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

Identifying and definitional attributes
Metadata item type:	Data Element
Short name:	Emergency department clinical care commencement time
METEOR identifier:	474118
Registration status:	Health, Superseded 19/11/2015 Independent Hospital Pricing Authority, Standard 01/11/2012 Tasmanian Health, Superseded 27/05/2020
Definition:	The time at which emergency department non-admitted clinical care commences, expressed as hhmm.
Context:	Emergency department care.
Data Element Concept:	Non-admitted patient emergency department service episode—clinical care commencement time

Value domain attributes
Representational attributes
Representation class:	Time
Data type:	Date/Time
Format:	hhmm
Maximum character length:	4
Source and reference attributes
Reference documents:	ISO 8601:2000 : Data elements and interchange formats - Information interchange - Representation of dates and times
Data element attributes
Collection and usage attributes
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 time, because they left before investigation, care and/or treatment was commenced by a health professional in accordance with an established clinical pathway defined by the emergency department. 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.
Collection methods:	Collected in conjunction with emergency department clinical care commencement date.
Source and reference attributes
Submitting organisation:	Australian Government Department of Health and Ageing
Relational attributes
Related metadata references:	Supersedes Non-admitted patient emergency department service episode—clinical care commencement time, hhmm Health, Superseded 30/01/2012 Supersedes Non-admitted patient emergency department service episode—service commencement time, hhmm Health, Superseded 30/01/2012 Has been superseded by Non-admitted patient emergency department service episode—clinical care commencement time, hhmm Health, Superseded 12/12/2018
Implementation in Data Set Specifications: All attributes +	Activity based funding: Emergency department care DSS 2013-2014 Independent Hospital Pricing Authority, Superseded 01/03/2013 DSS specific attributes + Implementation start date: 01/07/2013 Implementation end date: 30/06/2014 Conditional obligation: This data item is to be recorded if the patient has one of the following non-admitted patient emergency department service episode - episode end status values reported: 1 - Admitted to this hospital (either short stay unit, hospital in the home or non-emergency department hospital ward); 2 - Non-admitted patient emergency department service episode completed—departed without being admitted or referred to another hospital; 3 - Non-admitted patient emergency department service episode completed—referred to another hospital for admission; 5 - Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; 6 - Died in emergency department as a non-admitted patient; 7 - Dead on arrival, emergency department clinician certified the death of the patient. Emergency department care activity based funding DSS 2012-2013 Independent Hospital Pricing Authority, Superseded 31/10/2012 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Admitted to this hospital (either short stay unit, hospital in the home or non-emergency department hospital ward); Non-admitted patient emergency department service episode completed—departed without being admitted or referred to another hospital; Non-admitted patient emergency department service episode completed—referred to another hospital for admission; Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Died in emergency department as a non-admitted patient; Dead on arrival, emergency department clinician certified the death of the patient Non-admitted patient emergency department care DSS 2014-15 Health, Superseded 04/02/2015 DSS specific attributes + Implementation start date: 01/07/2014 Implementation end date: 30/06/2015 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Code 1 - Admitted to this hospital (either short stay unit, hospital-in-the-home or non-emergency department hospital ward); Code 2 - Non-admitted patient emergency department service episode completed - departed without being admitted or referred to another hospital; Code 3 - Non-admitted patient emergency department service episode completed - referred to another hospital for admission; Code 5 - Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Code 6 - Died in emergency department as a non-admitted patient; Code 7 - Dead on arrival, emergency department clinician certified the death of the patient. Non-admitted patient emergency department care DSS 2015-16 Health, Superseded 02/12/2015 DSS specific attributes + Implementation start date: 01/07/2015 Implementation end date: 30/06/2016 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Code 1 - Admitted to this hospital (either short stay unit, hospital-in-the-home or non-emergency department hospital ward); Code 2 - Non-admitted patient emergency department service episode completed - departed without being admitted or referred to another hospital; Code 3 - Non-admitted patient emergency department service episode completed - referred to another hospital for admission; Code 5 - Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Code 6 - Died in emergency department as a non-admitted patient; Code 7 - Dead on arrival, emergency department clinician certified the death of the patient. Non-admitted patient emergency department care NBEDS 2016-17 Health, Superseded 05/10/2016 DSS specific attributes + Implementation start date: 01/07/2016 Implementation end date: 30/06/2017 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Code 1 - Admitted to this hospital (either short stay unit, hospital-in-the-home or non-emergency department hospital ward); Code 2 - Non-admitted patient emergency department service episode completed - departed without being admitted or referred to another hospital; Code 3 - Non-admitted patient emergency department service episode completed - referred to another hospital for admission; Code 5 - Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Code 6 - Died in emergency department as a non-admitted patient; Code 7 - Dead on arrival, emergency department clinician certified the death of the patient. Non-admitted patient emergency department care NMDS 2012-13 Health, Superseded 07/02/2013 DSS specific attributes + Implementation start date: 01/07/2012 Implementation end date: 30/06/2013 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Admitted to this hospital (either short stay unit, hospital in the home or non-emergency department hospital ward); Non-admitted patient emergency department service episode completed—departed without being admitted or referred to another hospital; Non-admitted patient emergency department service episode completed—referred to another hospital for admission; Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Died in emergency department as a non-admitted patient; Dead on arrival, emergency department clinician certified the death of the patient. Non-admitted patient emergency department care NMDS 2013-14 Health, Superseded 11/04/2014 DSS specific attributes + Implementation start date: 01/07/2013 Implementation end date: 30/06/2014 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Admitted to this hospital (either short stay unit, hospital in the home or non-emergency department hospital ward); Non-admitted patient emergency department service episode completed—departed without being admitted or referred to another hospital; Non-admitted patient emergency department service episode completed—referred to another hospital for admission; Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Died in emergency department as a non-admitted patient; Dead on arrival, emergency department clinician certified the death of the patient. Non-admitted patient emergency department care NMDS 2014-15 Health, Superseded 13/11/2014 DSS specific attributes + Implementation start date: 01/07/2014 Implementation end date: 30/06/2015 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Code 1 - Admitted to this hospital (either short stay unit, hospital-in-the-home or non-emergency department hospital ward); Code 2 - Non-admitted patient emergency department service episode completed - departed without being admitted or referred to another hospital; Code 3 - Non-admitted patient emergency department service episode completed - referred to another hospital for admission; Code 5 - Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Code 6 - Died in emergency department as a non-admitted patient; Code 7 - Dead on arrival, emergency department clinician certified the death of the patient. Non-admitted patient emergency department care NMDS 2015-16 Health, Superseded 19/11/2015 DSS specific attributes + Implementation start date: 01/07/2015 Implementation end date: 30/06/2016 Conditional obligation: This data item is to be recorded if the patient has one of the following Episode end status values recorded: Code 1 - Admitted to this hospital (either short stay unit, hospital-in-the-home or non-emergency department hospital ward); Code 2 - Non-admitted patient emergency department service episode completed - departed without being admitted or referred to another hospital; Code 3 - Non-admitted patient emergency department service episode completed - referred to another hospital for admission; Code 5 - Left at own risk after being attended by a health care professional but before the non-admitted patient emergency department service episode was completed; Code 6 - Died in emergency department as a non-admitted patient; Code 7 - Dead on arrival, emergency department clinician certified the death of the patient.
Implementation in Indicators:	National Healthcare Agreement: PI 21b-Waiting times for emergency hospital care: Proportion completed within four hours, 2015 Health, Superseded 08/07/2016 National Healthcare Agreement: PI 21b–Waiting times for emergency hospital care: proportion of patients whose length of emergency department stay is less than or equal to four hours, 2016 Health, Superseded 04/08/2016 National Healthcare Agreement: PI 21b–Waiting times for emergency hospital care: proportion of patients whose length of emergency department stay is less than or equal to four hours, 2017 Health, Superseded 30/01/2018