Advice and guidance for consultants and provider clinician teams quick reference guide

Using your smartcard, log onto e-RS in the usual way.

Advice and guidance in e-RS can be used in one of several ways, through the:

• advice and guidance requests worklist or,
• advice and guidance responses enquiry

The advice and guidance worklist requests is the easiest way to see and manage incoming requests and ongoing conversations.

In addition to the guidance on this webpage, further information including short videos. can be accessed from the advice and guidance support webpage. 

To access the 'Advice and Guidance Requests' worklist:

1. select the worklist tab
2. select 'Advice and Guidance Requests' from the picklist options available, in the worklist type filter
3. ensure you use the load results button whenever it appears to activate the worklist

You can view and sort advice and guidance by:

• using filters, to view referrals across services, specialities, locations and by individual or all clinicians
• you can collapse the filters section by clicking on the hide filters text to give more space on the screen to view the advice and guidance requests
• sorting columns; select the column heading, which will show an arrow in the sorted column, for example: by UBRN created date or advice last updated

There are two advice and guidance statuses:

• 'Provider Response Required' - the patient's referrer has sent an an advice and guidance request which needs attention by the provider clinician/clinical team
• 'Referrer To Submit Further Information' - the provider clinician/clinical team have sent a response, asking the patient’s GP/referrer to give more information, or clarification on some aspect of the original advice and guidance request

Select the UBRN of the relevant advice and guidance on the worklist to open its content.

The advice and guidance request will include the following information:

• referral priority
• service details
• patient’s referrer
• advice question

It may also include one, or more, attachments.

Where there is an attachment to the advice and guidance request, this may be a useful information from the patient’s referrer.

Select the file name, which is a blue hyperlink, to open attachments.

Using the information in the advice and guidance request, respond by:

1. completing the mandatory free text box; and
2. selecting one of the following options

There is also an opportunity for you to add an attachment, if appropriate. Detail on this can be found in the 'Provider attachments: adding attachments' section. 

Return to referrer with advice

Selecting this option, you will be asked to explain your initial option by selecting one of the following:

• advice only – no referral recommended
• advice followed by referral if required
• referral only recommended
• none of the above

This further choice is for audit purposes only.

I require further information

This option allows you to ask for more details from the referrer

Convert this to a referral

This option will only be displayed if the referrer has authorisation to convert the request.

Selecting ‘Convert this to a referral’ displays two further options:

• ‘I will refer the patient now’
• ‘Request admin team to refer the patient’

Referrals should be accepted in line with local referral and commissioning guidelines.

When converting advice and guidance into a referral, comments must be added as these are displayed to the referrer.

Before converting the request, providers should ensure they have appropriate and adequate clinical information, this could be:

• the advice and guidance dialogue
• any other clinical information

The comments field should be completed with detailed management information as this is displayed to the referrer. This could include instructions on medication or treatment prior to the patient's appointment.

Users should also be aware that selecting 'Return to referrer with advice' will follow the original workflow.

The e-RS pathway start will capture the date on which the provider converts the referral.

‘I will refer the patient now’ option

Selecting the ‘I will refer the patient now’ option will present either the book/send for triage screen or the service search criteria screen.

• Book/Send for triage screen

This screen appears when the appointment priority is unchanged, and the advice and guidance service is also one that supports appointments (for example, is not an advice-only service).

The provider can select the ‘Change Service’ button to shortlist elsewhere.

From the appointment search screen, an appointment can be selected. If the patient is referred to the same service as the advice and guidance request, the referral will be automatically accepted into the service and will not appear on the referrals for review worklist.

Choosing to cancel the referral flow at this point returns the user to the Advice Request Details screen with nothing submitted.

• Service search criteria screen

This screen appears when either the:

- advice and guidance service supports triage requests

- advice and guidance service is an advice only service

- the priority is changed

In these cases, the speciality and clinic type from the advice and guidance request will be populated but can be changed.

Choosing to cancel the referral flow at this point returns the user to the Advice Request Details screen with nothing submitted.

From the Service search criteria screen the provider can search for the appropriate service/s, then either:

• raise the referral request (for booking later), placing it on the Appointments for Booking worklist
• search for and book the appointment

‘Request admin team to refer the patient’ option

Selecting the ‘Request admin team refer the patient’ option will present a Record Triage Outcome pop-up box.

From here the provider can change the priority of the referral and add clear instructions for the admin team in the mandatory comments field.

Selecting the ‘Back’ link will remove the pop-up box and present the Advice Request Details screen.

If returning to the pop-up box within the same session (meaning if you have not exited out of the flow, for example, back to worklist or an enquiry), any information previously added will be presented.

Once submitted the referral will be displayed on the Appointments for Booking worklist and removed from the Advice and Guidance worklist. Refer to the 'Booking a converted referral' section for information on how to book a converted referral.

The advice and guidance request will be visible immediately to the patient’s referrer, who may use the same UBRN to either carry on the advice and guidance conversation or refer the patient to a clinic. Where the request has been converted no further advice and guidance conversation can continue.

Attachments can be added by clicking on the add attachment text, which will open a pop-up that allows you to find a document to attach.

Suitable file types

Suitable file types for referral attachments are:

• plain text (text/plain) - .txt
• PDF (application/pdf) - .pdf
• XML Text (text/xml) - .xml
• RTF Text (text/rtf) - .rtf,. rtx
• basic audio (audio/basic) - .au
• MPEG audio layer 3 (audio/mpeg) - .mp3
• PNG Image (image/png) - .png
• GIF Image (image/gif) - .gif
• JPEG Image (image/jpeg) - .jpg, .jpe, .jpeg
• TIFF Image (image/tiff) - .tif, .tiff
• MPEG Video (video/mpeg) - .mpg, .mpeg, .mpe
• MSWORD (application/msword) - .doc
• MSWORD (application/vnd.openxmlformats-officedocument.wordprocessingml.document) - .docx
• DICOM (text/dcm) - .dcm

If there are any queries about attachment file type, check the above and ask the service provider’s IT department to allow it within their organisation.

To convert file types which are not support by e-RS please refer to the 'Attachments - converting files to formats' guidance.

Converted advice and guidance requests needing to be booked will appear on the Appointments for Booking worklist with a reason of ‘Triaged – A&G converted, see comments’.

When the UBRN is selected the ‘Service’ displayed is where the referral has been referred from. The reveal also provides the Triage Outcome and Comments.

Selecting the Actions dropdown and choosing to ‘Update/book’ will take the user to either the Appointment Search screen when the appointment priority is unchanged, and the advice and guidance service supports appointment requests, or the Service Search Criteria screen when either the:

• advice and guidance service supports triage requests
• advice and guidance service is an advice only service (for example, does not also support appointments)
• the priority is changed

Details on the subsequent processes can be found above in the ‘I will refer the patient now’ section.

If the advice and guidance is converted into a referral into the same bookable service, it will be automatically accepted and will not appear on the Referrals for Review worklist.

If the converted referral is sent to any other service, it will always appear on the Referrals for Review worklist.

Note: if the advice service is also the triage service the referral will still appear on the Referrals for Review worklist.

When reviewing the converted referral, information is available in the Attachments section of the Clinical Information summary (highlighted below). This is a PDF which contains the full advice conversation, including the authorised to convert instruction.

An image below shows the PDF version of the conversation which is displayed when selected in the Attachments section.

When reviewing the clinical information, users need to be aware that on the left of the screen they can select the:

• ‘Clinical Information’ link to view additional information added by the referrer
• ‘Service Provider Activity’ link to view the comments the clinician made for booking
• ‘Advice & Guidance Details’ link to view the advice conversation within e-RS

Selecting the ‘Advice and Guidance Details’ link will display the following screen. The advice status is on the grey bar.

Monitoring using the advice and guidance worklist

Regularly monitor the worklist to ensure that any new advice and guidance requests are responded to and any ongoing advice and conversations are managed.

The most recently actioned UBRN will appear at the top of the worklist (this also depends on the UBRN’s priority).

Monitoring using the advice and guidance responses enquiry

The advice and guidance responses enquiry enables providers to look up the UBRN after the advice and guidance has left the worklist. The filters allow users to see the information in a variety of ways, for example over a set time period and for individual services.

The UBRN gives access to the whole advice and guidance conversation between referrer and provider, as well as any attachments and the complete history.

To open advice and guidance from the enquiry, select:

1. the appropriate UBRN, which will open the actions pop up box
2. the ‘Process Advice Request’ option will be available if further action can be taken on the request. Selecting this will display the full advice and guidance information, including original request from the patient’s referrer; or
3. view history to see an audit trail of the UBRN

The patient enquiry can be used to find individual advice and guidance requests and responses.

You can search for a patient using either their NHS number or a specific UBRN and look up the advice and guidance information.

To look up multiple patient’s advice and guidance requests and responses, use the advice and guidance responses enquiry. More information on this can be found in the 'Monitoring advice and guidance' section.

Further advice and guidance information and training materials can be found on e-RS website.