1. Provincial Hospital Resource System Repatriation Tool Self - Directed Learning for Neonatal Users 1 The PowerPoint presentation is intended to be Self – Directed Learning for Neonatal Users. It will take approximately 15 minutes to view in “Slide Show” mode.

2. Overview of the Self - Learning Slide Deck  Background & Purpose of the PHRS Repatriation Tool  Module 1: Access and Log in to PHRS  Module 2: “Create to Repatriate” the Request  Module 3: “Cancel” a Request  Module 4: “Add a Hospital” to a Declined Request  Module 5: Responding to “Confirmation Delay”  Module 6: Responding to “Repatriation Delay”  Summary & Contact Information 2

3. Purpose of the Repatriation Tool  To streamline & simplify communication that is currently required to repatriate infants from higher to a lower level of care, often between multiple hospitals  CritiCall Call Centre will not be involved in this repatriation process  To generate data regarding the health of the retro-transfer system, for example,  Rate of successful repatriations  Reasons for retro-transfer delays  3 GTA Tertiary (Sunnybrook, Mount Sinai, Sick Kids) and 16 Participating Hospitals in 6 LHINs: Central West (5), Mississauga Halton(6), Toronto Central (7), Central (8), Central East (9) & North Simcoe Muskoka (12) 3

4. Repatriation Tool Implementation April 2013 Neonatal Retrotransfer GTA (19 hospitals) June 2013 LHIN 13 July 2013 LHIN 4 November 2013 LHIN 14 April 2014 LHIN 7 LHIN 8 LHIN 9 LHIN 12 May 2014 and beyond LHIN 1 LHIN 2 LHIN 3 LHIN 5 LHIN 6 LHIN 10 LHIN 11 4

5. Requirements of the PHRS Site Browser 5

6. Colored Font and Flags 6 Blue fontRepatriation requests from CritiCall Ontario for patients that have been sent out of province will appear in blue font Red fontRepatriation requests that are “Declined” or “Not Accepted” appear in red font Green font Repatriation requests that are “Repatriated” will appear in green font Appears for 24 hours next to “Active” requests Appears for 24 hours next to requests that have been modified Appears when the repatriation request becomes delayed two days after the Requested Transfer Date For Details on Definitions, go to the PHRS Library on https://www. phrs.criticall.org

7. 5 phases of the 2014 Repatriation Tool Neonatal Algorithm to show the Journey of the Repatriation Request from start to finish 7 Blue: Sending Hospital Green: Receiving Hospital 5 phases

8. Module 1 Access and Log in 8

9. PHRS Map view: Click on your LHIN LHIN Regions 9 Click on your LHIN

10. LHIN view: Click on the Repatriation TAB on the Toolbar Navigation displayed depends on User’s access level 10 Click on the Repatriation Tab on the Toolbar

11. Module 2 Create to Repatriate 11

12. 2014 Repatriation Tool Neonatal: Create Phase by Sending Hospital 12

13. 13 Create Send Request

14. Create: Step 1-Go to Outgoing Request for Repatriation Tab and Clicks on Add New Request 14 Sending Hospital

15. Create: Select Critical care bed, Requested Transfer Date, Neonatal (Sending Service), Add in or go to Lookup to select the Requested Hospitals for Repatriation then Click Next 15 Click NEXT to go to next step or on CANCEL to delete information Add 1 (min) or up to 5 hospitals (max.)

16. Create: Step 2 – Type the Health Card Number, Ward and Family Physician Select Patient Gender, Patient Age and Patient Home Hospital then Click NEXT 16 Click Next to go to Step 2 and click on Back to go previous step

17. Create: Step 3 – Select at least ONE in the Initial Precaution Status and in the Initial Patient Medical Info then Click NEXT 17 Click Next to go to Step 4 and Click on BACK to go to Back to go previous step Click on + to expand

18. Create: Step 4 – Type in Sending Physician and Primary Staff Contact Names and Phone Numbers then Click SAVE 18 Click SAVE or go to to previous steps Click on BACK

19. 19 Acknowledge Proceed Decline

20. 2014 Repatriation Tool Neonatal: Acknowledge Phase by Receiving Hospital 20

21. Acknowledge: Select Proceed or Decline then Click on SAVE 21 Receiving Hospital

22. Acknowledge: Proceed selected and Add Optional Proceed Comments then Click SAVE 22

23. Acknowledge: A dd “Contact Information” then Click on SAVE 23 Receiving Hospital

24. 24 Confirm Accept Not Accept

25. 2014 Repatriation Tool Neonatal: Confirm Phase by Receiving Hospital 25

26. Confirm: Go to Proceed Tab to view Proceed Request 26 Receiving Hospital

27. Confirm: Select “ Accept” or “Not Accept” and Click SAVE 27 Receiving Hospital

28. Confirm: Accept Selected, Add Optional Comments in the Accept Comments Box and Click SAVE 28

29. Confirm: View “Accepted” Request in the Accepted TAB 29 Sending Hospital

30. 30 Transport Transport Arranged Transport Scheduled

31. 2014 Repatriation Tool Neonatal: Transport Phase by Sending Hospital 31

32. Transport: Select “Transport” and Click on SAVE 32 Sending Hospital

33. Transport: Select “Transport Arranged” Date & “Transport Scheduled” Date and Click on YES 33

34. Transport: View “Transport” Request in the Transport Tab 34 Sending Hospital

35. 35 Repatriate Update Select Calendar Date

36. 2014 Repatriation Tool Neonatal Algorithm: Repatriate Phase by Sending Hospital 36

37. Repatriate: Select “Repatriate” and Click on SAVE 37 Sending Hospital

38. Repatriate: Select “Repatriate Date” and Click on YES 38

39. Repatriate: View “Repatriated” Request in the Repatriated Tab 39 Sending Hospital

40. Repatriate: View “Repatriated” Request in the Repatriated Tab 40 Receiving Hospital

41. Module 3 Cancel a Request 41

42. 2014 PHRS Repatriation Tool Algorithm: Cancel a Request by the Sending Hospital 42 Sending Hospital can cancel the request when the receiving hospital has declined or not accepted up to the Transport Phase

43. When does Cancel occur? “The Sending Hospital can cancel the request at any point in time if the repatriation is no longer required (e.g. patient deteriorates or is discharged). Cancelled requests will remain available for ‘Reissue for 7 days.” For more details, go to the Definitions document available in the PHRS Library Tab on https://www.phrs.criticall.org https://www.phrs.criticall.org

44. Cancel: Sending Hospital can view “declined requests” sent to multiple Hospitals in the Declined TAB 44 Sending Hospital

45. Cancel: View “Comments” related to Declined in the Comments TAB 45 Sending Hospital

46. Cancel: Select “Reason for Cancellation” and Click on YES 46

47. Cancel: Sending Hospital can View all the “Cancelled” Requests in the Cancelled TAB for 7 days and can Reissue the cancelled requests 47 Sending Hospital Cancelled requests will remain in the Cancelled Tab available for “Reissue” by the Sending Hospital for 7 days.

48. Cancel: Receiving Hospital can only view their Hospital’s “Cancelled” Request in the Cancelled Tab 48 Receiving Hospital

49. Module 4 Add a Hospital to a Declined Request 49

50. 2014 PHRS Repatriation Tool Algorithm: Add a Hospital to the Request by the Sending Hospital 50 Sending Hospital can add a hospital to the request when the receiving hospital has declined or not accepted up to the Transport Phase

51. Add a Hospital: Receiving Hospital views Active Neonatal Request 51 Receiving Hospital

52. Add a Hospital: Receiving Hospital selects “Decline” & Clicks on SAVE 52 Receiving Hospital

53. Add a Hospital: Receiving Hospital selects Reason for Decline and Clicks on SAVE 53 Add optional comments

54. Add a Hospital : Sending & Receiving Hospitals can view the Declined Request in their Declined TAB 54 Sending Hospital Receiving Hospital

55. Add a Hospital: Sending Hospital clicks on “ADD Hospital” to send the request to a new Hospital and clicks on SAVE 55 Sending Hospital

56. Add a Hospital: Sending Hospital selects a new Requested Hospital & Clicks YES 56

57. Add a Hospital: View newly created Active Request in the Active Tab 57 Sending Hospital

58. Comments: Sending Hospital views Comments related to Declined in the Comments TAB 58 Sending Hospital

59. Cancel: Sending Hospital selects “X” to cancel the declined request based on comments and clicks on SAVE 59 Sending Hospital

60. Cancel : Sending and Receiving Hospitals view Cancelled request in their Cancelled TAB 60 Sending Hospital Receiving Hospital

61. Module 5 Responding to Confirmation Delay 61

62. When does Confirmation Delay occur? “ Confirmation Delay occurs when the Receiving Hospital responds in the Confirm phase two days after the Requested Transfer Date” For more details, go to the Definitions document available in the PHRS Library on https://www.phrs.criticall.org https://www.phrs.criticall.org

63. Confirmation Delay: Click on Proceed Tab to respond to the delayed Proceed Request 63 Receiving Hospital Check in the flag column for the CLOCK icon indicating delay

64. Confirmation Delay: Select Accept or Not Accept then Click on SAVE 64 Receiving Hospital

65. Confirmation Delay: Select Reason for Confirmation Delay, Add Optional Comments and click on SAVE 65 Add optional comments

66. Confirmation Delay: Click on Comments Tab to view Comments related to delayed response 66

67. Confirmation Delay: Sending Hospital responds to the delayed Accepted request & selects Transport and Clicks on SAVE 67 Sending Hospital

68. Confirmation Delay: Select Transport Dates and Click on YES 68

69. Confirmation Delay: Sending Hospital Selects Repatriate and Click on SAVE 69 Sending Hospital

70. Sending Hospital selects Date, Reason for Repatriation Delay & Click on YES 70

71. Sending & Receiving Hospitals View the Completed Repatriated Requests 71 Sending Hospital Receiving Hospital

72. Module 6 Responding to Repatriation Delay 72

73. When does Repatriation Delay occur? “ Repatriation Delay occurs when the Sending Hospital responds two days after the Requested Transfer Date” For more details, go to the Definitions document available in the PHRS Library on https://www.phrs.criticall.org https://www.phrs.criticall.org

74. Repatriation Delay: Go to the Transport Tab to respond to the delayed Transport Request 74 Sending Hospital Check in the flag column for the CLOCK icon indicating delay

75. Repatriation Delay: Select Repatriate and Click on SAVE 75 Sending Hospital

76. Repatriation Delay: Select Repatriation Date, Reasons for Repatriation Delay and Click on YES 76

77. Repatriation Delay: Go to Repatriated Tab to view completed Repatriated Requests 77 Sending Hospital Receiving Hospital

78. Summary & Contact Information 78

79. Sending Hospital Responsibilities  Create and send new repatriation requests to hospitals participating in the repatriation agreement  Monitor and update repatriation request as required for the following: Transport, Repatriate, Add a hospital/Cancel  Add a Hospital/Cancel when requests are not accommodated in accordance with Requested Transfer Date or ‘Not Accepted’ by the receiving hospital  Contact accepting hospital by telephone to confirm repatriation details  Update request status to “Transport” by Selecting Date of transport arranged and scheduled transport date  If the Repatriation Date is 2 days greater than the Requested Transfer Date, select the ‘Reason for Repatriation Delay’ from the dropdown menu 79

80. Receiving Hospital Responsibilities  Acknowledge all new or redirected repatriation requests received and indicating ‘Proceed’ or ‘Decline’  If ‘Decline’ is selected choose a ‘Reason for Decline’ from the dropdown menu  Contact sending hospital for physician- to-physician dialogue to exchange patient details  Confirm the repatriation request by indicating ‘Accept’ or ‘Not Accept’  If ‘Not Accept’ is selected choose a ‘Reason for Not Accept’ from the dropdown menu  Select a Reason for Confirmation Delay If the Not Accept Date is more than 2 days after the Requested Transfer Date or Redirect date 80

81. Training Support  The following training materials are available in the PHRS Library Tab on https://www.phrs.criticall.org :https://www.phrs.criticall.org  Repatriation Tool Quick Guide  Reasons for cancellation, decline, not accepted, confirmation and repatriation delays (drop down document)  Definitions  Algorithm 81

82. Contact Information  For CritiCall Ontario Repatriation Tool Training Questions, contact Claudine Wathier – Doucet (T) 613- 321- 0603 (Email) claudine.wathier-doucet@criticall.orgclaudine.wathier-doucet@criticall.org  For PHRS Repatriation Username & Password access, contact your hospital designated PHRS-Registration Manager  For technical assistance first contact your hospital IT dept, if not resolved then contact PHRS help desk: phrshelpdesk@criticall.org phrshelpdesk@criticall.org 82