

For more information please look at the guide produced by UCLH primary care improvement team: www.uclh.nhs.uk/OurServices/ServiceA-Z/Cancer/NCV/MICa/Pages/Primarycareimprovement.
aspx

It is important to note whether you use the freestyle diary entry method seen in today’s video or whether you decide to utilise the template version you will be adopting a safer and more robust approach to cancer care.  Of course you can combine the best of both worlds should you wish and use both! An example of this may be a vulnerable adult with severe mental illness who requires a review of their vague abdominal pain as well as a lithium level blood test and MH care plan review.

3

Is this a lot of work from an admin perspective? What if I don’t have capacity in my practice to set this up?

Based on pre-pilots and proof of concept studies in large practices we do not expect this to generate a lot of additional admin. As primary care networks form within federations and development of ‘at scale’ operations such as sharing of back office functions an administrator may be able to lead this project for a group of practices.  Do read the testimonials from two administrators who have found this to be a rewarding experience from a professional development and job satisfaction perspective as well as improving patient safety and experience.

4

How can I get the search file and how often should the searches be conducted?

Please upload and import the search file or you can use the aforementioned electronic safety netting tool. We recommend that the searches are performed weekly as an autoreport however we appreciate depending on your in-house resource and practice size you may wish to review this. The system will pick up items that have expired or not completed prior to the search date.  It is also important to set realistic time frames for the administrator to complete the diary entries. Again we recommend one week to ensure there are no delays.

You can download and import the search file here to use or you can use the electronic safety netting tool.

5

What do I do if the search files produce long lists that are not realistic to manage on a weekly basis?

You may wish to apply a filter to the spreadsheet in order to streamline the key items you are tracking/safety netting. Alternatively when creating the diary entry the clinician may wish to insert the word ‘Admin’ into the free text box as a prefix; the workbook can then be filtered to show only diary entries containing the word ‘admin’ in the associated text - this will streamline the weekly list for the safety netting admin lead to action and complete.

6

Who do I contact if I need some help?

Do not hesitate to email us at
rmpartners.safetynetting@nhs.net

GP lead is Dr Ishani Patel
Project lead is Dominic Cunnane RM Partners
CRUK Facilitator is Neil Carmichael for Brent and Harrow
CRUK Facilitator is Liz Jacques for Hillingdon

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