Emergency service 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 service. 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 Emergency service stay—episode end status, code N of 'Did not wait to be attended by a healthcare professional' or 'Registered, advised of another health care service, and left the emergency service 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 service.

The following examples illustrate the commencement of emergency service clinical care.

Example 1

• A patient presents at the emergency service 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 service. At this point: emergency service clinical care has commenced.

Example 2

• A patient presents at the emergency service 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 service clinical care has commenced.

Example 3

• A patient presents at the emergency service 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 service clinical care has commenced.

Example 4

• A patient presents at the emergency service 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 service clinical care has commenced.

Example 5

• A patient presents at the emergency service 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 service clinical care has commenced.

Example 6

• A patient presents at the emergency service 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 service clinical care has commenced.

• A doctor subsequently arrives and the patient is transferred to the catheter lab after examination.

Example 7

• The emergency service 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 service clinical care has commenced.

Collected in conjunction with Emergency service stay—clinical care commencement time, hhmm.