emergency department firstnet business rules - tth...

Emergency Department FirstNet Business Rules

July 2016

V1.1

Emergency Department - Firstnet Business Rules V1.1 i

Document history

The version history table is useful while the document is in draft. Once the document has been approved, delete all rows except the row with the latest version number (usually 1.00). If an approved document is later updated, update the version history table.

Version Date Status Key changes made Author/s

0.1 10/07/16 Draft First revision Katrina Morris

0.2 13/07/16 Draft Review Robyn Copley

0.3 15/07/16 Formatting Formatting Amber Raabe

1.0 15/07/16 Final Final Paul Sullivan

1.1 18/07/2016 Revised FirstNet Katrina Morris

Contact for enquiries and proposed changes

If you have any questions regarding this document or if you have a suggestion for improvements,

please contact:

Contact Officer Paul Sullivan

Title ieMR Digital Release Project Manager

Phone 07 4433 1369

Email [email protected]

mailto:[email protected]

Emergency Department - Firstnet Business Rules V1.1 iii

Definitions, Acronyms and Abbreviation

Name Definition

AAPU Adult Acute Psychiatric Unit

ADT Admissions Discharges Transfers

AUSLAB State wide laboratory information management system (LIS) provided by PJAS

BCP Business Continuity Plan

CareCompass EMR component that displays nurse tasks

CBB Configuration Baseline Build (START is a collection of predefined, commonly used reference data or content in Cerner Millennium. QLD START content is based on NSW State Baseline Build (SBB) and VIC Medication Configuration, referred to as CBB)

CBH Cairns Base Hospital

CCU Coronary Care Unit

CD Client Directory – State wide patient matching system

CEC Current Encounter Chart

Cerner Clinical software provider contracted by QH for the ieMR

Charm See POIMS

CIM Clinical Information Management

CIMHA Consumer Integrated Mental Health Application providing patient (consumer) registration for QH Mental Health

CIMHA Consumer Integrated Mental Health Application

CL Consultation Liaison

CM Cerner Millennium

COTS Commercial Off-The-Shelf

CTU Cancer Trials Unit (part of DOCS)

DCW Data Collection Worksheet

DD Design Decisions

DDM Design Decision Matrix

Emergency Department - Firstnet Business Rules V1.1 iv

Name Definition

DOH Department of Health

Downtime When a digital system is offline and unable to be utilised

ED MH Emergency Department Mental Health

EDIS Emergency Department Information System – provides registration and result data for Emergency patients

EDS Electronic Discharge Summary

eFIT eHealth Foundation (information) Implementation Team

eGate Sun (Oracle) Integration Engine product currently deployed in QH

eHealth The program responsible for implementing electronic health solutions into Queensland Health

eMPI Enterprise Master Patient Index

eMR Electronic Medical Record

EMR Electronic Medical Record system

Encounter Patient visit in the EMR

Encounter Pocket Plastic pocket used to transport documents to scanning unit

ESI External Systems Inbound Interface (Cerner)

ESO External Systems Outbound Interface (Cerner)

FirstNet The Cerner Millennium system module for emergency medicine.

GCHSD Gold Coast Health Services District

HBCIS Hospital Based Corporate Information System – Current Qld Health Patient Admissions System (PAS) – iSoft product.

HIMS Health Information Management Services

HL7 Health Level Seven messaging standard for healthcare environments

HMS Hosting and Management Services Agreement (ICT2239c) with Cerner Corporation.

HSIA Health Service Information Agency

HSSQ Health Statewide Services Agency (previously CaSS) Qld Health Agency providing corporate support for Pathology QLD and the various District Medical Imaging Departments.

Emergency Department - Firstnet Business Rules V1.1 v

Name Definition

ICT Information and Communications Technology

ieMR Integrated Electronic Medical Record build on the Cerner Millennium Solution

iView Interactive View

JCAPS Java Composite Application Platform Suite. Sun (Oracle) successor to eGate and also currently deployed at Queensland Health

MBH Mackay Base Hospital

MHA Mental Health Act 2000

Millennium Cerner clinical application suite used for the QH ieMR

Mosaiq Radiation Oncology Information System

mPage Customised page in EMR, specific to the user group e.g. Nurse, doctor

Name Definition

NPR No Patient Record

NSW New South Wales

NTE Notes and Comments message segment (HL7)

OERR Order Entry Results Reporting

OOF Order of Filing

OSIM Outpatient Services Information Management. The current preferred term is Cerner Scheduling.

PAG Project Advisory Group

PAH Princess Alexandra Hospital

PAS Patient Admissions System (QH current PAS is HBCIS)

PJA Solutions AUSLAB software vendor

PMI Patient Master Index

PMI Patient master index

POIMS Pharmacy Oncology Information System (Charm). Chemotherapy prescribing

PowerChart Part of the EMR application used for viewing documents

PowerPlans Pre-configured set of documents targeted at a specific set of patients e.g. peri-operative

Emergency Department - Firstnet Business Rules V1.1 vi

Name Definition

PPID Positive Patient Identification

QH Queensland Health

QRIS Queensland Radiology Information System (RIS)

RadNet Cerner Radiology Information System (RIS)

RAWS Rapid Access Workstation Service

RBWH Royal Brisbane & Women’s Hospital

RCH Royal Children’s Hospital

RIPS Radiology Information Processing System (RIS)

ROI Request of Information

RWLS Referrals, Wait List and Scheduling Project

SBB NSW State Baseline Build

THHS Townsville Hospital and Health Service

TTH The Townsville Hospital

URN Unit Record Number – the hospital-based patient identification number assigned to a patient that uniquely identifies that patient for that hospital facility.

Emergency Department - Firstnet Business Rules V1.1 vii

Contents

1 FirstNet – Emergency Department Business Rules ............................................... 1

1.1 Purpose .......................................................................................................................................... 1

1.2 Scope ............................................................................................................................................. 1

1.3 Related Documents ........................................................................................................................ 1

2 FirstNet Pre-Arrival ................................................................................................... 2

2.1 Overview ........................................................................................................................................ 2

2.2 Capturing pre-arrival information.................................................................................................... 2

2.3 Cancelling pre-arrival information .................................................................................................. 2

2.4 Attaching pre-arrival information .................................................................................................... 2

3 FirstNet Quick Registration and Triage Assessment ............................................. 3

3.1 Overview ........................................................................................................................................ 3

3.2 Searching for patient demographic information (FirstNet) ............................................................. 3

3.3 Adding a new emergency encounter (patient has pre-existing TTH URN) .................................... 3

3.4 Adding a new TTH patient (patient has no pre-existing TTH URN) ............................................... 4

3.5 Automatically allocating a URN to a new TTH patient ................................................................... 4

3.6 Quick registering an unknown patient ............................................................................................ 4

3.7 Resolving quick registration errors ................................................................................................. 4

3.8 Wrong patient is selected during quick registration process .......................................................... 5

3.9 Completing the Triage Assessment Form ...................................................................................... 6

3.10 Editing the Triage Assessment Form ............................................................................................. 6

3.11 Capturing allergy information ......................................................................................................... 6

3.12 Attaching a Pre-Arrival Form .......................................................................................................... 6

3.13 Triaging an inpatient who is transferred into ED (e.g. HITH) ......................................................... 6

4 FirstNet Full Registration .......................................................................................... 8

4.1 Overview ........................................................................................................................................ 8

4.2 Assigning an AO provider .............................................................................................................. 8

4.3 Registering a FirstNet-allocated URN in HBCIS ............................................................................ 8

4.4 Unknown patient details become known (but patient has no previous TTH UR) .......................... 8

4.5 Unknown patient details become know (and the patient has a pre-existing TTH UR) .................. 9

4.6 Manually allocating and registering a URN in HBCIS .................................................................... 9

4.7 Searching for and/or updating patient demographic information in HBCIS ................................... 9

4.8 Completing the Patient Election Form ........................................................................................... 9

4.9 Printing emergency ieMR encounter labels ................................................................................... 9

4.10 Patient identification wristband (PPID) ......................................................................................... 10

4.11 Completing the full registration in FirstNet ................................................................................... 10

4.12 Cancelling duplicate patient records (no documentation started, no orders placed) ................... 10

4.13 Cancelling duplicate patient records (once documentation started or orders already placed) .... 10

Emergency Department - Firstnet Business Rules V1.1 viii

5 FirstNet Assessment and Treatment (Nursing) ..................................................... 11

5.1 Overview ...................................................................................................................................... 11

5.2 Assigning a Nursing provider ....................................................................................................... 11

5.3 Nursing documentation ................................................................................................................ 11

5.4 Perform Vital Signs Observations ................................................................................................ 12

5.5 Creating an ED Progress Note..................................................................................................... 12

5.6 Conducting a patient clinical handover between ED Nursing staff .............................................. 12

6 FirstNet Assessment and Treatment (Medical) ..................................................... 13

6.1 Overview ...................................................................................................................................... 13

6.2 Assigning a Senior Medical Officer/Treating Clinician provider ................................................... 13

6.3 Reassigning/Handing over a patient ............................................................................................ 13

6.4 Documenting the ED Doctor Workflow ........................................................................................ 13

6.5 Creating an ED Progress Note..................................................................................................... 14

6.6 Placing Inpatient Medical Service and Allied Health consultation orders .................................... 14

7 Orders and Results ................................................................................................. 15

7.1 Overview ...................................................................................................................................... 15

7.2 Placing radiology orders ............................................................................................................... 15

7.3 Protocol Initiated X-rays (Nurse Initiated X-rays) ......................................................................... 15

7.4 Endorsing radiology results .......................................................................................................... 16

7.5 Placing pathology orders .............................................................................................................. 16

7.6 Collecting a pathology specimen ................................................................................................. 16

7.7 Endorsing pathology results ......................................................................................................... 17

7.8 Placing an ECG order .................................................................................................................. 17

7.9 Performing an ECG ...................................................................................................................... 17

8 Managing patient deterioration – RAT, re-RAT and Early Warning Signs (EWS) 18

8.1 Overview ...................................................................................................................................... 18

8.2 Managing deterioration ................................................................................................................ 18

8.3 Altering mandatory notification criteria (AACC – Alteration to Alert Calling Criteria) ................... 19

9 Category 1, Trauma Attend, Resus and Red Blanket Patients ............................ 20

9.1 Overview ...................................................................................................................................... 20

9.2 Documenting clinical information for unstable patients ................................................................ 20

10 FirstNet Departure – Discharge Home, Did Not Wait, Left Against Medical Advice and Discharged to Other Service (e.g. OPD) ............................................ 21

10.1 Overview ...................................................................................................................................... 21

10.2 Preparing a patient to depart ED.................................................................................................. 21

10.3 Capturing and printing a patient’s Statement of Attendance ....................................................... 21

10.4 Capturing Depart Ready Time ..................................................................................................... 21

10.5 Departing a patient who has been discharged home .................................................................. 21

10.6 Departing a patient who did not wait ............................................................................................ 22

10.7 Departing a patient who left against medical advice .................................................................... 22

10.8 Departing a patient who died in ED ............................................................................................. 22

10.9 Departing a patient transferring to another hospital facility .......................................................... 22

10.10 Capturing actual departure time ................................................................................................... 23

Emergency Department - Firstnet Business Rules V1.1 ix

11 FirstNet Admission – Inpatient Ward ..................................................................... 24

11.1 Overview ...................................................................................................................................... 24

11.2 Patient referral to inpatient team .................................................................................................. 24

11.3 Texting TTH Patient Flow Unit ..................................................................................................... 24

11.4 Placing an ‘Admit to Inpatient’ order/Admit event ........................................................................ 24

11.5 Inpatient team consultation attended ........................................................................................... 25

11.6 Capturing “ED to Inpatient Admission” information ...................................................................... 25

11.7 Capturing departure ready information ........................................................................................ 25

11.8 Inpatient Admission on HBCIS ..................................................................................................... 25

11.9 Adding ‘Bed Events’ ..................................................................................................................... 25

11.10 Capturing free text information in the Bed Management comments............................................ 25

11.11 Capturing Delay information ......................................................................................................... 26

11.12 Physically departing ED to an inpatient location .......................................................................... 26

11.13 Allocating the patient to the ED Exit location ............................................................................... 26

12 FirstNet Admission – ED Short Stay Unit .............................................................. 27

12.1 Overview ...................................................................................................................................... 27

12.2 Patient referral to Short Stay Unit ................................................................................................ 27

12.3 Completing a SSU Admission Form............................................................................................. 27

12.4 Placing an ‘Admit to Inpatient’ order/Admit event ........................................................................ 27

12.5 Capturing departure ready information ........................................................................................ 27

12.6 Capturing “ED to Inpatient Admission” information ...................................................................... 28

12.7 SSU Admission on HBCIS ........................................................................................................... 28

12.8 Adding ‘Bed Events’ ..................................................................................................................... 28

12.9 Capturing Delay information ......................................................................................................... 28

12.10 Physically departing ED to SSU location ..................................................................................... 28

12.11 Allocating the patient to the SSU FirstNet location ...................................................................... 29

12.12 Transferring the SSU patient on HBCIS ...................................................................................... 29

13 Assessment and Treatment within ED SSU .......................................................... 30

13.1 Overview ...................................................................................................................................... 30

13.2 Documenting assessment and treatment activities – Nursing ..................................................... 30

13.3 Documenting assessment and treatment activities – Medical ..................................................... 30

14 Discharge – ED SSU ................................................................................................ 31

14.1 Overview ...................................................................................................................................... 31

14.2 Preparing the patient to depart ED SSU ...................................................................................... 31

14.3 Capturing and printing a patient’s Statement of Attendance ....................................................... 31

14.4 Discharging the patient ................................................................................................................ 31

15 Transfer from ED SSU to Inpatient Ward ............................................................... 32

15.1 Overview ...................................................................................................................................... 32

15.2 Placing a referral to an inpatient unit ........................................................................................... 32

15.3 Contacting TTH Patient Flow Unit ................................................................................................ 32

15.4 Updating admission details in HBCIS .......................................................................................... 32

15.5 Updating FirstNet Comments screen with inpatient admission information ................................ 32

15.6 Locating and allocating an inpatient ward bed ............................................................................. 32

15.7 Transferring the patient ................................................................................................................ 33

Emergency Department - Firstnet Business Rules V1.1 x

16 FirstNet Transfer – From ED SSU to ED Resuscitation/ED Acute ....................... 34

16.1 Overview ...................................................................................................................................... 34

16.2 Transferring the patient back to ED ............................................................................................. 34

16.3 Conducting a patient clinical handover to ED nursing staff ......................................................... 34

16.4 Updating HBCIS ........................................................................................................................... 34

16.5 Updating FirstNet ......................................................................................................................... 34

16.6 Transferring a SSU admitted patient in ED to ward ..................................................................... 34

17 FirstNet Disaster Patients ....................................................................................... 35

17.1 Overview ...................................................................................................................................... 35

17.2 Quick registering disaster patients ............................................................................................... 35

17.3 Completing the FirstNet Triage Assessment Form for disaster patients ..................................... 35

17.4 Using disaster charts .................................................................................................................... 36

18 Downtime ................................................................................................................. 37

18.1 Overview ...................................................................................................................................... 37

18.2 Managing clinical information and functions during ieMR unplanned downtime ......................... 37

18.3 Managing clinical information and functions during ieMR planned downtime ............................. 37

18.4 Planned and unplanned PASLink downtime ................................................................................ 38

18.5 HBCIS Downtime ......................................................................................................................... 38

Emergency Department - Firstnet Business Rules V1.1 1

1 FirstNet – Emergency Department Business Rules

1.1 Purpose

The purpose of this section is to detail the underlying business rules that facilitate the

successful operation of the FirstNet system module within the EMR.

1.2 Scope

The scope of this document is to identify and define the business rules applicable when FirstNet module of the ieMR is implemented.

This document applies to the following TTH stakeholders, but is not limited to:

ED (including Triage, Resuscitation, Acute, Ambulatory Care, ED Mental Health (ED MH)and ED Short Stay Unit (SSU))

Inpatient Teams and Units

Patient Flow Unit.

Hospital in the Home (HITH)

1.3 Related Documents

TTH Digital Release General Business Rules

Business continuity plan

Code Brown Mass Casualty Registration and Documentation in the Emergency Department TTH Procedure Manual, THHS

ED Disaster Plan V10 2012

ED Guidelines

SSU Guidelines

Quick reference guides

Pathology Troubleshooting Guide

Radiology Troubleshooting Guide


2 FirstNet Pre-Arrival

2.1 Overview

The FirstNet Pre-Arrive Patient system functionality is used to capture and manage pre-arrival information related to the patient (equivalent of EDIS expects screen).

Pre-arrival information can only be recorded by an ED Consultant/Registrar, or the TTH

Patient Flow Unit.

2.2 Capturing pre-arrival information

The following information must be captured within the Pre-Arrival Form:

o A minimum of three (3) patient identifiers (i.e. Source of referral, Family name, Given name)

o The patient’s presenting complaint and relevant clinical

o The patient’s location must remain as “Pre_Arrival”.

Only the following TTH staff are to enter “Pre-Arrival” information into FirstNet:

o ED Consultants and Registrars

o Patient Flow Unit staff.

2.3 Cancelling pre-arrival information

If a patient is no longer expected to arrive and a Pre-Arrival Form exists within FirstNet for the patient, the ED Clinician must cancel the patient’s Pre-Arrival Form.

Pre-Arrival forms that are not attached to a patient’s electronic medical record will be removed automatically from the FirstNet ED Tracking List after 72 hours.

2.4 Attaching pre-arrival information

Once the patient has arrived to the TTH ED and has been is triaged, the pre-arrival form

information related to the patient will need to be attached to the patient’s electronic

medical record by the ED Triage Nurse. (Refer to Attaching a Pre-Arrival Form within the

section Quick registration and Triage)


3 FirstNet Quick Registration and Triage Assessment

3.1 Overview

A patient who has presented to the TTH ED must be Quick Registered and Triaged promptly by the ED Triage Nurse.

The FirstNet Quick Registration system functionality is used to rapidly register new patients within HBCIS and create a new emergency encounter within a patient’s electronic medical record.

The FirstNet Triage Assessment Form is used to capture and manage ED Triage

information related to the patient.

3.2 Searching for patient demographic information (FirstNet)

Prior to Quick Registration, the ED Triage Nurse must search for a patient via FirstNet by initially populating the patient's last name and date of birth (DOB) into the respective search fields.

If search results are returned, the ED Triage Nurse must check the patient's given and family names in order to match these details to an existing patient TTH URN within the system.

3.3 Adding a new emergency encounter (patient has pre-existing TTH URN)

For patients who have previously presented to the TTH and have been registered within the hospital’s patient administration system (PAS), HBCIS, a new emergency encounter must be added to the patient’s electronic medical record via FirstNet.

If positive patient identification has occurred, the ED Triage Nurse must select the correct URN and demographic information related to the patient from the search result window.

The ED Triage Nurse must select "Add Encounter" for the patient who has an existing URN. This will create a new Emergency Encounter for the patient’s emergency presentation within the system.

Within the Quick Registration screen itself, the ED Triage Nurse must ensure:

o the patient’s family and given names have been pre-populated

o Male or Female is pre-populated for the patient’s sex

o any mandatory fields are completed (right click highlight mandatory fields).

Once Quick Registration is completed, the patient’s emergency encounter will be automatically assigned a FIN by the system.


3.4 Adding a new TTH patient (patient has no pre-existing TTH URN)

If the patient’s URN and demographic information has not been found via FirstNet, the ED Triage Nurse must confirm the correct spelling of the patient's given and family names and confirm the patient’s DOB. The ED Triage Nurse must again search for the patient within the system using the patient’s confirmed correct information. A URN must not be issued until this has been done.

If positive patient identification has not occurred, the ED Triage Nurse must select “Add Person”.

Within the Quick Registration screen itself, the ED Triage Nurse must ensure:

o the patient’s family and given names are spelt correctly

o Male or Female is selected for the patient’s sex (note: “indeterminate” must not

be used)

o any mandatory fields are completed (right click highlight mandatory fields).

Once Quick Registration is completed, the patient will be automatically assigned a URN as well as be automatically assigned a FIN for their new emergency encounter.

3.5 Automatically allocating a URN to a new TTH patient

For patients who have not been previously allocated a TTH URN, FirstNet will automatically allocate a new URN from a pre-determined sequence, assigned by TTH Health Information Management Service (HIMS). Currently this sits within 900000-949999 TTH URN range.

FirstNet will automatically allocate new URNs even during HBCIS downtime.

3.6 Quick registering an unknown patient

If a patient is unable to be positively identified, the triage nurse selects the next

unknown patient UR from a physical list provided by HIMS.

The triage nurse searches using the unknown patient UR in FirstNet and selects ‘Add Encounter’.

The triage nurse completes the Quick Registration process. The patient’s unknown demographic information will already be populated. Any additional mandatory fields need to be completed.

3.7 Resolving quick registration errors

A Quick Registration is deemed successful when the patient’s URN is captured within HBCIS and all mandatory fields are populated with either Not Stated or Unknown.

A Quick Registration is deemed unsuccessful if a patient’s URN is entered into HBCIS and all mandatory fields are blank.


A Quick Registration can fail for one or more of the following reasons, but is not limited to:

o A symbol, number or unknown character is captured within the patient’s Family Name

o The patient’s first and/or family name exceeds the 23 character limit within HBCIS

o The patient’s information already exists in HBCIS.

There are five types of Quick Registration failures that can occur:

o Data validation failures

o HBCIS registration failures

o HBCIS user account expiring

o HBCIS user account expired

o PASLink Heartbeat Monitor failure.

Depending on the reason for failure, an email will be sent to one or more of the

following email addresses:

o Generic ED AO email account - TBA

o [email protected]

o [email protected]

If the Quick Registration failure is a single notification, the ED AO is required to

perform a manual patient registration in HBCIS. (Refer to section Full Registration).

If there are multiple Quick Registration failure notifications, the ED AO must escalate

this via phone to the Information Service Centre 1800 198 175.

The ED AO staff member must be informed of any PASLink issues. Once the error

has been resolved, ED will be informed via phone and email.

ED AO staff will need to follow up the Information Service Centre if notification has

not been received within 30 minutes.

3.8 Wrong patient is selected during quick registration process

If the triage nurse selects the wrong patient during the patient search and quick registration process, this needs to be rectified as soon as the error is identified.

Any open orders will need to be cancelled.

Any documentation will need to be marked as ‘written in error – wrong patient’.

Pathology and Radiology departments to be notified if any investigations have already been completed.

ED AO to notify TTH HIMS that a wrong patient encounter has been added to a patient.




ED AO will cancel the incorrect encounter.

The Triage Nurse will repeat the patient’s Quick Registration and Triage process (back dating to the original triage date and time) this time selecting the correct patient details.

3.9 Completing the Triage Assessment Form

The ED Triage Nurse must complete the following mandatory fields as part of the patient's Triage Assessment:

o Presenting complaint

o Tracking acuity (ATS)

o Visit reason

o Type of visit

o Stream (e.g. FastTrack).

If the ED Triage Nurse completes vital sign observations of the patient during the triage process (to assist with assigning an appropriate triage category), this information must be populated in the relevant observation fields within the Triage Assessment form.

3.10 Editing the Triage Assessment Form

If any triage information (including triage category) need to be edited this can be done by opening the completed triage form in the documentation section of the patient’s chart.

3.11 Capturing allergy information

The ED Triage Nurse will attempt to capture allergy information related to the patient during the Triage Assessment process. This information will be used to print the correct coloured identification wristband for the patient (refer to Positive Patient Identification wristband (PPID) within section Full registration).

3.12 Attaching a Pre-Arrival Form

If the patient has an existing Pre-Arrival Form within FirstNet, the ED Triage Nurse will manually attach this information to the patient’s electronic medical record.

3.13 Triaging an inpatient who is transferred into ED (e.g. HITH)

If a patient has been transferred in from an inpatient facility and has an open TTH inpatient encounter, quick registration is not required.

The ED AO will transfer the patient from their inpatient location into the TWAA location.

This will automatically populate the patient onto the FirstNet Tracking screen.

The triage nurse will update the patient location on the FirstNet Tracking screen.


The patient will be triaged by launching the triage form using the Triage icon on the FirstNet Tracking screen.

****please note patient LOS will be much greater than expected as the LOS will commence from the initial encounter creation date and time.


4 FirstNet Full Registration

4.1 Overview

Once a patient has been Quick Registered and Triaged by the ED Triage Nurse within FirstNet, the ED AO will complete a full registration in the ED Arrival Conversation of FirstNet.

The ED AO must ensure the patient’s registration information (demographics information) has been captured within the TTH Patient Administration System (PAS), HBCIS.

The FirstNet ED Arrival Conversation is used to capture and manage information pertinent to the patient’s emergency episode of care.

Emergency ieMR encounter labels are printed via FirstNet so that paper-based clinical hospital information/documentation can be labelled appropriately for scanning.

Patient identification wristbands are printed via FirstNet in order to identify the patient by their full name, DOB and URN while being actively treated in TTH ED.

4.2 Assigning an AO provider

At the time of completing a patient’s HBCIS registration, documenting emergency episode of care information, printing patient encounter labels and identification wristband the ED AO must assign themselves as a provider to the patient within FirstNet.

4.3 Registering a FirstNet-allocated URN in HBCIS

FirstNet will automatically allocate a new URN to patients who have not previously presented to the TTH ED.

If the FirstNet Quick Registration process fails for a new patient, the patient will need to be manually registered in HBCIS, using the FirstNet automatically allocated URN.

4.4 Unknown patient details become known (but patient has no previous TTH UR)

Now known patient demographic details are updated in HBCIS by ED AO.

This will update ieMR.

The patient will then retain their allocated unknown URN for this and any subsequent TTH presentations.


4.5 Unknown patient details become know (and the patient has a pre-existing TTH UR)

Now known patient demographic details are updated in HBCIS by ED AO.

This will update ieMR.

The patient will retain their allocated unknown URN for this presentation/admission until discharge.

The ED AO must note within the Comment column of the FirstNet Tracking List that a “Duplicate Record exists for URN xyz”.

Duplicate details must be captured in HBCIS in the PMI field.

ED AO to email [email protected] with the completed duplicate patient form.

Once discharged, the patient’s URNs will be merged by TTH HIMS in due course.

4.6 Manually allocating and registering a URN in HBCIS

A URN will be manually allocated and registered in HBCIS for the following patients:

o Boarder patients (babies or otherwise) (refer to section ED Boarder Patients)

o Disaster patients (refer to section Disaster Patients)

o ieMR Downtime (refer to section Downtime)

o Unknown patients (refer to section Quick Registering of Unknown Patients).

4.7 Searching for and/or updating patient demographic information in HBCIS

Searching for demographic information related to a patient within HBCIS will continue as per current business processes.

Updating demographic information related to a patient in HBCIS will continue as per current business process.

4.8 Completing the Patient Election Form

Patient Election Form (PEF) will continue to be completed by the patient as per current process. The PEF will remain on paper.

4.9 Printing emergency ieMR encounter labels

Continues as per current ieMR Release 2 functionality.

If a patient is admitted as an inpatient, the patient’s clinical forms that have been labelled with emergency ieMR encounter labels do not need to be re-labelled with inpatient ieMR encounter labels.


4.10 Patient identification wristband (PPID)

A patient must be fitted with an identification wristband upon commencing active treatment within ED.

ED AO will print a red or white arm band based on the patient’s allergy status within the FirstNet tracking board.

4.11 Completing the full registration in FirstNet

The following mandatory fields must be completed within the ED Arrival

conversation:

o Mode of Arrival

o Insurance

o Compensable Status

o Interpreter Required

o eARF Number (for QAS patients)

o Next of Kin (NOK) – this information must be captured manually in both HBCIS and FirstNet.

4.12 Cancelling duplicate patient records (no documentation started, no orders placed)

If a duplicate patient is identified within a timely manner, the ED AO must inform the ED Triage Nurse as soon as possible.

The ED Triage Nurse will request ED Admin cancel the patient’s duplicate encounter/registration and will redo a Quick Registration, searching for the patient’s correct URN and adding a new emergency encounter.

The duplicate URN must be rectified as per current business processes:

o Duplicate details must be captured in HBCIS in the PMI field

o Email [email protected] with the completed duplicate patient form.

4.13 Cancelling duplicate patient records (once documentation started or orders already placed)

If documentation has commenced or orders have been placed for a patient within FirstNet, the patient must continue to receive treatment under the URN in use.

The ED AO must note within the Comment column of the FirstNet ED Tracking List that a “Duplicate Record exists for URN xyz”.

The duplicate URN must be rectified as per current business processes:

o Duplicate details must be captured in HBCIS in the PMI field

o Email [email protected] with the completed duplicate patient form.

Once discharged, the patient’s URNs will be merged by TTH HIMS in due course.




5 FirstNet Assessment and Treatment (Nursing)

5.1 Overview

The ED Primary Treating Nurse has two mandatory assessments to complete for every patient who has presented to the TTH ED for care:

o Initial ED Clinical Handover

o Primary Assessment

Optional other assessments include

o Systems assessment

o Past medical history

o Procedure history

o Family history

o Social history

o Patient belongings

The above outlined clinical information will be documented by the ED Primary Treating Nurse in the ‘ED Nursing Assessment Form’.

5.2 Assigning a Nursing provider

The ED Primary Treating Nurse must assign themselves as a provider to the patient prior to commencing clinical documentation within the patient’s electronic medical record.

A timestamp will be captured by FirstNet when any provider is assigned to a patient. This information will be used for ED reporting purposes.

5.3 Nursing documentation

The Primary Treating Nurse will document the following information in the ‘ED Nursing Assessment Form’, i-view, Ad-Hoc forms, and documentation tab:

o Clinical handover

o Primary assessment

o Past medical history and problems

o Behavioral or infections alerts

o Allergies

o Systems Assessment information.


If there are any abnormalities detected, the ED Primary Treating Nurse must document the abnormality and treat the patient as required. The ED Primary Treating nurse must then alert the appropriate ED Consultant and/or Registrar of the patient’s condition.

The ED Primary Treating Nurse will then document any further interventions that have been implemented and the name of the Medical Officer alerted.

5.4 Perform Vital Signs Observations

Vital signs information related to the patient is captured within the Interactive View – ED Adult Condensed View – Vital Signs section of the patient’s electronic medical record.

The ED Primary Treating Nurse must view the patient’s electronic medical record (Vital Signs iView) to confirm the vital signs observations have been automatically sent and the appropriate Early Warning Signs notifications have been triggered and validated.

5.5 Creating an ED Progress Note

The ED Primary Treating Nurse will create an ED Progress Note in order to document the clinical care activities performed for the patient within the patient’s electronic medical record.

A new progress note should be created for any new information. This ensure that all documentation from multiple clinicians remains in chronological order.

Additional information or changes pertinent to a previously written note can be added as an addendum.

Refer to the Progress Notes section of the TTH Digital Release General Business Rules document for further guidelines such as naming conventions.

5.6 Conducting a patient clinical handover between ED Nursing staff

ED Nursing staff will conduct a patient clinical handover supported by the ED Nursing Summary page in the patient’s electronic medical record as per current business processes (SBAR).

The ED Primary Treating Nurse will un-assign themselves as the patient’s provider in FirstNet when the patient’s care has been handed over to the new ED Primary Treating Nurse.


6 FirstNet Assessment and Treatment (Medical)

6.1 Overview

The ED Primary Treating Doctor will complete the following where applicable for every patient who has presented to the TTH ED for care:


o History of present illness Primary Assessment

o Past Medical History (Family, Procedure, Social), Problems and Diagnoses

o Allergy/adverse effect

o Physical examination

o Assessment and management plan.

The FirstNet ieMR module provides access to the patient’s electronic medical record where the above outlined clinical information can be documented via the ED Doctor Workflow page.

6.2 Assigning a Senior Medical Officer/Treating Clinician provider

The ED Treating Doctor must assign themselves as a provider to the patient (within FirstNet/ED LaunchPoint) prior to commencing clinical documentation within the patient’s electronic medical record.

A timestamp will be captured by FirstNet when any provider is assigned to a patient. This information will be used for ED reporting purposes.

6.3 Reassigning/Handing over a patient

The ED Treating Doctor must reassign/hand over their assigned patients to the appropriate ED Treating Doctor on shift when required within FirstNet/ED LaunchPoint (i.e. between shifts).

6.4 Documenting the ED Doctor Workflow

The ED Treating Doctor will complete the following in the ED Doctor Workflow:

o Review Triage Assessment documentation

o Document Presenting Complaint and History of Present Illness

o Review and document Past Medical History, Problems and Diagnoses (ensure diagnosis for this encounter is marked as ‘Working’)

o Review, update and document Alerts and Allergies

o Document physical exam information


o Document assessment and management plan information.

6.5 Creating an ED Progress Note

The ED Treating Doctor will create an ED Progress Note that includes all information already documented as part of the ED Doctor Workflow within the patient’s electronic medical record.

Refer to the Progress Notes section of the TTH Digital Release General Business Rules document for further guidelines such as naming conventions.

6.6 Placing Inpatient Medical Service and Allied Health consultation orders

The ED Treating Doctor will request (via phone call) an inpatient medical service consultation and/or allied health consultation for the patient if required.

Once the phone call has been made, the ED Treating Doctor will place the consultation order as an electronic order within FirstNet.

The ED Treating Doctor will be prompted to capture a working diagnosis for the patient in the patient’s electronic medical record.

Once the consultation has been provided to the patient, the Inpatient Medical Service/Allied Health specialty will update the patient’s consultation order to “Completed”. As a result, the FirstNet ED Tracking List will be updated, displaying the completed consultation order in the Completed Column for the patient.

Refer to the Consult Orders (Allied Health) section of the TTH Digital Release

General Business Rules document for further information.


7 Orders and Results

7.1 Overview

Paper radiology orders will be now be placed electronically within FirstNet. Radiology results will also be endorsed within ieMR.

Paper pathology orders and recording specimen collection will now occur electronically within FirstNet. Pathology results in ieMR are currently not available. Endorsement of pathology results will remain a paper process in ED until electronic pathology results within ieMR are available.

ECG recording will remain a paper process and will be scanned into the ieMR as per current process. Integrated ECG will be considered during the optimization phase of the Digital Release.

7.2 Placing radiology orders

Each radiology order must specify at a minimum:

o “Requested start date/time” fields (defaulted to current date/time)

o “Reason for order/details” field

o “Requestor phone/pager” field

o “Imaging is needed to” field

o “Medical risk/alerts” field

o “Priority” field – change from “Routine” to “Urgent”.

Additional details required for placing radiology orders:

o “Payment Class” field if known

o “Special Instructions” if any.

The ED Treating Doctor must enter their individual Novell password in order to sign and place the radiology order for the patient.

A paper-based radiology request form is not required.

The ED Treating Doctor is expected to contact the relevant Radiologist if required to discuss the radiology request as per business current process. This can be done prior to or post placing a radiology order.

Refer to the Orders section of the TTH Digital Release General Business Rules document for further information.

Refer to the Radiology Troubleshooting Guide.

7.3 Protocol Initiated X-rays (Nurse Initiated X-rays)

Registered Nurses can continue to order Protocol Initiated X-rays (PIX) in accordance to their current scope and TTH policy.

PIX will now be ordered electronically.


The PIX order must specify:

o the patient’s Treating Medical Officer – the ED Floor Consultant should be

populated in this field

o the way the order was requested (i.e. protocol). Selecting protocol ensures the order goes directly to Radiology and does not require co-signing by the medical officer.

7.4 Endorsing radiology results

The patient’s ED Treating Doctor is required to review and endorse patient radiology results within the patient’s electronic medical record.

7.5 Placing pathology orders

Each pathology order must specify:

o the patient’s Treating Medical Officer

o the order’s date and time

o the way the order was requested (written, verbal or protocol).

Additional details required for placing pathology orders:

o “Clinician collect” field to remain as “Yes”

o “Collected” field to remain as “No”.

If “No” is selected for the “Collected” field, the order/s will appear as outstanding task/s (specimen/s to be collected) for the patient.

The ED Treating Doctor must enter their individual Novell password in order to sign and place the pathology order for the patient.

Refer to the Orders section of the TTH Digital Release General Business Rules

document for further information.

Refer to the Pathology Trouble Shooting Guide.

7.6 Collecting a pathology specimen

Positive patient identification must be confirmed (preferably via the scanning function) in order to ensure printed pathology labels are correct prior to attaching to specimen tubes.

Each pathology label must have the collector’s initials and the date and time of collection prior to being attached to the specimen tube/s.

Pathology specimen tubes must be labelled at the patient’s bedside, at the time of collection.

Re-printing pathology specimen tubes will require identifying the original order’s accession number.

Pathology specimen tube/s will be sent as per current process to the Pathology Laboratory for analysis.


Refer to the Orders section of the TTH Digital Release General Business Rules

document for further information.

Refer to the Pathology Trouble Shooting Guide.

7.7 Endorsing pathology results

Not currently available.

7.8 Placing an ECG order

Not currently required.

7.9 Performing an ECG

Remains a manual process and printed on paper.

ECG integration will be revisited during the optimization phase after digital release


8 Managing patient deterioration – RAT, re-RAT and Early Warning Signs (EWS)

8.1 Overview

Current RAT and re-RAT TTH process will still remain with the introduction of QADDS and EWS within ieMR.

Managing deterioration warnings must be managed and actioned appropriately within ieMR.

Alteration to Alert Calling Criteria may be used to adjust deteriorating patient warnings if appropriate.

8.2 Managing deterioration

A relevant managing patient deterioration warning will display when a patient’s observations are outside the normal ED QADDS ranges.

If a managing deterioration warning is displayed for the patient within the Managing Deterioration tab of the patient’s electronic medical record, “0 minutes” must be selected prior to acknowledging/suspending the warning.

When a patient’s vital signs observations meet RAT/re-RAT criteria or a managing deterioration warning is displayed within FirstNet, the ED Primary Treating Nurse must notify the relevant ED Consultant, Registrar and/or Nursing Team Leader and request a RAT/re-RAT of the patient.

The ED Primary Treating Nurse must perform all critical patient care activities necessary prior to documenting the action/s taken for the patient within the patient’s electronic medical record.

The ED Primary Treating Nurse must ‘flag and comment’ on the abnormal observations within iView e.g. ‘hypotensive RAT requested’.

The ED Medical Officer will place an event of ‘Rapid Assessment’ against the patient. This will time and date stamp the patient with the Medical Officer’s name to determine a RAT has occurred (indicated by a ‘lightning strike’ symbol.

An ED Progress Note must be documented within the patient’s electronic medical record by the ED Primary Treating Nurse and ED Treating MO. The ED Progress Note must document all patient care actions taken and the senior ED team members/s notified of the patient’s deterioration.

The ED Progress Note must be labeled ‘ED – RN/MO – re-RAT’.

Refer to the Early Warning Tool (EWT) section of the TTH Digital Release General Business Rules document for further information.


8.3 Altering mandatory notification criteria (AACC – Alteration to Alert Calling Criteria)

The ED Treating Doctor may alter the patient’s mandatory notification criteria (as part of managing a patient’s deterioration) if required and clinically safe to do so.

Any altering of EWS notification criteria must first be discussed and approved by the ED Consultant or Registrar, and this must be recorded both in the Alteration to Alert Calling Criteria free text field, and as a progress note.


9 Category 1, Trauma Attend, Resus and Red Blanket Patients

9.1 Overview

Patients who require urgent clinical attention will be immediately transferred to an

available TTH ED Resuscitation location for assessment and treatment by ED

Clinicians.

9.2 Documenting clinical information for unstable patients

Clinical documentation for all unstable, trauma attend and red blanket patients in the resuscitation room will remain on paper as per current business process.

A paper-based Trauma Assessment form will be completed by an ED Medical Officer as per current business process.

Pathology and medical imaging paper based forms are available in resus and can be used for unstable patients if required.

ECGs will remain a manual process and will be printed.

The ED Resuscitation Coordinator may choose to capture relevant information about the patient’s invasive devices (such as IVCs, ICCs, ART lines and CVLs) within the patient’s electronic medical record (within the ED Lines – Devices – Procedures i-View band heading) retrospectively.

Any progress notes that are documented within ieMR must be titled ‘Emergency – RN/MO – Resus’.


10 FirstNet Departure – Discharge Home, Did Not Wait, Left Against Medical Advice and Discharged to Other Service (e.g. OPD)

10.1 Overview

Once the required healthcare services have been delivered and their emergency episode of care is complete, the patient will depart from TTH ED.

FirstNet system functionality in use is the Depart Process – including the ability to capture and print a patient’s Statement of Attendance, departure information (via ED Departure conversation) and Depart Ready Time and Actual Departure Time.

This process applies to patients who are discharged home, did not wait, left against medical advice, died in ED, or transferred to another facility.

10.2 Preparing a patient to depart ED

Prior departing the patient from ED (and FirstNet), the relevant ED Clinician must remove all outstanding pathology, radiology and patient care orders for the patient.

The ED Primary Treating Nurse must document the removal of Peripheral IV Lines from the patient within the patient’s electronic medical record.

10.3 Capturing and printing a patient’s Statement of Attendance

The ED Treating Medical Officer must complete the patient’s Statement of Attendance prior to the patient departing ED. This is completed through the depart process icon.

10.4 Capturing Depart Ready Time

The ED Treating Medical Officer must capture the date and time the patient is ready to depart from ED (i.e. their emergency episode of care has finished).

Depart Ready Time must be captured prior to the patient’s actual departure date and time.

10.5 Departing a patient who has been discharged home

The ED Treating Medical Officer must complete the following information within the FirstNet ED Departure conversation (contained within the Depart Process):

o “ED Departure Status” field – “Discharged ED service completed”

o “ED In-Pt Ward (EDIP) Pt” field – “No”

o “Departure Destination” field – e.g. Home/usual residence

“Depart in the care of” field (if applicable).


10.6 Departing a patient who did not wait

The ED Medical Officer or the ED Nurse must complete the following information within the FirstNet ED Departure conversation (contained within the Depart Process):

o “ED Departure Status” field – “Did not wait”


o “Departure Destination” field – “Did not wait”

o “Depart in the care of” field (if applicable).

Mandatory Diagnosis of “Did not wait for treatment” must be captured.

10.7 Departing a patient who left against medical advice


-“ED Departure Status” field – “Left after treatment commenced”

-“ED In-Pt Ward (EDIP) Pt” field – “No”

-“Departure Destination” field – “Discharged at Own Risk - Left against medical advice”

-“Depart in the care of” field (if applicable).

Mandatory Diagnosis of “Left against medical advice” must be captured.

10.8 Departing a patient who died in ED

The ED Treating Medical Officer must complete the following information within the FirstNet ED Departure conversation, under the Departure Information tab:

“Departure Status” field – “Died in ED”.

10.9 Departing a patient transferring to another hospital facility


o “ED Departure Status” field – “Transfer to another hospital”


o “Referred to on Departure” field – e.g. “Other Hospital”

o “Depart Facility” field - This is the facility the patient is being transferred to.

o “Departure Mode”

“Depart in the care of” field (if applicable).


10.10 Capturing actual departure time

Once a patient has physically left ED, the ED Nurse or ED Treating Medical Officer must capture the end date and time of the patient’s actual departure.

Once an actual departure time has been captured for the patient, the patient’s information will be removed from the FirstNet ED Tracking List.


11 FirstNet Admission – Inpatient Ward

11.1 Overview

A patient whose health requires further assessment, observation, investigation and treatment and input from specialist inpatient teams (and will take longer than 24 hours) will be admitted to a hospital inpatient ward.

FirstNet system functionality in use is placing an Admit to Inpatient order, various admit events, capturing bed management comments, capturing delay information, capturing departure information, capturing a working diagnosis and flipping the patient’s emergency encounter to an inpatient encounter.

11.2 Patient referral to inpatient team

If the patient requires inpatient team consultation and admission, a phone call will be placed to the inpatient team.

The ED Treating Medical Officer will then place a Consult Order within FirstNet to capture the referral time.

Once the Consult Order has been placed, the ED Medical Officer will inform the ED Nursing Navigator. The ED Nursing Navigator will update the comments section with the ED Tracking List (e.g. Ref Cardio 1716hrs).

11.3 Texting TTH Patient Flow Unit

Once the patient has been referred to an inpatient team and is likely for admission, the ED Nursing Navigator will notify the TTH Patient Flow Unit via text buddy in order for them to organise the patient’s inpatient ward bed.

11.4 Placing an ‘Admit to Inpatient’ order/Admit event

Once the Patient Flow Unit has been notified, the ED Nursing Navigator will create an “Admit to Inpatient” order within FirstNet.

An “Admit to Inpatient” order can only be placed once a diagnosis is captured by the ED Treating Medical Officer.

The “Admit to Inpatient” order must contain the following information:

o “Bed requirements” e.g. General Bed

o the order’s date and time.

Once the “Admit to Inpatient” order is placed, the patient will then appear on the FirstNet TTH Bed Management Tracking List with an “Admit” event.


11.5 Inpatient team consultation attended

When the inpatient admitted team attends ED to review the patient they will change the Consult Order to complete

This can be done in FirstNet or PowerChart.

11.6 Capturing “ED to Inpatient Admission” information

Once the patient has been accepted for admission the ED Nursing Navigator will capture the Admitting Team and Admitting Consultant information via the ED to Inpatient Admission Conversation in FirstNet.

The ED Nursing Navigator will update the comments section with the ED Tracking List (e.g. Cardio Inpt 1716hrs).

11.7 Capturing departure ready information

Once the patient has been accepted for admission and is ready to depart ED, the ED Navigator will mark the patient as depart ready through ‘Set Events’.

11.8 Inpatient Admission on HBCIS

Once the ED Nursing Navigator updates the comments section with inpatient information (e.g. Cardio Inpt 1716hrs) the ED AO will complete the HBCIS admission and will admit the patient to the TWAA location.

Once the HBCIS admission is complete the ED AO will update the comments section to include the prefix of a/ (e.g. a/Cardio Inpt 1716hrs).

11.9 Adding ‘Bed Events’

The ED Nursing Navigator will use the Event function to document and update bed status according to the following:

o Admit Bed Requested – the Patient Flow Unit has been contacted and an inpatient bed requested

o Bed Assigned event - a suitable inpatient bed has been located for the patient

o Bed Not Ready event - an inpatient bed has been located for the patient, but is not yet ready

No Bed event - there are no hospital beds available.

11.10 Capturing free text information in the Bed Management comments

The Bed Management column (“Bed Mgt”) on the TTH Bed Management Tracking List will be used by the ED Nursing Navigator to document the allocated inpatient ward and the time the bed is ready once known.


11.11 Capturing Delay information

If the TTH Patient Flow Unit notifies the ED Nursing Navigator that there are inpatient bed delays for the patient, the ED Nursing Navigator will capture delay information for the patient within the FirstNet ED Departure Conversation.

11.12 Physically departing ED to an inpatient location

The ED Nursing Navigator will complete the following information within the FirstNet ED Departure conversation:

o “Departure Status” field – i.e. “Admitted (excl. ED bed)”

o “ED In-Pt Ward (EDIP) Pt – “Yes”

o “Admitted Destination” – ward allocation

o “Admission Specialty”

o “EDIP Admit Date” – the date of departure from ED

o “EDIP Admit Time” – the time of departure from ED.

***The EDIP Admit Date and Time is what stops the NEAT clock for admitted

patients for reporting purposes.

Documenting the above information must be performed prior to the patient being transferred to an inpatient ward on HBCIS as this will drop them off the tracking board

***ED Inpatients do not have their actual departure time completed in FirstNet as this would close the Inpatient Encounter.

11.13 Allocating the patient to the ED Exit location

When the patient is physically exiting ED to be taken to their inpatient ward location, the ED Nursing Navigator will update the patient’s location to “Exit” within FirstNet. This frees up the patient’s bed in FirstNet whilst the HBCIS ward transfer is occurring.

Once the patient has been transferred on HBCIS to the inpatient ward location (by ward staff) the patient will automatically be removed off the FirstNet Tracking screen.


12 FirstNet Admission – ED Short Stay Unit

12.1 Overview

A patient whose health requires further assessment, observation, investigation and treatment and take longer than four (4) hours, but less than 24 hours, will be admitted to the ED SSU.

FirstNet system functionality in use is placing an Admit to Inpatient order, various admit events, capturing bed management comments, capturing delay information, capturing departure information, capturing a working diagnosis and flipping the patient’s emergency encounter to an inpatient encounter.

12.2 Patient referral to Short Stay Unit

If the patient requires a SSU admission, a phone call will be placed to the SSU admitting consultant.

Once the patient has been accepted to SSU, the ED Medical Officer will inform the ED Nursing Navigator.

12.3 Completing a SSU Admission Form

A patient who is being admitted to ED SSU must have an ED SSU Admission Form completed by the reviewing ED Medical Officer.

12.4 Placing an ‘Admit to Inpatient’ order/Admit event

Once the patient has been accepted for a SSU admission, the ED Nursing Navigator will create an “Admit to Inpatient” order within FirstNet.

An “Admit to Inpatient” order can only be placed once a diagnosis is captured by the ED Treating Medical Officer.

The “Admit to Inpatient” order must contain the following information:

o “Bed requirements” e.g. Short Stay

o the order’s date and time.

Once the “Admit to Inpatient” order is placed, the patient will then appear on the FirstNet TTH Bed Management Tracking List with an “Admit” event.

12.5 Capturing departure ready information

Once the patient has been accepted for admission and is ready to depart ED, the ED Navigator will activate the departure ready field through ‘Set Events’.


12.6 Capturing “ED to Inpatient Admission” information

Once the patient has been accepted for SSU admission the ED Nursing Navigator will capture the Admitting Team and Admitting Consultant information via the ED to Inpatient Admission Conversation in FirstNet.

The ED Nursing Navigator will update the comments section with the inpatient information (e.g. TESS Inpt 1716hrs).

12.7 SSU Admission on HBCIS

Once the ED Nursing Navigator updates the comments section with SSU inpt information (e.g. TESS Inpt 1716hrs) the ED AO will complete the HBCIS admission and will admit the patient to the TWAA location.

Once the HBCIS admission is complete the ED AO will update the comments section to include the prefix of a/ (e.g. a/TESS Inpt 1716hrs).

12.8 Adding ‘Bed Events’

The ED Nursing Navigator will use the Event function to document and update bed status according to the following:

o Bed Assigned event - once a SSU bed is available for the patient, the ED Nursing Navigator will add an Admit-Bed Assigned event

o Bed Not Ready event - if an SSU bed has been located for the patient, but is not ready for the patient, the ED Nursing Navigator will add an Admit-Bed Not Ready event

No Bed event - If there are no SSU beds available, the ED Nursing Navigator will add an Admit-No Bed event.

12.9 Capturing Delay information

If there are bed delays for the patient, the ED Nursing Navigator will capture delay information for the patient within the FirstNet ED Departure Conversation.

12.10 Physically departing ED to SSU location

The ED Nursing Navigator will complete the following information within the FirstNet ED Departure conversation:

o “Departure Status” field – i.e. “Admitted (excl. ED bed)”

o “ED In-Pt Ward (EDIP) Pt – “Yes”

o “Admitted Destination” – Short Stay

o “Admission Specialty”

o “EDIP Admit Date” – the date of departure from ED.

***The EDIP Admit Date and Time is what stops the NEAT clock for admitted

patients for reporting purposes.


***ED SSU patients do not have their actual departure time completed in FirstNet as this would close the Inpatient Encounter.

12.11 Allocating the patient to the SSU FirstNet location

When the patient is physically exiting ED to be taken to their SSU location, the ED Nursing Navigator or ED SSU Nursing Team Leader will update the patient’s location to the correct SSU bed location on the FirstNet Tracking screen.

12.12 Transferring the SSU patient on HBCIS

The SSU AO will also complete the patient transfer on HBCIS from TWAA to the bed location in SSU.


13 Assessment and Treatment within ED SSU

13.1 Overview

The PowerChart ieMR module provides access to the patient’s electronic medical record where the further clinical information can be documented by the ED Primary Treating SSU Nurse and the ED Treating SSU Doctor.

13.2 Documenting assessment and treatment activities – Nursing

The ED Primary Treating SSU Nurse will access the patient’s chart via PowerChart to complete any nursing documentation.

Refer to TTH Digital Release General Business Rules document.

13.3 Documenting assessment and treatment activities – Medical

The ED Treating SSU Doctor will continue to document individual progress notes.

Refer to TTH Digital Release General Business Rules document.


14 Discharge – ED SSU

14.1 Overview

Once the required healthcare services have been delivered and their inpatient episode of care is complete, the patient will depart from TTH SSU.

14.2 Preparing the patient to depart ED SSU

Prior departing the patient from ED SSU, the relevant ED Clinician must remove all outstanding pathology, radiology and patient care orders for the patient.

The ED Primary Treating SSU Nurse must document the removal of Peripheral IV Lines from the patient within the patient’s electronic medical record.

14.3 Capturing and printing a patient’s Statement of Attendance

The ED Treating Medical Officer will complete the patient’s Statement of Attendance prior to the patient departing ED SSU from within the FirstNet Tracking screen – through the “Depart Process’ icon.

The ED Treating Medical Officer must capture a working diagnosis for the patient. This information will be captured within the patient’s Statement of Attendance.

The ED Treating Medical Officer must print the patient’s Statement of Attendance and provide this to the patient.

14.4 Discharging the patient

The ED SSU AO will discharge the patient from ED SSU via HBCIS, once the patient has physically left SSU. This will also remove the patient from the FirstNet Tracking screen.

Note: SSU Nursing staff must not discharge ED SSU patients from FirstNet using the Depart Process.

The SSU patient can be placed in the exit location of FirstNet pending the HBCIS transfer removing them off the FirstNet Tracking List.


15 Transfer from ED SSU to Inpatient Ward

15.1 Overview

If an ED SSU patient is reviewed and is deemed to require further assessment and treatment, the patient will be accepted for admission to a TTH inpatient ward.

15.2 Placing a referral to an inpatient unit

The SSU Treating Medical Officer contacts the relevant inpatient team to organize referral and admission to an inpatient unit.

This information is documented in the patient’s ieMR as a progress note.

15.3 Contacting TTH Patient Flow Unit

Once an inpatient admission is confirmed the SSU Team Leader must notify the TTH Patient Flow Unit in order for them to organise the patient’s inpatient ward bed as per current business process.

15.4 Updating admission details in HBCIS

Once an inpatient admission is confirmed the SSU Admin Officer updates the new treating team details on HBCIS.

15.5 Updating FirstNet Comments screen with inpatient admission information

Once an inpatient admission is confirmed the SSU Team Leader will update the comments field of FirstNet to reflect the new inpatient information e.g. ‘SSU Inpt 1716hrs’ will be updated to ‘Surg Inpt 2135hrs.

No further information is required to be updated in FirstNet.

15.6 Locating and allocating an inpatient ward bed

The TTH Patient Flow Unit will continue to locate and allocate inpatient beds.

The SSU Team Leader will continue to liaise with the relevant Inpatient Ward Team Leader to identify an available inpatient bed.

Once a suitable inpatient bed has been located for the patient, the TTH Patient Flow Unit will notify the SSU Team Leader.


15.7 Transferring the patient

The receiving unit transfers the patient on HBCIS into the updated inpatient unit and bed number.

Once the HBCIS transfer has been processed, the patient will automatically be removed from the FirstNet Tracking screen.

The SSU patient can be placed in the exit location of FirstNet pending the HBCIS transfer removing them off the FirstNet Tracking List.


16 FirstNet Transfer – From ED SSU to ED Resuscitation/ED Acute

16.1 Overview

If a patient’s condition rapidly deteriorates while in ED SSU, the patient will be physically moved to either an ED Resuscitation or ED Acute location for further urgent treatment (see TTH ED Short Stay Guidelines).

16.2 Transferring the patient back to ED

The patient is reviewed by the ED SSU Medical Team and decision is made to transfer the patient back to ED.

The SSU Team Leader contacts the ED Navigator to organize transfer.

16.3 Conducting a patient clinical handover to ED nursing staff

A patient clinical handover will occur between SSU nursing staff and ED nursing staff as per current business process.

The patient’s ieMR Nursing Summary will be used to assist in SBAR handover, as well as any paper documents e.g. medication charts.

16.4 Updating HBCIS

The ED Admin officer will update the patient’s HBCIS location information.

Admitting details remain as the Short Stay Admitting Consultant (until taken over by an inpatient team) but the patient will be transferred into the TWAA location.

16.5 Updating FirstNet

Once the patient is transferred back to ED the patient is also moved on the FirstNet Tracking screen to accurately reflect their current location in ED.

16.6 Transferring a SSU admitted patient in ED to ward

If the SSU patient within ED is then required to be admitted and transferred to an inpatient unit, the ED Navigator is to follow the previous process xx ‘Transfer from ED SSU to Inpatient Ward’.


17 FirstNet Disaster Patients

17.1 Overview

Patients who have been involved in a mass casualty incident/disaster may present to the TTH ED for assessment and treatment. A Code Brown Response Activation will be triggered, alerting ED clinical staff to anticipate the arrival of such patients to the TTH.

It is imperative that an accurate and unique identification system is available to be implemented in order to manage multiple ED presentations during a Code Brown Response Activation.

Refer to the Code Brown Mass Casualty Registration and Documentation in the Emergency Department TTH Procedure Manual, THHS for more information.

17.2 Quick registering disaster patients

Multiple patients who are unable to be identified by ED Staff or an overwhelming number of presentations at the point of registration are to be allocated a ‘Disaster Name’ and a URN sourced from a dedicated code brown CEC (pre-numbered).

The first 200 Disaster Names (100 Male and 100 Female) have been allocated a URN and pre-registered within HBCIS.

Once a URN is used, it cannot be used again for future Code Brown activations.

Further URNs will need to be created in order to ensure there are at least 200 disaster URNs available for future Code Brown activations.

The ED Triage Nurse will search for and identify the pre-registered URN within FirstNet (the disaster URN is pre-recorded on a Code Brown CEC).

The ED Triage Nurse will “add emergency encounter” in order to complete the patient’s Quick Registration within FirstNet.

17.3 Completing the FirstNet Triage Assessment Form for disaster patients

The ED Triage Nurse must complete the following mandatory fields as part of the patient's Triage Assessment:


o Tracking acuity (ATS)

o Visit reason - this field must be populated with “Disaster”

Type of visit - this field must be populated with “Disaster”.


17.4 Using disaster charts

In a disaster, pre-made disaster charts will be used that are made up of the following contents:

o Medical Imaging Request form

o Pathology Request form

o ED Patient Worksheet

o ED Trauma record

o 3x armbands with blank labels

o Medication Chart

o Fluid Order Chart

o Continuation Notes

Preformatted UR labels


18 Downtime

18.1 Overview

With the implementation of FirstNet within TTH ED comes an increased reliance on technology to enable the management of patient clinical information.

The THHS ieMR Business Continuity Plan outlines the plan and approach to both planned and unplanned system downtimes of the ieMR – ensuring that staff can continue to care for patients with minimal disruption. Refer to the THHS ieMR Business Continuity Plan for further information.

18.2 Managing clinical information and functions during ieMR unplanned downtime

Physical whiteboards will be set up to track patients within the ED during the time of system downtime.

Paper-based clinical documentation forms will be used during an ieMR unplanned downtime.

The 724 Access terminals (with read-only access to the ieMR) located within ED can be unlocked and accessed via password if required.

18.3 Managing clinical information and functions during ieMR planned downtime

Planned ieMR/FirstNet system downtimes will most likely occur overnight.

During planned system downtimes, ED staff will revert to paper-based documentation. Paper-based documentation will be filed within the patient’s CEC.

The same rules outlined above for using the 724 Access terminals in ED will apply during an ieMR planned downtime.

The Downtime Kit will include the following resources:

o Paper-based forms (i.e. assessment/observation forms, acute observation forms, clinical/progress notes forms)

o Pathology request forms

o Radiology request forms

o Blank labels (used to label the patient’s paper-based forms)

o Blank patient identification wristbands (PPID).

A blank patient identification (PPID) wristband will be written on by the ED Triage Nurse to include the patient’s:

o Family name and given name

o TTH URN

o Alerts and allergies.


HBCIS must be used by ED staff to validate patient information, including next of kin information.

A blank label will be affixed to the patient’s specimen collection container/s. This will be written on by the ED Clinician with the patient’s UR, name, DOB, sex and date/time of the specimen collection. The patient’s specimen collection container/s and pathology request form will be placed into a specimen collection bag and sent to pathology.

Priority scanning will not occur if planned system downtime is less than 30 minutes. If planned system downtime is more than 30 minutes, priority scanning will occur.

Once FirstNet/ieMR becomes available after a system downtime, the following information must be retrospectively captured within FirstNet:

o Quick Registration

o Triage Assessment Form

o Admission information (Inpatient, Operating Theatre, ED SSU).

All paper-based clinical documentation must be labelled with the appropriate ieMR encounter label for the patient.

18.4 Planned and unplanned PASLink downtime

PASLink is the technology used to send the Quick Registration information captured by FirstNet to HBCIS.

ICT will need to notify ED Admin to provide notification that PASLink work is occurring and a downtime estimate prior to PASLink being taken offline.

If the PASLink technology is unavailable due to system downtimes or server upgrades, the following applies:

o The ED Triage Nurse will still complete a quick registration for the patient in FirstNet

If FirstNet has allocated a new URN to the patient, the ED AO must manually register the URN via HBCIS as soon as possible.

18.5 HBCIS Downtime

During HBCIS downtime, FirstNet will continue to allocate new URs from the 900000-949999 TTH URN range.

After HBCIS downtime the ED AO will retrospectively update patients in HBCIS as per normal registration process (see section Full Registration).