Non-admitted patient emergency department service episode—service commencement time, hhmm

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• Health, Superseded 30/01/2012

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An Emergency Department service event 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. 

The following examples illustrate the commencement of an Emergency Department service event.

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 service event 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 service event 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 service event 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 service event 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 service event 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 service event 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 service event has commenced.

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