New Process Flowchart

VALLEY PRESBYTERIAN HOSPITAL

ED Redesign-Redesigned Process Map
October 31, 2014

ATC1 takes PT to ATC1 takes PT to ATC2 assembles

ATC1 shows EKG
EKG Room and ATC2 in ED2 with chart rooms PT and PT waits
strip to ED1 Doc
completes EKG stickers updates Tracker

YES ED2
(60%)

PT greeted by Does the PT Intake RN

Reg completes Reg prints stickers Does PT need an
Intake RN and need a Doc NO completes and NO ED1 or ED2?
Reception and bands PT EKG?
Registration immediately? documents Intake

CC, Vitals, Wgt.,

BP, Temp, Name, DOB ED1
Pulse Ox (40%)

ATC1 assembles chart-

beds PT (monitor/O2
YES ATC1 takes PT to
if clinically needed)- PT waits
ED1 Bed hands off to ED1 staff
ATC1 determines member
bed assignment
until one bed
available-then
check with Charge

PT taken to ED1 Intake Reg alerts RN completes

open bed or bed ED1 Reg of Reception of PT at
scramble occurs incoming PT bedside

Whoever answers
Reg Receives PT, Charge completes EKG competed on
Red phone phone verbally Ambo greeted by
prints labels and Intake and gurney if
answered communicates with Charge RN and Doc
bands PT documents appropriate
Charge RN and Doc

PAGE ONE
 New Process Flowchart
To Discharge
“A” Page 4
ARN and Provider
indicate exam
complete with flag
outside door as YES
visual cue
PT taken to
Provider writes
Assessment RN appropriate clinical
Does the PT Orders-enters Lab specimens
assesses PT, assigns Provider assesses Can PT be space as Treatment RN/Tech
NO need an ED1 NO PT waits Orders on WOW placed in Lab Bucket
ESI and documents PT Dispo’d? determined by fills Orders
Bed? outside Exam for transport to Lab
per clinical need Provider and Specimens walked
Expectation is that the Final Rooms
RN and Provider
Tracker updated Radiology Orders to Lab by ED staff
Registration can Room, Recliner,
Assessments will be print in Radiology- (EMT assumes
completed together be completed at Results Waiting, primary
Lab bar coded
when possible. this point Procedure Room labels print in ED responsibility

YES
ED2 provider calls ED1 Doc alerts ED2 Tech contacts Charge To Discharge
ED1 Doc to transfer Charge of incoming for bed assignment and or Admit
PT takes PT to ED1 with chart Page 4
PT

YES

Primary RN assesses Provider assesses

Lab specimens Radiology moves PT Results returned/
PT, assigns ESI and PT-indicates Provider writes Primary RN/Tech Can PT be
PT waits placed in Lab Bucket to and from- Wait for results Provider reviews
documents per Decision To Admit if Orders fills Orders Dispo’d?
for transport to Lab updates Tracker results
clinical need appropriate
Expectation is that the Final Registration can Specimens walked Updated Tracker
Radiology Orders Radiology has
RN and Provider be completed at this to Lab by ED staff Visual Cues for
print in Radiology-
Assessments will be point-Financials to be (EMT assumes ED Tracker in
completed together completed within 30 Lab bar coded
primary
Lab/Rad in NO
labels print in ED department
when possible. minutes responsibility progress/results

Provider reviews
results with PT

PAGE TWO
 Provider reviews
New Process Flowchart
NO
results with PT

Radiology moves PT Results returned/ To Discharge

Can PT be or Admit
to and from- Wait for results Provider reviews YES Page 4
Dispo’d?
updates Tracker results
Updated Tracker
Radiology has
Visual Cues for
ED Tracker in
Lab/Rad in
department
progress/results

PAGE THREE
 DISPO
New Process Flowchart
RN (Tx RN in ED2)
Provider puts chart RN separates paper
Provider writes D/C Provider prints D/C preps PT for D/C
in To Be D/C Rack chart-charge
Provider reviews Instructions and Instructions and (remove IV, D/C PT leaves (walked
DISCHARGE PT waits outside D/C Room sheets/sticker
results with PT change Status to Scripts and places in Vitals, D/C out/wheel chair)
(ED2) or D/C Rack sheets and places in
Ready D/C chart Teaching, paper
(ED1) appropriate bin
PT work)
taken to
private location
as necessary
(ED2) RN Charts PT Out,
documents D/C
Room/Tx Space
Assessment and
readied for next PT
PT taken to Departs PT from
private location Meditech
as necessary
(ED2)

Provider prints D/C Treatment RN preps

Provider writes Instructions and Treatment RN PT for D/C (D/C
Provider reviews PT walked to D/C PT leaves (walked
DISCHARGE “A” PT waits diagnosis specific Scripts, places in To confirms PT is Final Vitals, D/C
results with PT Room out/wheel chair)
D/C Instructions Be D/C Rack outside Reg’d Teaching, paper
D/C Rack work)

RN separates paper RN Charts PT Out,

chart-charge documents D/C
Room/Tx Space
sheets/sticker Assessment and
readied for next PT
sheets and places in Departs PT from
For Peds, bed
assignment occurs appropriate bin Meditech
directly between ED
and Peds Unit after
docs confer-30 MIN to
assignment

Provider indicates ED Provider hits Admitting Doc

Clerk pages Admitting Doc calls Orders completed
Decision To Admit Page Admitting Doc Advance Status in writes CPOE Orders Wait for Admitting
ADMIT Admitting Doc or Wait for call back back and Providers are automatically
in Meditech if not again if necessary Meditech indicating or ED Doc writes Orders
IPA as appropriate confer on Admit indicated on Tracker
already noted docs have conferred Bridge Orders
Follow-up in 15
minute increments- Admitting Doc has 30
after 45 minutes MIN to complete
admit to Hospitalist Orders

Clerk changes PT Bed Placement or Receiving Unit RN PT transported to unit Admitting changes
ED RN hits Advance by RN/Tech as
Status to Pending House Sup enter has 15 MIN to call ED RN gathers chart ED RN completes PT status to Admit
ED RN completes Status in Meditech appropriate-chart
Admit in Meditech- comment of bed Bed assigned ED RN with elements for Depart Screen Part in Meditech within
Triggers 10 MIN clock SBAR in Meditech changing PT to dropped off at NSG
availability In questions from transport One in Meditech Station to confirm PT
5 MIN of PT Status
to bed assigned Inpatient Status
Meditech Tracker SBAR arrival change
Expectation is that PT For ICU/PICU admits
is in the inpatient bed Primary ED RN
within 30 MIN transports

Charge completes
Room readied for PAGE FOUR
Depart Part 2 within
next PT (Cleaned/
5 MIN of PT
replace gurney)
indicated as Admit