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' or 'Registered, advised of another health care service, and left the emergency department without being attended by a health care professional' should not have a clinical care commencement date, 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, blood pressure 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 electrocardiogram (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.
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