NIC/Lead RN Report - Outpatients

"*" indicates required fields

Nurse or Practitioner in Charge*

First Last

Trust

Hospital*

Other hospital*

Speciality*

Days worked*

Sat date*

Sun date*

Mon date*

Tues date*

Wed date*

Thu date*

Fri date*

Confirmation of Start and End Times

In order for you and the team to be paid correctly and on time please ensure the start and finish times are completed and are accurate on uTRAC as well.

Team start time – Sat*

Team end time – Sat*

Did you finish on time – Sat

Yes

If No, please state the reason why

Team start time – Sun*

Team end time – Sun*

Did you finish on time – Sun

Yes

If No, please state the reason why

Team start time – Mon*

Team end time – Mon*

Did you finish on time – Mon

Yes

If No, please state the reason why

Team start time – Tues*

Team end time – Tues*

Did you finish on time – Tues

Yes

If No, please state the reason why

Team start time – Wed*

Team end time – Wed*

Did you finish on time – Wed

Yes

If No, please state the reason why

Team start time – Thu*

Team end time – Thu*

Did you finish on time – Thu

Yes

If No, please state the reason why

Team start time – Fri*

Team end time – Fri*

Did you finish on time – Fri

Yes

If No, please state the reason why

IMPORTANT: Please contact the On Call Manager or Coordinator to have them correct the staff on uTRAC for you to sign them in.

Activity Breakdown

Types of Activity (i.e. Outpatients, Minor Ops, Virtual, Pre-Assessment)

Please fill in the number of different types of activity running on each day. For example, if minor ops and outpatients are running, please select two. If only outpatients is running, please select one.

How Many Types of Activity – Sat*

How Many Types of Activity – Sun*

How Many Types of Activity – Mon*

How Many Types of Activity – Tue*

How Many Types of Activity – Wed*

How Many Types of Activity – Thu*

How Many Types of Activity – Fri*

Patient Activity – Confirmation of timing and numbers for each session

Please fill in the room numbers and start/end times of the consultations in each room then confirm the total number of patients who are seen, cancelled, or did not attend. We are relying on your accuracy so that our financial information and feedback to the Trust is robust. For all patients treated, please ensure the numbers correspond with the patient clinical outcomes you return to 18 Week Support

Saturday – Activity 1

Activity Type – Sat 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sat 1*

Start time of first patient Consultation – Sat 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sat 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sat 1*

No. of new patients booked on list – Sat 1*

No. of follow-up patients booked on list – Sat 1*

No. of patients added to list – Sat 1*

No. of patients DNA – Sat 1*

No. of patients seen – Sat 1*

No. of patients cancelled – Sat 1*

No. of patients discharged – Sat 1*

No. of referral for surgery – Sat 1*

No. of patients referred for further investigation – Sat 1*

No. of admin letters actioned – Sat 1*

No. of Patient Initiated Follow-Up (PIFU) – Sat 1*

No. of audiograms performed (Audiology) – Sat 1*

No. of hearing aid referrals (Audiology) – Sat 1*

No. of patients seen by Audiologist (Audiology) – Sat 1*

No. of ultrasound procedures (Breast) – Sat 1*

No. of mammographs (Breast) – Sat 1*

No. of patients seen by the sonographer (Vascular) – Sat 1*

Patients treated validation – Sat 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Saturday – Activity 2

Activity Type – Sat 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sat 2*

Start time of first patient Consultation – Sat 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sat 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sat 2*

No. of new patients booked on list – Sat 2*

No. of follow-up patients booked on list – Sat 2*

No. of patients added to list – Sat 2*

No. of patients DNA – Sat 2*

No. of patients seen – Sat 2*

No. of patients cancelled – Sat 2*

No. of patients discharged – Sat 2*

No. of referral for surgery – Sat 2*

No. of patients referred for further investigation – Sat 2*

No. of admin letters actioned – Sat 2*

No. of Patient Initiated Follow-Up (PIFU) – Sat 2*

No. of audiograms performed (Audiology) – Sat 2*

No. of hearing aid referrals (Audiology) – Sat 2*

No. of patients seen by Audiologist (Audiology) – Sat 2*

No. of ultrasound procedures (Breast) – Sat 2*

No. of mammographs (Breast) – Sat 2*

No. of patients seen by the sonographer (Vascular) – Sat 2*

Patients treated validation – Sat 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Saturday – Activity 3

Activity Type – Sat 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sat 3*

Start time of first patient Consultation – Sat 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sat 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sat 3*

No. of new patients booked on list – Sat 3*

No. of follow-up patients booked on list – Sat 3*

No. of patients added to list – Sat 3*

No. of patients DNA – Sat 3*

No. of patients seen – Sat 3*

No. of patients cancelled – Sat 3*

No. of patients discharged – Sat 3*

No. of referral for surgery – Sat 3*

No. of patients referred for further investigation – Sat 3*

No. of admin letters actioned – Sat 3*

No. of Patient Initiated Follow-Up (PIFU) – Sat 3*

No. of audiograms performed (Audiology) – Sat 3*

No. of hearing aid referrals (Audiology) – Sat 3*

No. of patients seen by Audiologist (Audiology) – Sat 3*

No. of ultrasound procedures (Breast) – Sat 3*

No. of mammographs (Breast) – Sat 3*

No. of patients seen by the sonographer (Vascular) – Sat 3*

Patients treated validation – Sat 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Saturday – Activity 4

Activity Type – Sat 4*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sat 4*

Start time of first patient Consultation – Sat 4*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sat 4*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sat 4*

No. of new patients booked on list – Sat 4*

No. of follow-up patients booked on list – Sat 4*

No. of patients added to list – Sat 4*

No. of patients DNA – Sat 4*

No. of patients seen – Sat 4*

No. of patients cancelled – Sat 4*

No. of patients discharged – Sat 4*

No. of referral for surgery – Sat 4*

No. of patients referred for further investigation – Sat 4*

No. of admin letters actioned – Sat 4*

No. of Patient Initiated Follow-Up (PIFU) – Sat 4*

No. of audiograms performed (Audiology) – Sat 4*

No. of hearing aid referrals (Audiology) – Sat 4*

No. of patients seen by Audiologist (Audiology) – Sat 4*

No. of ultrasound procedures (Breast) – Sat 4*

No. of mammographs (Breast) – Sat 4*

No. of patients seen by the sonographer (Vascular) – Sat 4*

Patients treated validation – Sat 4*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Saturday – Activity 5

Activity Type – Sat 5*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sat 5*

Start time of first patient Consultation – Sat 5*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sat 5*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sat 5*

No. of new patients booked on list – Sat 5*

No. of follow-up patients booked on list – Sat 5*

No. of patients added to list – Sat 5*

No. of patients DNA – Sat 5*

No. of patients seen – Sat 5*

No. of patients cancelled – Sat 5*

No. of patients discharged – Sat 5*

No. of patients referred for further investigation – Sat 5*

No. of referral for surgery – Sat 5*

No. of admin letters actioned – Sat 5*

No. of Patient Initiated Follow-Up (PIFU) – Sat 5*

No. of hearing aid referrals (Audiology) – Sat 5*

No. of audiograms performed (Audiology) – Sat 5*

No. of patients seen by Audiologist (Audiology) – Sat 5*

No. of ultrasound procedures (Breast) – Sat 5*

No. of mammographs (Breast) – Sat 5*

No. of patients seen by the sonographer (Vascular) – Sat 5*

Patients treated validation – Sat 5*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Sunday Activity 1

Activity Type – Sun 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sun 1*

Start time of first patient Consultation – Sun 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sun 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sun 1*

No. of new patients booked on list – Sun 1*

No. of follow-up patients booked on list – Sun 1*

No. of patients added to list – Sun 1*

No. of patients DNA – Sun 1*

No. of patients seen – Sun 1*

No. of patients cancelled – Sun 1*

No. of patients discharged – Sun 1*

No. of referral for surgery – Sun 1*

No. of patients referred for further investigation – Sun 1*

No. of admin letters actioned – Sun 1*

No. of Patient Initiated Follow-Up (PIFU) – Sun 1*

No. of audiograms performed (Audiology) – Sun 1*

No. of hearing aid referrals (Audiology) – Sun 1*

No. of patients seen by Audiologist (Audiology) – Sun 1*

No. of ultrasound procedures (Breast) – Sun 1*

No. of mammographs (Breast) – Sun 1*

No. of patients seen by the sonographer (Vascular) – Sun 1*

Patients treated validation – Sun 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Sunday Activity 2

Activity Type – Sun 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sun 2*

Start time of first patient Consultation – Sun 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sun 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sun 2*

No. of new patients booked on list – Sun 2*

No. of follow-up patients booked on list – Sun 2*

No. of patients added to list – Sun 2*

No. of patients DNA – Sun 2*

No. of patients seen – Sun 2*

No. of patients cancelled – Sun 2*

No. of patients discharged – Sun 2*

No. of referral for surgery – Sun 2*

No. of patients referred for further investigation – Sun 2*

No. of admin letters actioned – Sun 2*

No. of Patient Initiated Follow-Up (PIFU) – Sun 2*

No. of audiograms performed (Audiology) – Sun 2*

No. of hearing aid referrals (Audiology) – Sun 2*

No. of patients seen by Audiologist (Audiology) – Sun 2*

No. of ultrasound procedures (Breast) – Sun 2*

No. of mammographs (Breast) – Sun 2*

No. of patients seen by the sonographer (Vascular) – Sun 2*

Patients treated validation – Sun 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Sunday Activity 3

Activity Type – Sun 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sun 3*

Start time of first patient Consultation – Sun 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sun 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sun 3*

No. of new patients booked on list – Sun 3*

No. of follow-up patients booked on list – Sun 3*

No. of patients added to list – Sun 3*

No. of patients DNA – Sun 3*

No. of patients seen – Sun 3*

No. of patients cancelled – Sun 3*

No. of patients discharged – Sun 3*

No. of referral for surgery – Sun 3*

No. of patients referred for further investigation – Sun 3*

No. of admin letters actioned – Sun 3*

No. of Patient Initiated Follow-Up (PIFU) – Sun 3*

No. of audiograms performed (Audiology) – Sun 3*

No. of hearing aid referrals (Audiology) – Sun 3*

No. of patients seen by Audiologist (Audiology) – Sun 3*

No. of ultrasound procedures (Breast) – Sun 3*

No. of mammographs (Breast) – Sun 3*

No. of patients seen by the sonographer (Vascular) – Sun 3*

Patients treated validation – Sun 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Sunday Activity 4

Activity Type – Sun 4*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sun 4*

Start time of first patient Consultation – Sun 4*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sun 4*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sun 4*

No. of new patients booked on list – Sun 4*

No. of follow-up patients booked on list – Sun 4*

No. of patients added to list – Sun 4*

No. of patients DNA – Sun 4*

No. of patients seen – Sun 4*

No. of patients cancelled – Sun 4*

No. of patients discharged – Sun 4*

No. of referral for surgery – Sun 4*

No. of patients referred for further investigation – Sun 4*

No. of admin letters actioned – Sun 4*

No. of Patient Initiated Follow-Up (PIFU) – Sun 4*

No. of audiograms performed (Audiology) – Sun 4*

No. of hearing aid referrals (Audiology) – Sun 4*

No. of patients seen by Audiologist (Audiology) – Sun 4*

No. of ultrasound procedures (Breast) – Sun 4*

No. of mammographs (Breast) – Sun 4*

No. of patients seen by the sonographer (Vascular) – Sun 4*

Patients treated validation – Sun 4*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Sunday Activity 5

Activity Type – Sun 5*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Sun 5*

Start time of first patient Consultation – Sun 5*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Sun 5*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Sun 5*

No. of new patients booked on list – Sun 5*

No. of follow-up patients booked on list – Sun 5*

No. of patients added to list – Sun 5*

No. of patients DNA – Sun 5*

No. of patients seen – Sun 5*

No. of patients cancelled – Sun 5*

No. of patients discharged – Sun 5*

No. of referral for surgery – Sun 5*

No. of patients referred for further investigation – Sun 5*

No. of admin letters actioned – Sun 5*

No. of Patient Initiated Follow-Up (PIFU) – Sun 5*

No. of audiograms performed (Audiology) – Sun 5*

No. of hearing aid referrals (Audiology) – Sun 5*

No. of patients seen by Audiologist (Audiology) – Sun 5*

No. of ultrasound procedures (Breast) – Sun 5*

No. of mammographs (Breast) – Sun 5*

No. of patients seen by the sonographer (Vascular) – Sun 5*

Patients treated validation – Sun 5*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Monday – Activity 1

Activity Type – Mon 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Mon 1*

Start time of first patient Consultation – Mon 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Mon 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Mon 1*

No. of new patients booked on list – Mon 1*

No. of follow-up patients booked on list – Mon 1*

No. of patients added to list – Mon 1*

No. of patients DNA – Mon 1*

No. of patients seen – Mon 1*

No. of patients cancelled – Mon 1*

No. of patients discharged – Mon 1*

No. of referral for surgery – Mon 1*

No. of patients referred for further investigation – Mon 1*

No. of admin letters actioned – Mon 1*

No. of Patient Initiated Follow-Up (PIFU) – Mon 1*

No. of audiograms performed (Audiology) – Mon 1*

No. of hearing aid referrals (Audiology) – Mon 1*

No. of patients seen by Audiologist (Audiology) – Mon 1*

No. of ultrasound procedures (Breast) – Mon 1*

No. of mammographs (Breast) – Mon 1*

No. of patients seen by the sonographer (Vascular) – Mon 1*

Patients treated validation – Mon 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Monday – Activity 2

Activity Type – Mon 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Mon 2*

Start time of first patient Consultation – Mon 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Mon 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Mon 2*

No. of new patients booked on list – Mon 2*

No. of follow-up patients booked on list – Mon 2*

No. of patients added to list – Mon 2*

No. of patients DNA – Mon 2*

No. of patients seen – Mon 2*

No. of patients cancelled – Mon 2*

No. of patients discharged – Mon 2*

No. of referral for surgery – Mon 2*

No. of patients referred for further investigation – Mon 2*

No. of admin letters actioned – Mon 2*

No. of Patient Initiated Follow-Up (PIFU) – Mon 2*

No. of audiograms performed (Audiology) – Mon 2*

No. of hearing aid referrals (Audiology) – Mon 2*

No. of patients seen by Audiologist (Audiology) – Mon 2*

No. of ultrasound procedures (Breast) – Mon 2*

No. of mammographs (Breast) – Mon 2*

No. of patients seen by the sonographer (Vascular) – Mon 2*

Patients treated validation – Mon 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Monday – Activity 3

Activity Type – Mon 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Mon 3*

Start time of first patient Consultation – Mon 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Mon 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Mon 3*

No. of new patients booked on list – Mon 3*

No. of follow-up patients booked on list – Mon 3*

No. of patients added to list – Mon 3*

No. of patients DNA – Mon 3*

No. of patients seen – Mon 3*

No. of patients cancelled – Mon 3*

No. of patients discharged – Mon 3*

No. of referral for surgery – Mon 3*

No. of patients referred for further investigation – Mon 3*

No. of admin letters actioned – Mon 3*

No. of Patient Initiated Follow-Up (PIFU) – Mon 3*

No. of audiograms performed (Audiology) – Mon 3*

No. of hearing aid referrals (Audiology) – Mon 3*

No. of patients seen by Audiologist (Audiology) – Mon 3*

No. of ultrasound procedures (Breast) – Mon 3*

No. of mammographs (Breast) – Mon 3*

No. of patients seen by the sonographer (Vascular) – Mon 3*

Patients treated validation – Mon 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Tuesday – Activity 1

Activity Type – Tue 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Tue 1*

Start time of first patient Consultation – Tue 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Tue 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Tue 1*

No. of new patients booked on list – Tue 1*

No. of follow-up patients booked on list – Tue 1*

No. of patients added to list – Tue 1*

No. of patients DNA – Tue 1*

No. of patients seen – Tue 1*

No. of patients cancelled – Tue 1*

No. of patients discharged – Tue 1*

No. of referral for surgery – Tue 1*

No. of patients referred for further investigation – Tue 1*

No. of admin letters actioned – Tue 1*

No. of Patient Initiated Follow-Up (PIFU) – Tue 1*

No. of audiograms performed (Audiology) – Tue 1*

No. of hearing aid referrals (Audiology) – Tue 1*

No. of patients seen by Audiologist (Audiology) – Tue 1*

No. of ultrasound procedures (Breast) – Tue 1*

No. of mammographs (Breast) – Tue 1*

No. of patients seen by the sonographer (Vascular) – Tue 1*

Patients treated validation – Tue 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Tuesday – Activity 2

Activity Type – Tue 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Tue 2*

Start time of first patient Consultation – Tue 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Tue 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Tue 2*

No. of new patients booked on list – Tue 2*

No. of follow-up patients booked on list – Tue 2*

No. of patients added to list – Tue 2*

No. of patients DNA – Tue 2*

No. of patients seen – Tue 2*

No. of patients cancelled – Tue 2*

No. of patients discharged – Tue 2*

No. of referral for surgery – Tue 2*

No. of patients referred for further investigation – Tue 2*

No. of admin letters actioned – Tue 2*

No. of Patient Initiated Follow-Up (PIFU) – Tue 2*

No. of audiograms performed (Audiology) – Tue 2*

No. of hearing aid referrals (Audiology) – Tue 2*

No. of patients seen by Audiologist (Audiology) – Tue 2*

No. of ultrasound procedures (Breast) – Tue 2*

No. of mammographs (Breast) – Tue 2*

No. of patients seen by the sonographer (Vascular) – Tue 2*

Patients treated validation – Tue 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Tuesday – Activity 3

Activity Type – Tue 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Tue 3*

Start time of first patient Consultation – Tue 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Tue 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Tue 3*

No. of new patients booked on list – Tue 3*

No. of follow-up patients booked on list – Tue 3*

No. of patients added to list – Tue 3*

No. of patients DNA – Tue 3*

No. of patients seen – Tue 3*

No. of patients cancelled – Tue 3*

No. of patients discharged – Tue 3*

No. of referral for surgery – Tue 3*

No. of patients referred for further investigation – Tue 3*

No. of admin letters actioned – Tue 3*

No. of Patient Initiated Follow-Up (PIFU) – Tue 3*

No. of audiograms performed (Audiology) – Tue 3*

No. of hearing aid referrals (Audiology) – Tue 3*

No. of patients seen by Audiologist (Audiology) – Tue 3*

No. of ultrasound procedures (Breast) – Tue 3*

No. of mammographs (Breast) – Tue 3*

No. of patients seen by the sonographer (Vascular) – Tue 3*

Patients treated validation – Tue 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Wednesday – Activity 1

Activity Type – Wed 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Wed 1*

Start time of first patient Consultation – Wed 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Wed 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Wed 1*

No. of new patients booked on list – Wed 1*

No. of follow-up patients booked on list – Wed 1*

No. of patients added to list – Wed 1*

No. of patients DNA – Wed 1*

No. of patients seen – Wed 1*

No. of patients cancelled – Wed 1*

No. of patients discharged – Wed 1*

No. of referral for surgery – Wed 1*

No. of patients referred for further investigation – Wed 1*

No. of admin letters actioned – Wed 1*

No. of Patient Initiated Follow-Up (PIFU) – Wed 1*

No. of audiograms performed (Audiology) – Wed 1*

No. of hearing aid referrals (Audiology) – Wed 1*

No. of patients seen by Audiologist (Audiology) – Wed 1*

No. of Ultrasound procedures (Breast) – Wed 1*

No. of mammographs (Breast) – Wed 1*

No. of patients seen by the sonographer (Vascular) – Wed 1*

Patients treated validation – Wed 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Wednesday – Activity 2

Activity Type – Wed 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Wed 2*

Start time of first patient Consultation – Wed 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Wed 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Wed 2*

No. of new patients booked on list – Wed 2*

No. of follow-up patients booked on list – Wed 2*

No. of patients added to list – Wed 2*

No. of patients DNA – Wed 2*

No. of patients seen – Wed 2*

No. of patients cancelled – Wed 2*

No. of patients discharged – Wed 2*

No. of referral for surgery – Wed 2*

No. of patients referred for further investigation – Wed 2*

No. of admin letters actioned – Wed 2*

No. of Patient Initiated Follow-Up (PIFU) – Wed 2*

No. of audiograms performed (Audiology) – Wed 2*

No. of hearing aid referrals (Audiology) – Wed 2*

No. of patients seen by Audiologist (Audiology) – Wed 2*

No. of ultrasound procedures (Breast) – Wed 2*

No. of mammographs (Breast) – Wed 2*

No. of patients seen by the sonographer (Vascular) – Wed 2*

Patients treated validation – Wed 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Wednesday – Activity 3

Activity Type – Wed 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Wed 3*

Start time of first patient Consultation – Wed 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Wed 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Wed 3*

No. of new patients booked on list – Wed 3*

No. of follow-up patients booked on list – Wed 3*

No. of patients added to list – Wed 3*

No. of patients DNA – Wed 3*

No. of patients seen – Wed 3*

No. of patients cancelled – Wed 3*

No. of patients discharged – Wed 3*

No. of referral for surgery – Wed 3*

No. of patients referred for further investigation – Wed 3*

No. of admin letters actioned – Wed 3*

No. of Patient Initiated Follow-Up (PIFU) – Wed 3*

No. of audiograms performed (Audiology) – Wed 3*

No. of hearing aid referrals (Audiology) – Wed 3*

No. of patients seen by Audiologist (Audiology) – Wed 3*

No. of ultrasound procedures (Breast) – Wed 3*

No. of mammographs (Breast) – Wed 3*

No. of patients seen by the sonographer (Vascular) – Wed 3*

Patients treated validation – Wed 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Thursday – Activity 1

Activity Type – Thu 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Thu 1*

Start time of first patient Consultation – Thu 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Thu 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Thu 1*

No. of new patients booked on list – Thu 1*

No. of follow-ups booked on list – Thu 1*

No. of patients added to list – Thu 1*

No. of patients DNA – Thu 1*

No. of patients seen – Thu 1*

No. of patients cancelled – Thu 1*

No. of patients discharged – Thu 1*

No. of referral for surgery – Thu 1*

No. of patients referred for further investigation – Thu 1*

No. of admin letters actioned – Thu 1*

No. of Patient Initiated Follow-Up (PIFU) – Thu 1*

No. of audiograms performed (Audiology) – Thu 1*

No. of hearing aid referrals (Audiology) – Thu 1*

No. of patients seen by Audiologist (Audiology) – Thu 1*

No. of ultrasound procedures (Breast) – Thu 1*

No. of mammographs (Breast) – Thu 1*

No. of patients seen by the sonographer (Vascular) – Thu 1*

Patients treated validation – Thu 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Thursday – Activity 2

Activity Type – Thu 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Thu 2*

Start time of first patient Consultation – Thu 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Thu 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Thu 2*

No. of new patients booked on list – Thu 2*

No. of follow-ups booked on list – Thu 2*

No. of patients added to list – Thu 2*

No. of patients DNA – Thu 2*

No. of patients seen – Thu 2*

No. of patients cancelled – Thu 2*

No. of patients discharged – Thu 2*

No. of referral for surgery – Thu 2*

No. of patients referred for further investigation – Thu 2*

No. of admin letters actioned – Thu 2*

No. of Patient Initiated Follow-Up (PIFU) – Thu 2*

No. of audiograms performed (Audiology) – Thu 2*

No. of hearing aid referrals (Audiology) – Thu 2*

No. of patients seen by Audiologist (Audiology) – Thu 2*

No. of ultrasound procedures (Breast) – Thu 2*

No. of mammographs (Breast) – Thu 2*

No. of patients seen by the sonographer (Vascular) – Thu 2*

Patients treated validation – Thu 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Thursday – Activity 3

Activity Type – Thu 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Thu 3*

Start time of first patient Consultation – Thu 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Thu 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Thu 3*

No. of new patients booked on list – Thu 3*

No. of follow-ups booked on list – Thu 3*

No. of patients added to list – Thu 3*

No. of patients DNA – Thu 3*

No. of patients seen – Thu 3*

No. of patients cancelled – Thu 3*

No. of patients discharged – Thu 3*

No. of referral for surgery – Thu 3*

No. of patients referred for further investigation – Thu 3*

No. of admin letters actioned – Thu 3*

No. of Patient Initiated Follow-Up (PIFU) – Thu 3*

No. of audiograms performed (Audiology) – Thu 3*

No. of hearing aid referrals (Audiology) – Thu 3*

No. of patients seen by Audiologist (Audiology) – Thu 3*

No. of ultrasound procedures (Breast) – Thu 3*

No. of mammographs (Breast) – Thu 3*

No. of patients seen by the sonographer (Vascular) – Thu 3*

Patients treated validation – Thu 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Friday – Activity 1

Activity Type – Fri 1*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Fri 1*

Start time of first patient Consultation – Fri 1*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Fri 1*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Fri 1*

No. of new patients booked on list – Fri 1*

No. of follow-up patients booked on list – Fri 1*

No. of patients added to list – Fri 1*

No. of patients DNA – Fri 1*

No. of patients seen – Fri 1*

No. of patients cancelled – Fri 1*

No. of patients discharged – Fri 1*

No. of referral for surgery – Fri 1*

No. of patients referred for further investigation – Fri 1*

No. of admin letters actioned – Fri 1*

No. of Patient Initiated Follow-Up (PIFU) – Fri 1*

No. of audiograms performed (Audiology) – Fri 1*

No. of hearing aid referrals (Audiology) – Fri 1*

No. of patients seen by Audiologist (Audiology) – Fri 1*

No. of ultrasound procedures (Breast) – Fri 1*

No. of mammographs (Breast) – Fri 1*

No. of patients seen by the sonographer (Vascular) – Fri 1*

Patients treated validation – Fri 1*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Friday – Activity 2

Activity Type – Fri 2*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Fri 2*

Start time of first patient Consultation – Fri 2*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Fri 2*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Fri 2*

No. of new patients booked on list – Fri 2*

No. of follow-up patients booked on list – Fri 2*

No. of patients added to list – Fri 2*

No. of patients DNA – Fri 2*

No. of patients seen – Fri 2*

No. of patients cancelled – Fri 2*

No. of patients discharged – Fri 2*

No. of referral for surgery – Fri 2*

No. of patients referred for further investigation – Fri 2*

No. of admin letters actioned – Fri 2*

No. of Patient Initiated Follow-Up (PIFU) – Fri 2*

No. of audiograms performed (Audiology) – Fri 2*

No. of hearing aid referrals (Audiology) – Fri 2*

No. of patients seen by Audiologist (Audiology) – Fri 2*

No. of ultrasound procedures (Breast) – Fri 2*

No. of mammographs (Breast) – Fri 2*

No. of patients seen by the sonographer (Vascular) – Fri 2*

Patients treated validation – Fri 2*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Friday – Activity 3

Activity Type – Fri 3*

Outpatient Clinic

Virtual Clinic

Pre-Assessment

Minor Ops

Colorectal

Urogynaecology

How Many Rooms of Activity – Fri 3*

Start time of first patient Consultation – Fri 3*

This is the time the first patient enters the consultation/clinic room

End time of last patient consultation – Fri 3*

This is the time the last patient leaves the consultation/clinic room. Please exclude recovery time etc.

No. of patients booked on list – Fri 3*

No. of new patients booked on list – Fri 3*

No. of follow-up patients booked on list – Fri 3*

No. of patients added to list – Fri 3*

No. of patients DNA – Fri 3*

No. of patients seen – Fri 3*

No. of patients cancelled – Fri 3*

No. of patients discharged – Fri 3*

No. of referral for surgery – Fri 3*

No. of patients referred for further investigation – Fri 3*

No. of admin letters actioned – Fri 3*

No. of Patient Initiated Follow-Up (PIFU) – Fri 3*

No. of audiograms performed (Audiology) – Fri 3*

No. of hearing aid referrals (Audiology) – Fri 3*

No. of patients seen by Audiologist (Audiology) – Fri 3*

No. of ultrasound procedures (Breast) – Fri 3*

No. of mammographs (Breast) – Fri 3*

No. of patients seen by the sonographer (Vascular) – Fri 3*

Patients treated validation – Fri 3*

These figures don’t add up as expected. Please recheck your calculations.

The no. patients treated should equal the no. patients booked and added to the list minus the no. DNAs and cancellations

Cancellations

Please accurately record reasons for patients being cancelled. If patients are cancelled for clinical reasons, this should be captured on the patient cancellation outcome form which must be signed by the relevant doctor.

Cancellations

Date	Patient Hospital Number	Clinical or Non Clinical	Who made the decision to cancel?	Actions

There are no Patients.

Incidents, Near Misses and Complaints

Please ensure you report any Incidents on Datix here. Please gather professional accounts from relevant team members and email to governance@18weeksupport.com

Patient Informal Complaints or Potential Complaints

Date of incident	Patient ID	Briefly describe the event	Actions taken to resolve the informal complaint	Actions

There are no Complaints.

Anything you think may need to be followed up with the Trust

If the informal complaint has not been resolved or the patient would like to raise a formal complaint, please signpost to the Trust/PALS/Complaints Team. Please gather professional accounts from relevant team members and a brief description of the event and email this to governance@18weeksupport.com

Patient Satisfaction

Have the patient satisfaction surveys been collected and posted from your site?

Sat*

Yes

Sun*

Yes

Mon*

Yes

Tues*

Yes

Wed*

Yes

Thu*

Yes

Fri*

Yes

Patients of Concern

Breast

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Cardiology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Dermatology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Endoscopy

Date	Consultant Name	Surgery/Procedures	Incomplete colonoscopy – referred for: CTC, repeat colonoscopy, clinic (Select one)	Type of Concern	Urgent	Comments	Actions

There are no Patients.

ENT

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Gastroenterology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Prostate Specific Antigen Test	Repeat Prostate Specific Antigen Test	Actions

There are no Patients.

General Surgery

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Gynaecology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Neurology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Oral Surgery

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Orthopaedics

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Radiology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Urology

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Vascular

Date	Consultant Name	Patient Identifier Hospital Number	Surgery/Procedures	Type of Concern	Urgent	Comments	Actions

There are no Patients.

Cancer Alert

Patient Hospital Number	Routine or urgent?	Diagnosis	Actions

There are no Entries.

Quality Assurance

Clinical Administration

All specimens are correctly labeled checked by a registered Nurse*

Yes

If No, please state reason why*

Trust Environment

Have you restocked all clinical areas?*

Yes

N/A

If No, please state reason why*

Have you cleaned all clinical areas?*

Yes

N/A

If No, please state reason why*

Have you checked all clinical equipment?*

Yes

N/A

If No, please state reason why*

Resus Trolleys – Saturday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Resus Trolleys – Sunday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Resus Trolleys – Monday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Resus Trolleys – Tuesday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Resus Trolleys – Wednesday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Resus Trolleys – Thursday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Resus Trolleys – Friday

Was the emergency equipment (Resuscitation Trolley, oxygen, difficult intubation trolley, etc.) checked and documented prior to the shift*

Yes

If No*

Operational Issues

18 Week Support Operational Issues

What was the issue/situation?	What was the impact on service?	What was the outcome?	Was the 18WS manager informed on the day?	Actions

There are no Issues.

Staff issues with accommodation and travel

What was the issue/situation?	What was the outcome?	Actions

There are no Issues.

Trust Operational Issues

What was the issue/situation?	What was the impact on service?	What was the outcome?	Was the Trust Link nurse informed on the day?	Actions

There are no Issues.

Any other comments?

Date Completed*

Email*

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