Download ICD-10 Impact on ED Patient Flow

ICD-10 Impact on the ED Process Flow
Catholic Health East performed a gap analysis to determine what processes and workflows would be disrupted by the ICD-10 conversion. For
instance, the following analysis evaluates risk in the ED process flow.
Impact Ranking Level Definitions
Minor Impact (Green)
Potential for little or no
measurable impact to cost
and/or schedule of the project
Medium Impact (Yellow)
Potential for moderate cost
and/or schedule increases to
the project
High Impact (Red)
Potential for significant cost
and/or schedule increases to
the project
Risk Ranking Level Definitions
Minor Impact (Green)
Potential for minimal or
routine modifications to the
process
Medium Impact (Yellow)
Potential for moderate
modifications to the process
High Impact (Red)
Potential for significant
modifications to the process
(work disruption)
Cost Ranking Level Definitions
Minor Impact (Green)
No Costs
Medium Impact (Yellow)
Cost between $1 and $1,000
High Impact (Red)
Cost > $1,000
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Overall Process Rank for
Emergency Department (ED) Patient Flow:
High (Red Level)
Process Flow
Pre-Arrival Patient
Patient Arrival
Department
Function
ICD-10
Impact?
Impact
Risk
Cost
Medium
Medium
Minor
Yes
Medium
Medium
Medium
Yes
High
Medium
High
Nursing
Receives phone call from sending party—
nursing home, other acute facility, EMS
Yes
Nursing
Plans patient location: room set-up
No
Nursing
Patient arrives and is placed in bay
-Triage assessment performed, including
triage level on triage form.
-Med reconciliation initiated – complete
home med history form
-Notifies physician orally of high-priority
patient to be seen
ED Registration
Receives triage form from nursing, patient
registered from triage form data and bedside
interview.
-Patient signature(s) obtained
-Documents scanned into document
repository
-Labels and armband printed and placed on
patient
Nursing
Initiates order entry
- All orders are STAT one time
-Protocol orders
2
-Convenience order sets
ED Physician
Checks board for next patient to be seen
based on triage level
No
ED Physician
Reviews home med history form
No
ED Physician
Writes orders on preprinted order set form or
blank order form.
No
-Red sticker on chart to indicate orders to be
entered into health information system (HIS)
Unit Clerk
Enters diagnostic orders into HIS based on
physician order sheet
Yes
High
Medium
High
Medium
Medium
Medium
-Lab, radiology, respiratory, cardiology
-Lab labels (yellow) print from laboratory
information system when order placed in the
HIS
-Physician consults: entered in the HIS and
phone call to physician for notification of
consult
-Social services, pastoral care: orders
communicated to departments by phone call,
not entered in the HIS
Nursing
Performs labs, EKGs, and respiratory tests
as ordered
No
Nursing
Med orders
Yes
- Medications pulled from the medication
management system and ED chart used for
3
charting
- Medications not in the medication
management system require med order form
to be sent to pharmacy via the automated
medication management system for
pharmacy to dispense
Radiology
CT scans
Yes
Medium
Low
Medium
- .Faxes “stat reading” results to ED
Ultrasound – Results placed on ED chart
ED Physician
First reading of X-rays
Yes
Medium
Low
Medium
ED Physician
Evaluates patient, results, and observations
Yes
High
Medium
High
Determines patient disposition:
-Patient to be released from ED
-Patient admitted for inpatient care (main
hospital or St. James)
-Patient admitted to observation
-Patient transferred to another facility
-Patient transferred to cath lab
-Patient transferred to surgery
Transfer to Cath Lab
Nursing
Call “Code 90” upon arrival
No
-Code 90 alerts cardiology and other team
members of patient needing cath lab
4
services.
-Code 90 must be completed within 90
minutes.
Cardiology
Physician
Evaluates patient for disposition
Yes
High
Medium
High
-Move to cath lab
-Remain in ED
Nursing
Notifies admissions to transfer patient to cath
lab
No
Admissions
Upgrades ED registration to active inpatient
Yes
High
Medium
High
High
Medium
High
-Place patient in bed
Transfer to Surgery
Surgeon
Notifies OR of need to schedule patient for
surgery
Yes
Surgery
Notifies ED to transfer patient to surgical
area
No
Nursing
Notifies admissions to transfer patient to OR
No
Admissions
Upgrades ED registration to active inpatient
Yes
High
Medium
High
Yes
Medium
Medium
Medium
-Place patient in bed
Transfer to
Observation Service
Nursing
Notifies admissions to transfer patient to
observation service
- Fax admit order sheet
5
Admissions
Revises ET registration to observation (OBV)
hospital service code and patient type = 0
No
-Assigns patient to bed: Observation patients
can be assigned to unoccupied beds on the
nursing floor, express admission unit, or ED
overflow bed
Unit Clerk
Converts patient chart from blue to red/white
chart
No
Nursing
Records hourly status updates on
observation flowsheet
No
-If patient reaches 20 hours of observation,
nursing contacts physician to determine
disposition
Physician
Determines patient disposition
Yes
High
Medium
High
Yes
High
Medium
High
Yes
Medium
Medium
Medium
Yes
Medium
Low
Medium
-Release patient
-Admit patient as inpatient
Admit Patient to Active
Inpatient
Patient Released from
ED
Nursing
Provides discharge instructions to patient
-Instructions for ED patients generated from
the ED electronic health record
-Instructions for ED/observation patients use
hospital manual form
ED Physician
Completes med reconciliation form and
provides to patient
6
-Prescriptions provided to patient (if needed)
ED Charge Entry
(Billing)
Nursing
Provides copy of ED forms to ED billing
Yes
Medium
Medium
Medium
Nursing
Updates ED log for patient release
No
ED Registration
Upgrades ED registration
Yes
High
Medium
High
ED Billing
Abstracts chart to identify
procedures/supplies for ED services
Yes
High
High
High
ED Billing
Selects procedures from ED screens
Yes
High
High
High
-Procedures have weighted value
-Values calculated to determine final Level of
care
-Level of care total linked to appropriate
charge code (CDM)
-Supply charges entered in the HIS
ED
Diagnosis/Procedure
Coding
ED Billing
Sends copy of ED form to medical records
Yes
Medium
Medium
Medium
Medical Records
Enters diagnosis/procedure codes
Yes
High
High
High
Source: Catholic Health East.
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