cardiothoracic surgery inter hospital transfers policy v1.0 ......cardiothoracic surgery inter...

Cardiothoracic Surgery Inter Hospital

Transfers Policy

V1.0

July 2020

Cardiothoracic Surgery Inter Hospital Transfers Policy V1.0 of 20

Table of Contents

1. Introduction ................................................................................................................. 3

2. Purpose of this Policy/Procedure ............................................................................. 3

3. Scope ........................................................................................................................... 3

4. Definitions / Glossary ................................................................................................. 3

5. Ownership and Responsibilities ............................................................................... 4

5.1. Role of the Managers ............................................................................................ 4

5.2. Role of the Cardiology consultants and consultant of the week (COW) ................ 4

5.3. Role of the junior/middle grade medical team ....................................................... 5

5.4. Role of the Cardiac Surgery Liaison Team ............................................................ 6

5.5. Role of the Cardiology secretarial team ................................................................. 8

5.6. Role of ward nursing staff ...................................................................................... 9

6. Standards and Practice .............................................................................................. 9

6.17. Escalation of the Deteriorating Patient and Emergency Pathway ........................ 10

7. Dissemination and Implementation ........................................................................ 11

8. Monitoring compliance and effectiveness ............................................................. 11

9. Updating and Review ............................................................................................... 12

10. Equality and Diversity .............................................................................................. 12

Appendix 1. Governance Information ............................................................................ 13

Appendix 2. Equality Impact Assessment ..................................................................... 15

Appendix 3. Inpatient Surgical Pathway Flowchart ...................................................... 17

Appendix 4. Escalation of the Deteriorating Patient ..................................................... 18

Appendix 5. Cardiothoracic Surgery Work Up Checklist ............................................. 19

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1. Introduction

The surgical referral process incorporates a wide multidisciplinary team, each with

their own role and responsibilities in ensuring a timely, high quality patient orientated

service. Good communication, clarity of process and pathways, as well as defined

role responsibilities between heath care providers, patients, family and carers will

improve the patient experience by ensuring:

Accurate patient assessment, documentation and dissemination of information

Reduce delays for procedure

Reduce patient complaints

Result in timely transfer to surgical centre

2. Purpose of this Policy/Procedure

This document provides a structured overview of the inpatient surgical referral

process, detailing individual role responsibilities as well as clarifying the pathway

process.

3. Scope

This document provides guidance for any professional involved in the clinical management of patients admitted to Royal Cornwall Hospital NHS Trust and who requires transfer to a tertiary centre for cardiac surgery / intervention. This will include:

Consultants

Speciality Registrars

Junior Doctors

Specialist Nurses

Ward nursing staff Secretarial staff

4. Definitions / Glossary

4.1. COW – Consultant of the week

4.2. sMDT – Surgical multi-disciplinary team

4.3. Interventional cardiologists – consultant who carries out catheter-based

procedures

4.4. CSLT – Cardiac surgical liaison team

4.5. PCI – Percutaneous coronary intervention

4.6. CABG – Coronary artery bypass graft


4.7. PACS - Picture archiving and communication system – for the transfer of clinical

images

4.8. IEP - Image exchange portal – electronic computer system

4.9. CIVS – RCHT Cardiology electronic whiteboard to record patients awaiting

surgery

4.10.IHT – Cardiac Inter-hospital transfers system – electronic record / audit of

patients awaiting transfer to a surgical Centre. Currently being piloted for 1 year.

5. Ownership and Responsibilities

5.1. Role of the Managers

Managers are responsible for:

Ensuring Cardiothoracic surgeons have access RCHT cardiology IT services

to enable them to accurately assess and consult with patients in out-patients

regarding decisions about the patients forthcoming proposed surgery

Service level management are responsible for working within RCHT

Cardiology in facilitating the surgical referral process

Divisional management are responsible for escalating to senior management

teams where referral to transfer waits exceeds 21 days

Escalating to senior management teams where inpatient surgical waiter

numbers cause capacity concerns

Communicate with receiving centre opposite number

When prompted by the Surgical Liaison Team, Consultant of the Week,

Junior Doctor Team or Ward Managers that there is a failure or delay within

the pathway for Escalation of the Deteriorating Patient, to bring this to the

attention of the Senior Management team, and ensure the next step of the

escalation process has been followed

5.2. Role of the Cardiology consultants and consultant of the week

(COW)

The Cardiology consultants and consultants of the week are responsible for:

The presence of 1 non-interventional cardiologist, 2 interventional

cardiologists and 1 cardiothoracic Surgeon shall constitute a quorum at the

surgical MDT. The meeting will be chaired by the consultant who is COW for

Roskear


Ensure all patients referred to MDT are discussed and where the referring

cardiologist is unable to attend a representative presents the patient

Ensuring all identified in-patients are brought to MDT for discussion (patients

brought to the attention of the CSLT via the daily checking of the angiogram

list)

Ensuring referral letters for the patients under their care are dictated and are

with the secretarial teams within 24 hours of MDT ready for formal referral to

cardiothoracic surgeon

Taking a lead in escalating care and the expediting of transfer where a

deterioration/concern is noted

Working within the existing clinical pathways according to the patient’s

clinical priority (appendix 3)

Communicating with the Cardiac Surgical Liaison Team and/or Cardiology

ward manager of patients that require consideration/referral at an alternative

surgical centre

Taking lead in escalating care and expediting transfer where a deterioration /

concern is noted

To identify when the patient is deteriorating, either through escalation from

the junior doctor/middle grade medical team, nursing team or Surgical

Liaison Team and invoke the pathway for Escalation of the Deteriorating

Patient (Appendix 4)

Review patients post-surgery if they have had their operation at an

alternative surgical centre

5.3. Role of the junior/middle grade medical team

Junior/middle grade medical team are responsible for:

Assisting the COW in referring inpatients to the surgical MDT via the Maxims

internal referral system indicating why they have been referred Valve

surgery/PCI v CABG/complicated PCI for discussion/plan of further

management etc.

Attending the surgical MDT

Bringing the inpatient medical records for their area to the MDT meeting

Documenting in the medical notes the outcome of MDT


Once accepted by the visiting surgeon following the MDT, it is expected that

where safe to do so, all patients will have their antiplatelet medication

stopped.

To ensure the Cardiothoracic Surgery work-up checklist is completed and

included in the patient’s medical records with the relevant investigation

results (see appendix 5)

Communicating with the Cardiothoracic surgical Liaison nurse and/or

Cardiology ward manager where there is a concern/change/deterioration in a

patient’s clinical condition


the nursing team or Surgical Liaison Team and inform the COW, with a view

to invoking the pathway for Escalation of the Deteriorating Patient or

Emergency Pathway (appendix 4). This includes immediate liaison with the

receiving hospital when patients are deemed to require immediate transfer.

5.4. Role of the Cardiac Surgery Liaison Team

Cardiac surgery Liaison responsible for:

Providing a 5 day service, Monday – Friday 9:00 – 17:00 (weekend and out

of hours communication / transfers to be managed by ward staff / doctors as

advised by surgical centre)

A Cardiac Surgery Liaison Team member to attend sMDT once weekly –

Monday at 13:00 and be available to advocate for patients

Provide education and support to patients and their significant other

throughout their in-patient stay – liaising and updating them on a daily basis

and documenting in patients notes

Adding patients who have been accepted for surgery to CVIS (RCH

Cardiology electronic whiteboard) to provide up-to-date information to those

managing patient flow

Complete the IHT system with patient details, results and transfer information

Manage the ‘surgical waiter’ report / spreadsheet, ensuring all information is

accurate and up-to-date and circulate to the contracted surgical centre and

agreed recipients on Tuesday’s before 11:00 via email

Complete key performance indicator (KPI) audit to record accurate transfer

information and waiting times


Cardiac surgical liaison team to liaise with Operational Co-ordinator at

cardiothoracic centres regarding date for surgery / medical work-up and

report back to the patient and ward staff

Commence ‘Cardiothoracic surgery work-up checklist’ (appendix 5) and

include in the patient’s notes

Liaise with medical staffing to ensure all pre-surgical tests are requested and

carried out. Cardiac Surgical Liaison Team to ensure relevant surgical centre

Co-ordinator is kept up to date with information

Liaising with all teams involved in the patients care and expedites any

potential problems with ‘work up’ investigations to prevent delay in transfer.

Where the contracted provider (Derriford Hospital) is unable to comply with

the agreed timeframe of 7 days from receipt of referral letter (and the patient

is fully ‘worked up’ for surgery), approach alternative surgical centres to

establish whether an earlier date can be provided

When the decision to refer to an alternate surgical centre is made, the

patient’s referral letter / results and investigations are forwarded electronically

– on the same day for review by the cardiothoracic surgeon

CSLT to forward Angiogram and Echocardiogram images to surgical centre

using ‘Image exchange portal’ (IEP) electronic system

If patients are accepted by an alternative surgical centre – inform Derriford so

they can be removed from their waiting list

Inform secretaries about patients who are transferred to alternative surgical

centres (any centre other than Derriford) so they can book a follow up

consultant appointment at RCHT


the junior doctor/middle grade team or ward nursing team, and escalate

immediately to the Consultant of the Week, in order to invoke the pathway for

Escalation of the Deteriorating Patient or Emergency Pathway (appendix 4)

Documenting all contact with cardiothoracic centres, patient, family and/or

carers in patients’ medical notes and update surgical waiters report

accordingly

Removing the patient from CVIS/whiteboard and update KPI once transfer is

complete

Responsible for teaching cardiology ward based staff of the process for

preparing patients for surgery and transfer


Spreadsheet of up-to-date contacts for surgical service available on the

Cardiac surgical liaison team shared drive

5.5. Role of the Cardiology secretarial team

Cardiology secretarial team are responsible for:

The secretaries will ensure that notes for outpatients listed for the surgical

MDT meeting are available. However, the availability of notes for any

patients added to the MDT list after 12.00 on the Friday preceding the

meeting cannot be guaranteed

The secretaries will provide an MDT schedule to the Consultant

Cardiologists, Locum Cardiologists, SpRs, Cardiac Liaison Team, bed

coordinator and Nicola Hardiman on the morning of the meeting.

The secretaries will record the meeting outcomes on Maxims and distribute

these outcomes to the relevant staff (Consultants, SpRs, Cardiac Liaison

Team, Wards and Booking Team).

The secretaries will type any referral letters as soon as they are available on

Maxims and complete and distribute these letters as soon as they have been

checked by the consultant (where necessary) but cannot be held responsible

for when they are dictated, checked and sent. In order to facilitate this please

could all consultants mark MDT letters in Red on Winscribe.

The secretaries will email the referral letters directly to the chosen surgical

provider and include the Cardiac Liaison Team, Bed Co-ordinators and

Booking Hub (Nicola Hardiman) in the email. They will require the Cardiac

Liaison Team to provide them with the relevant email addresses for tertiary

centres other than Derriford. E.g. Barts/Wolverhampton/Bristol.

The secretaries will include echo/angio/carotid Doppler and any other reports

requested in the letter that are available on Maxims at the time the letter is

sent. If blood reports are needed to be sent the secretaries will need to be

informed of the exact result needed and the date of the test to ensure the

correct information is forwarded.

The secretaries are not trained to send images via the IEP system and this

will need to be requested via PACS/Cardiac Department by the Cardiac

Liaison Team.


5.6. Role of ward nursing staff

Ward staff members are responsible for:

Informing and escalating to the medical team any patient concerns, such a

change or deterioration in clinical condition (appendix 4).

Having an awareness of the surgical work-up required for their patient, with

particular attention to the need to stop antiplatelet medication following

acceptance for surgery.

Ensuring the ‘Cardiac surgical transfer checklist’ in the patients’ medical

notes is updated with the relevant investigation results (see appendix 5).

Ensuring patient, family and/or carers are kept informed of all tests required

prior to procedure as well as date for procedure

Ward staff to photocopy patient notes including nursing documentation on

current admission to be sent to cardiothoracic centre.

Ward staff to book transport through patient transport (access via intranet) or

contact ext. 3274 with an aim for the patient to arrive in Derriford before

midday on the day before planned surgery

Ward staff will contact the receiving centre to confirm bed availability on date

of transfer and will undertake telephone handover and provide an ETA at the

point the patient has been collected by transport and is being transferred.

The transferring ward are also responsible for ensuring the patient is going to

a ward that meets the patient’s level of care i.e. a CCU bed.

6. Standards and Practice

6.1. Where clinically appropriate, all patients identified as potentially requiring

surgical intervention must be discussed at a surgical MDT prior to formal referral.

6.2. The MDT will be attended by a visiting cardiothoracic surgeon.

6.3. When no surgeon is available to attend these meeting then CSLT to discuss with

the cardiology consultant about consideration of a direct referral to the

cardiothoracic surgeon.

6.4. The meeting is chaired by the consultant who is COW for Roskear.

6.5. Attendees and apologies of absence are recorded on MDT outcomes.

6.6. No phones to be used during the meeting except for those on-call/covering

‘COW’.


6.7. It is an expectation that all will participate and engage in the decision process.

6.8. In the absence of the referring consultant/when a meeting ends without having

discussed all the patients those relisted must be discussed as a priority at the

next meeting.

6.9. A patient can only be deferred for one meeting before another consultant must

discuss their case.

6.10. The chair of the meeting is responsible for ensuring an outcome is agreed and

verbally clarified within the meeting.

6.11. In the absence of a visiting surgeon the meeting is still held and where agreed

by the MDT, the patient’s referrals progressed as normal.

6.12. Once accepted by the visiting surgeon following the MDT, it is expected that

where safe to do so, all patients will have their antiplatelet medication stopped.

6.13. Work-up should be undertaken at the earliest opportunity where a decision for

surgical intervention is anticipated.

6.14. Referral letters should be completed no later than 24hrs following provisional

acceptance at MDT.

6.15. The patient’s clock (the time they have waited for their surgery) starts once the

referral letter and completed and received by Derriford.

6.16. A change in clinical condition that requires an escalation of care and transfer is

led by the COW, with a member of the medical team contacting the on-call

cardiothoracic surgical registrar at the chosen centre to refer for

urgent/emergency transfer (see Appendix 4).

6.17. Escalation of the Deteriorating Patient and Emergency Pathway

6.17.1. When a patient is deemed to be deteriorating, the nursing,

junior/middle grade medical staff or Surgical Liaison Nurse will

immediately escalate concern to the Consultant of the Week

(COW). Once the Consultant of the Week has confirmed the

patient is deteriorating, he/she will immediately invoke the policy

for Escalation of the Deteriorating Patient (Appendix 4).

6.17.2. Strict timescales, as indicated on the Escalation policy, will be

adhered to. For patients meeting the criteria for Emergency

Pathway, immediate transfer will be arranged via emergency

ambulance (999) services and the receiving hospital will be

informed. For patients who are deteriorating, but do not meet the

criteria for emergency transfer, the process for Escalation of the

Deteriorating Pathway (appendix 4) should be immediately


invoked, with the Consultant of the Week overseeing the initial

arrangements.

6.17.3. Should there be any delay in ensuring urgent transfer of the

patient, this will be immediately be highlighted to the

Directorate Manager and/or Deputy Associate Director who will

take the necessary steps to ensure the delays are minimised.

6.17.4. Patients who are deemed to meet the Emergency pathway will

be immediately transferred to the receiving hospital via 999

Ambulance and the Emergency transfer pathway invoked.

6.17.5. The surgical liaison team hold an up-to-date contact list for all

tertiary centres

7. Dissemination and Implementation This document will be reviewed annually at the Cardiology Governance Meeting

following which it will be sent to all Cardiology staff via email. Its compliance will

be monitored by the Cardiac Surgical Team and will be presented at the junior

doctor induction sessions. A copy will also be sent to the relevant colleagues at

Plymouth Hospitals Trust.

8. Monitoring compliance and effectiveness Element to be

monitored

Full policy

Lead Clinical Lead in Cardiology

Tool Adherence to guidelines will be monitored as part of the ongoing audit process on a Word or Excel template specific to the topic. Datix will be completed when the contracted provider (Derriford Hospital) is unable to comply with the agreed timeframe of 7 days. Discussion and review of the SOP will occur at the Cardiology

Governance meeting.

Frequency The gathering of feedback and observation will be on-going

Presentation at the junior doctor teaching session will be at each

new rotation

Review at Governance annually

An element of reporting is captured on an on-going basis via the

‘weekly surgical waiter’ report and via the Cardiology database

‘CVIS’. This data is compiled and presented as weekly report which

is disseminated to senior management

Reporting

arrangements

The weekly surgical report is sent to RCHT senior management

and the Derriford cardiothoracic surgical coordinator

The weekly performance report is sent to RCHT senior

management and staff involved in the operational running of

Cardiology


Acting on

recommendations

and Lead(s)

The Cardiac Surgical Liaison Team will undertake subsequent

recommendations and action planning for any or all deficiencies

and recommendations within reasonable timeframes

Change in

practice and

lessons to be

shared

Required changes to practice will be identified and actioned within

a month. A lead member of the team will be identified to take each

change forward where appropriate. Lessons will be shared with all

the relevant stakeholders

9. Updating and Review

9.1. This document will be updated by the surgical liaison team every 3 years.

9.2. Revisions will be made ahead of the review date if new, relevant national

guidelines are published. Where the revisions are significant and the overall

policy is changed, the surgical liaison team lead will ensure the revised

document is taken through the standard consultation, approval and

dissemination processes.

9.3. Where the revisions are minor, e.g. amended job titles or changes in the

organisational structure, approval can be sought from the Executive Director

responsible for signatory approval, and can be re-published accordingly

without having gone through the full consultation and ratification process.

9.4. Any revision activity is to be recorded in the Version Control Table as part of

the document control process.

10. Equality and Diversity

10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service

Equality and Diversity Statement, which can be found in the 'Equality,

Inclusion & Human Rights Policy' or the Equality and Diversity website.

10.2. Equality Impact Assessment

The Initial Equality Impact Assessment Screening Form is at Appendix 2.

http://www.rcht.nhs.uk/GET/d10268876



http://intranet-rcht.cornwall.nhs.uk/shelf/equality-and-diversity/


Appendix 1. Governance Information

Document Title Cardiothoracic Surgery Inter Hospital Transfers

Policy V1.0

This document replaces (exact

title of previous version): New Document

Date Issued/Approved: 30 January 2020

Date Valid From: July 2020

Date Valid To: July 2023

Directorate / Department

responsible (author/owner):

Kathy Hamilton – Surgical Liaison & Cardiac

Rehabilitation Team Lead

Contact details: 01872 253740

Brief summary of contents

This document provides context and guidance to health professionals involved in the transfer of cardiac in-patients at the Royal Cornwall Hospital NHS Trust to a tertiary centre for cardiac surgery / intervention

Suggested Keywords: Cardiac surgery. CABG. Transfer. Valve.

Target Audience RCHT CFT KCCG

Executive Director responsible

for Policy: Medical Director

Approval route for consultation

and ratification: Cardiology Governance Group Meeting

General Manager confirming

approval processes Sharon Matson

Name of Governance Lead

confirming approval by specialty

and care group management

meetings

Becky Osborne

Links to key external standards None required

Related Documents: None required

Training Need Identified? No additional training needs. This is formalising the clinical practice.

Publication Location (refer to

Policy on Policies – Approvals

and Ratification):

Internet & Intranet Intranet Only

Document Library Folder/Sub

Folder Clinical/Cardiology


Version Control Table

Date Version

No Summary of Changes

Changes Made by

(Name and Job) Title)

30.01.2020 V1.0 Initial issue

Kathy Hamilton,

Surgical Liaison &

Cardiac Rehabilitation

Team Lead

All or part of this document can be released under the Freedom of Information

Act 2000

This document is to be retained for 10 years from the date of expiry.

This document is only valid on the day of printing

Controlled Document

This document has been created following the Royal Cornwall Hospitals NHS Trust

Policy for the Development and Management of Knowledge, Procedural and Web

Documents (The Policy on Policies). It should not be altered in any way without the

express permission of the author or their Line Manager.


Appendix 2. Equality Impact Assessment

Section 1: Equality Impact Assessment Form

Name of the strategy / policy /proposal / service function to be assessed

Cardiothoracic Surgery Inter hospital Transfers Policy V1.0

Directorate and service area:

Specialist Medicine, Cardiology

Is this a new or existing Policy?

New

Name of individual/group completing EIA

Kathy Hamilton, Surgical Liaison & Cardiac Rehabilitation CNS / Team Lead

Contact details:

01872 253740

1. Policy Aim

Who is the

strategy / policy /

proposal / service

function aimed at?

Provides guidance and clarification of the cardiothoracic

surgery inter-hospital transfer process, detailing the different

pathways used depending on clinical urgency

2. Policy Objectives Ensure the MDT understand their role and responsibility in relation

to cardiothoracic surgery inter-hospital transfers and where they fit

in the pathway process

3. Policy Intended

Outcomes Resolve ambiguity in the pathway process and improve quality and

efficiency of care

4. How will

you measure

the outcome?

Regular observation, monitoring and feedback from attending MDT and

ward visits

5. Who is intended

to benefit from the

policy?

Medical staff, nursing staff, patients and their families

6a). Who did you

consult with?

b). Please list any

groups who have

been consulted

about this procedure.

Workforce Patients Local

groups

External

organisations Other

Cardiology Governance Group

c). What was the

outcome of the

consultation?

Agreed


7. The Impact

Please complete the following table. If you are unsure/don’t know if there is a negative impact you

need to repeat the consultation step.

Are there concerns that the policy could have a positive/negative impact on:

Protected

Characteristic Yes No Unsure Rationale for Assessment / Existing Evidence

Age

Sex (male, female

non-binary, asexual

etc.)

Gender

reassignment

Race/ethnic

communities

/groups

Disability

(learning disability,

physical disability,

sensory impairment,

mental health

problems and some

long term health

conditions)

Religion/

other beliefs

Marriage and civil

partnership

Pregnancy and

maternity

Sexual orientation

(bisexual, gay,

heterosexual,

lesbian)

If all characteristics are ticked ‘no’, and this is not a major working or service change, you can

end the assessment here as long as you have a robust rationale in place.

I am confident that section 2 of this EIA does not need completing as there are no highlighted risks of

negative impact occurring because of this policy.

Name of person confirming result of initial

impact assessment:

Kathy Hamilton, Surgical Liaison & Cardiac

Rehabilitation CNS/ Team Lead

If you have ticked ‘yes’ to any characteristic above OR this is a major working or service

change, you will need to complete section 2 of the EIA form available here:

Section 2. Full Equality Analysis

For guidance please refer to the Equality Impact Assessments Policy (available from the

document library) or contact the Human Rights, Equality and Inclusion Lead

[email protected]

http://doclibrary-rcht-intranet.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/ChiefExecutive/Templates/Section2FullEqualityAnalysis.docx

mailto:[email protected]

Cardiothoracic Surgery Inter Hospital Transfers Policy V1.0

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Appendix 3. Inpatient Surgical Pathway Flowchart

Patient’s ECHO and/or angiogram indicates they require surgical opinion

Patients’ case is discussed with the visiting surgeon at the MDT

Referred via MAXIMS for discussion at the Monday 1pm surgical MDT

Patient accepted by visiting surgeon

Cardiac surgical liaison nurse approaches Derriford - our usual provider

Patient not accepted by visiting surgeon

Work-up commenced by ward medical team: - Spirometry

- Carotid Doppler’s

- ECHO

- Anticoagulation stopped as per centres

instructions and clinical requirement

(NOAC/warfarin/LMWH)

- MRSA screened

- Up-to-date blood tests

For valve surgery: MaxFax referral by medical team for

review +/_ dental extraction /clearance • Outcomes /results are added to the ‘Cardiac surgical

checklist’ by the Surgical liaison nurse or the ward.

Referral letter emailed by secretaries to Derriford within 24hrs of

MDT

Derriford have an above average wait (≥ 1 week)

Patient is added to the Whiteboard by the cardiac surgical liaison nurse

Referral letter, patient tests / investigations and images sent over to new surgical centre by cardiac

surgical liaison nurse / secretaries

Cardiac surgical liaison nurse approaches patients 2nd

choice surgical centre

Derriford have an average wait (≤ 1week)

Emergency pathway: Surgical intervention indicated within 24 hours from coronary angiographic diagnosis or acute coronary event to prevent death or major morbidities. Following reasons include: extensive dissection causing ischemia or threatened ischemia, recurrent acute closure, perforation or tamponade, hemodynamic instability, and other indications warranting CABG that was not electively scheduled.

Standard pathway: Surgery planned for a hemodynamically stable patient, to be scheduled > 72 hour after the initial decision to operate

Urgent pathway: Surgical intervention indicated within 72 hours from coronary angiographic diagnosis or acute

coronary event to prevent death or major morbidities. Cardiology Consultant phones the on-call cardiothoracic surgical Reg at Derriford. From this point, the surgical escalation pathway is then followed. If not accepted approach alternative surgical centres for opinion.

After transfer, the patient is removed from the whiteboard by the Cardiac surgical liaison nurse

Once transfer and surgical date confirmed, the cardiac surgical liaison nurse informs the relevant teams and ensures ward arranges transport

Cardiac surgical liaison nurse has regular contact with coordinator of surgical receiving centre and updates all teams as required, ensuring all necessary

documentation and work-up has been completed

Once accepted by the receiving centre and a CCU bed secured, the Cardiac surgical liaison nurse informs the relevant teams, ensures a referral letter urgently completed and emailed along with all work-up reports and urgent transport is organised

Clock starts when: Referral letter is emailed to Derriford. The patient must be fully worked up and accepted for surgery

Cardiothoracic Surgery Inter Hospital Transfers Policy V1.0

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Appendix 4. Escalation of the Deteriorating Patient


Appendix 5. Cardiothoracic Surgery Work Up Checklist

Cardiothoracic Surgery Work Up Checklist - all MUST be completed

prior to transfer.

Co

mm

un

ica

tio

n: Proposed Procedure:

Date: Signed:

MDT: / /

Seen by surgeon: / /

Referral letter completed & sent: / /

Referral letter received: / /

Me

dic

al

Wo

rk-u

p

Requested: Completed:

Spirometry: / / / /

Carotid Dopplers: / / / /

ECHO: / / / /

Max Fax - Surgical valve only:

(NB:Order OPG X-ray & request on

maxims)

/ / / /

Stop Ticagrelor/Clopidogrel: / /

Anti-coagulation: / /

Other:

Tra

nsfe

r

Date ready for surgery (work-up

& washout completed): / /

Signed:

Surgical Centre:

Confirmed date of surgery: / /

Confirmed date of transfer: / /

Transport booked: YES / NO

MPT number:

Transferred & discharged:

Dati

x

Datix prolonged wait (from work-up complete): Date & sign:

>7 days from work-up complete Yes / N/A

>14 days from work-up

complete Yes / N/A

>21 days from work-up

complete Yes / N/A

NB: Clopidogrel must be stopped 7 days prior to surgery and Ticagrelor 5 day prior

to surgery. Warfarin must be stopped 3 days prior to surgery. Rivaroxaban must be

stopped 2-3 days prior to surgery (3 days if poor renal function). Apixaban must be

stopped 2-3 days prior to surgery (3 days if poor renal function). Dabigatran must be

stopped 2-5 days prior to surgery (dependent on renal function).


Appendix 5. Cardiothoracic Surgery Work Up Checklist Cont.

Surgical Liaison Inpatient Service

Contact: 01872252134/3015 or bleep 3164.

Information discussed: Date: Signed.

Diagnosis explained / /

Surgical procedure. / /

Sternotomy wound care. / /

Chest pain management. / /

Transfer information. / /

Transport home / /

Support post-op. / /

Physical activity pre-op □post-op □ / /

Returning to work. / /

Driving restrictions. / /

Medications. / /

Other:

Literature provided: Date: Signed.

BHF Heart Surgery Leaflet / /

BHF Valve Surgery Leaflet / /

RCHT Cardiac Surgery Information Booklet. / /

BHF Cardiac Rehabilitation Leaflet / /

BHF Cardiac Medications Leaflet / /

Chest pain leaflet (RCH248) / /

Other:

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