[MEDITECH-L] Premature Admission from the ER causing issues in EDM/PD

[Mike Moran]

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[Michele Banks]

We typically convert the REG ER account to a ADM IN or ADM INo account when either the patient is physically on the floor OR if the patient will be "waiting" in the ER for a bed then they are assigned to a "virtual" inpatient location and the account is converted to ADM IN or ADM INo. Either way the patient is not departed from er (DEP ER) until they are physically on the inpatient floor

-----Original Message-----
From: meditech-...@mtusers.com [mailto:meditech-...@mtusers.com] On Behalf Of Mike Moran
Sent: Monday, December 22, 2008 8:25 AM
To: medit...@mtusers.com
Subject: [MEDITECH-L] Premature Admission from the ER causing issues in EDM/PD

Hello Meditech L and Merry Christmas to all!!

We are a magic 5.62 hospital utilizing EDM, RXM and PDoc in our ER. We are experiencing issues when registration prematurely admits patients who will still be receiving treatment in the Emergency Department. Our nursing staff has always been trained to request the inpatient bed as soon as the decision is made to admit the patient (as there is usually a good competition for beds on the inpatient side). This process has worked quite well for years until EDM, RXM and (especially) Physician Documentation was implemented.

Admitting a patient early in this manner, changing the patient's registration status from REG ER to ADM IN, while the patient is still be documented/treated in the ER is causing at least 3 major problems:

1) Any automated charges from EDM (i.e. Nebulizer treatments, Point of
care testing) will REJECT in BAR due to an invalid Service Date as the patient is admitted and the Service Date converts to an Admit Date

2) Any At-Home Medication added in RXM after the patient is admitted
will NOT be reflected on the EDM Summary either in EDM or in PCI as the change to ADM IN causes the Summary to "lock out" additional data from flowing to the Summary report.

3) Formatted data set up to pull into the physician documentation
templates will stop refreshing once the patient's registration status changes to ADM IN. This can cause an issue with incomplete documentation where the results a physician expects to have automatically pull into the report will never show up. The patient's registration status change to ADM IN stops results from flowing back into the template (even if it is still at Draft status).

We have had long conversations with Meditech about these issues and they are aware that this is a problem in a busy ER setting where competition for inpatient rooms is great. They have agreed to code fixes for these issues so data will continue to update until the patient reaches the final status event in EDM. We would like to avoid spending a great amount of money on these fixes (as they assure me these issues will be resolved when we upgrade to 5.63).

Now, I have to convince the registration department and the Emergency Department nursing/physician staff to stop admitting patients to the inpatient side until all of the results for that patient (ordered by the ER
physician) have been resulted and the physician signs off that she/he is done and no longer treating. Have any of you out there gone through a process/patient flow change similar to this?

I am doing my best to convince this ER to change their process but it seems as if no matter how often they are reminded of these HUGE issues, they continue to fall back on registering patients as inpatients hours before they are done being treated in the ER.

Any advice, stories, suggestions will be greatly appreciated!!! Thank you so much and Merry Christmas again!! - Mike

Michael T. Moran

Applications Analyst

Morton Hospital and Medical Center

88 Washington Street

Taunton, MA 02780

(508)828-7559

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Cook Children's Health Care System

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[Michele Banks]

I guess C/S is different. In EDM, our staff can still document in EDM even if the patient is in a ADM IN or ADM INo. The patient is converted from REG ER to ADM IN, however they are not departed from the ER so we are still able to document, order etc.. from the EDM tracker. Now, we are still performing nursing acuity on paper however our respiratory document/charge from EDM assessments. When we convert our patients to ADM IN, we assign them to a "fake" inpatient location that is built in MIS since they are still "physically" in the ED.

-----Original Message-----
From: Lisee, Jan [mailto:JLi...@fmh.org]
Sent: Monday, December 22, 2008 2:37 PM
To: Michele Banks
Subject: RE: [MEDITECH-L] Premature Admission from the ER causing issuesin EDM/PD

We convert the ED acct to the inpatient acct.. So they can not be in
both places at once.. Our ED staff want to get acuity credit if they
are still caring for them.. So they do not want us to admit them....
We are planning to have hospitalists do online ordering next
spring/summer... And this is a big issue now and will be a BIGGER issue
later..

Janice B Lisee RNC, BSN
Senior Systems Analyst
Frederick Memorial Hospital
240-566-3437
<mailto:jli...@fmh.org>