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Emergency Department (ED)

Run the emergency department from a live board: register arrivals, triage by acuity with vitals, treat with orders and notes, and record disposition — with wait‑time breach flags and abnormal‑vitals alerts against ESI targets.

Screenshot: Emergency board — TODO

Emergency Board

Medical → Emergency (/medical/emergency) is a real‑time board of all active ED patients, ordered by acuity, with KPIs: Active, Waiting, In Treatment, High Acuity. It refreshes incrementally, and rows past their target door‑to‑provider time are flagged as breaches — a breach raises an escalation alert. ED zones/beds (/medical/emergency/zones) define the physical spaces a patient can be placed in.

The ED visit flow

Medical → Emergency → Visits (/medical/emergency/visits) drives each patient through:

  1. Register arrival — patient, arrival time, arrival mode (Walk‑in, Ambulance, Referral, Police/Medico‑legal, Other), chief complaint, location → status Waiting. An EMERGENCY encounter is opened automatically, and an emergency ticket charge is raised so the visit is forwarded to the billing counter. Care is never blocked on payment — triage, treatment, tests and emergency medicines proceed immediately; the counter marks Billing cleared when settled (a red Billing pending badge shows until then).
  2. Triage — record structured vitals (BP, pulse, resp rate, SpO₂, temperature) — out‑of‑range values are flagged and can raise an abnormal‑vitals alert — and assign an ESI level (target door‑to‑provider time):
  3. ESI‑1 Resuscitation — 0 min · ESI‑2 Emergent — 10 min · ESI‑3 Urgent — 30 min · ESI‑4 Less Urgent — 60 min · ESI‑5 Non‑Urgent — 120 min → status Triaged.
  4. Start Treatment — assign attending provider and location → In Treatment. From the visit you can place ED orders (labs/imaging) and write an ED clinical note, and the system prompts a timed reassessment based on acuity.
  5. Move to Observation (optional) → Observation.
  6. Disposition — Discharged Home, Admitted (IPD), Transferred Out, Referred, Observation Unit, LWBS (left without being seen), LAMA (left against medical advice), or Deceased → Dispositioned (leaves the board). A Discharged disposition can auto‑create a follow‑up appointment.
  7. Referred captures the target facility, department, reason and transport mode, and prints a referral slip on the government masthead.
  8. Deceased captures a death declaration (time and cause of death, certifying clinician) and automatically opens a mortuary record — flagged medico‑legal when the arrival mode was Police/Medico‑legal.

A timeline panel shows Arrived → Triaged → Treatment → Dispositioned with timestamps. A visit can be Cancelled any time before disposition.

Unidentified patients

An unconscious, unaccompanied patient with no documents can be registered immediately, without any demographics. On Register arrival, set Who is arriving? to Unidentified patient; the patient picker is replaced by what can actually be observed:

  • Apparent gender (Unknown is a valid answer) and an estimated age — both required. The estimated age is what the record's date of birth is derived from, and the record remembers that the date is an estimate rather than a stated fact.
  • Distinguishing details (optional) — "brought by ambulance from Kalanki, tattoo on left forearm". This is what tells two simultaneous unknowns apart at the bedside.

A provisional patient record is created and the visit proceeds exactly as normal: triage, orders, medicines, notes and disposition all work. The record is shown everywhere as [PROVISIONAL] Unknown male, approx 40s — it stays selectable in clinical pickers (you must be able to order bloods for the patient in bay 3) but can never be mistaken for a real name.

What a provisional record deliberately does not do

It is not counted as a new registration in the HMIS master register or the new-registration indicator until its identity is confirmed — a placeholder must never enter a statutory return. The ED register (HMIS 8.3) still counts the visit, because the visit really happened. No patient portal invitation is created either; there is nobody to invite yet.

Resolving the identity

When the patient is identified — family arrives, an ID is recovered — open the visit and click Resolve identity. There are two paths, and picking the right one matters:

Situation Action What happens
The patient was never registered here before Confirm Identity Real name, gender, date of birth and contact are written onto the same record. It keeps its MRN and its entire clinical history. Nothing moves. Prefer this whenever it applies.
The patient already has a record Merge Records Every encounter, order, result, note, vital, charge and invoice recorded under the provisional MRN is re-pointed onto the existing patient, and the provisional record becomes a tombstone.

The merge asks for a reason (at least 10 characters — "Brother identified patient at 14:20, citizenship certificate produced") and an explicit confirmation tick, because it cannot be undone from this screen. It is recorded permanently, with a count of exactly how many records moved from which tables.

What the merge guarantees:

  • Nothing clinical is left behind — including cancelled or deleted records, which still belong to the patient and remain retrievable.
  • The surviving record wins any disagreement. A blood group typed during resuscitation is carried across only if the existing record has none; it never overwrites one. A death declared under the provisional identity is carried across.
  • Only a provisional record can be merged, and only into a confirmed one — you cannot merge two real patients, and the destination list never offers another unidentified record.

Order sets & FHIR export

  • Order‑set templates let a clinician apply a pre‑defined bundle of labs/imaging in one step for common presentations, rather than ordering each item.
  • An ED encounter can be exported as a FHIR R5 Encounter for interchange.

Admit creates the IPD record

Choosing Admitted (IPD) at disposition starts an inpatient admission — no re-registration needed.