Non-admitted patient emergency department service episode—clinical care commencement date, DDMMYYYY

Guide for use:

Emergency department non-admitted clinical care can be commenced by a doctor, nurse, mental health practitioner or other health professional, when investigation, care and/or treatment is provided in accordance with an established clinical pathway defined by the emergency department. Placement of a patient in a cubicle and observations taken to monitor a patient pending a clinical decision regarding commencement of a clinical pathway, do not constitute commencement.

Patients with an episode end status of 'Did not wait to be attended by a healthcare professional' should not have a clinical care commencement date, because by definition, they left before being attended by a health professional.

The following examples illustrate the commencement of emergency department non-admitted clinical care.

Example 1

• A patient presents at the emergency department with mild asthma. At triage, the patient is categorised as category three and returns to the waiting area.
  
• The patient has a more severe asthma attack in the waiting area, is re-triaged to category two and shown to a cubicle where standard observations are taken.
  
• A nurse comes to the cubicle and commences treatment based on an acknowledged clinical pathway of the emergency department. At this point: emergency department clinical care has commenced.

Example 2

• A patient presents at the emergency department in an agitated, delusional state. At triage, the patient is categorised as category two and placed in a cubicle and the mental health practitioner notified.
  
• Observations are taken and nursing staff continue to observe the patient.
  
• The mental health practitioner arrives, assesses the patient and develops a management plan. At this point: emergency department clinical care has commenced.

Example 3

• A patient presents at the emergency department with an ankle injury from football. At triage, the patient is categorised as category four and moved to the 'fast track area'.
  
• The physiotherapist attends, examines the patient, makes an assessment (including diagnostic imaging requirements) and determines a treatment plan. At this point: emergency department clinical care has commenced.

Example 4

• A patient presents at the emergency department with a sore arm, following a fall, with limited arm movement possible.
  
• The patient is categorised as category three at triage and placed in a cubicle.
  
• A nurse provides analgesia and assesses the patient, including ordering diagnostic imaging. At this point: emergency department clinical care has commenced.

Example 5

• A patient presents at the emergency department feeling vague and having been generally unwell for a day or two. The patient has a slight cough. At triage, the patient is categorised as category three.
  
• The patient is placed in a cubicle where standard observations are taken. Respiration is 26 bpm, BP is 90/60 and the patient is hypoxic. The patient is given oxygen, and the treating clinician attends and provides instruction regarding patient care. At this point: emergency department clinical care has commenced.

Example 6

• A patient presents at the emergency department with chest pain. Triage category two is allocated. The patient is placed in a cubicle and a nurse gives oxygen and Anginine, takes blood samples and conducts an ECG. The ECG is reviewed. At this point: emergency department clinical care has commenced.
  
• A doctor subsequently arrives and the patient is transferred to the catheter lab after examination.

Example 7

• The emergency department is notified by ambulance that a patient is being transported having severe behavioural problems.
  
• The patient is taken to an appropriate cubicle and restrained.
  
• A clinician administers sedation and requests the attendance of a mental health practitioner. At this point: emergency department clinical care has commenced.

  Context:
  Emergency Department care