Accident and Emergency Procedure
Version:Version 3.0 / Issue Date:
4th May 2004
Responsible Person:
Elin Williams
Assistant General Manager for Emergency Care / Review Date:
4th May 2005
DO NOT USE THIS PROCEDURE AFTER THE REVIEW DATE
Contents
1Introduction
1.2Purpose
2General Procedure
2.1Unknown Patients
2.2Patients brought in by Ambulance
2.3See and Treat
2.4Locating a patient on the PAS
2.5Overseas Patient
2.6Multiple/Duplicate/Old Prefix records on the PAS
2.7Updating Patient Details on the PAS
3Booking in Patients
3.1Patient Type
3.2Booking in Review Patients
3.3Booking in Minor Operations (Crawley)
3.4Booking in Lodged Patients (East Surrey & Crawley)
3.5Booking in New Attendances
(that have not previously attended the Trust)
3.6Booking in New Attendances (that have previously attended the trust)
3.7Booking in A&E Unplanned Follow Up Attendance
3.8Recording Patients Attendance
3.9Road Traffic Accident (RTA)
3.10Disposing of Casualty Cards
3.11Casualty Cards Administration
3.12Filing Casualty Cards
3.13Medical Assessment Unit (MAU)
4Admitting Patients
4.1Admitting a Patient to A&E Department
4.2Transferring Patient to Ward within the Trust
4.3Discharging a patient from the A&E Department
4.4Transferring Patient to another Trust
5Patient Referral Requests
5.1Dealing with Referral Requests
5.2Booking Outpatient Appointments
5.3End of day for review and Minor Ops
6Case-Notes
6.1Tracking Case-notes
6.2Case-note numbering
6.3Case-note structure
6.4Making up Case-notes for new patients
6.5Temporary Case-notes
6.6Transporting Case-notes
7Security and Confidentiality
7.1Requests for Information
8Deceased Patients
8.1Patients that are Dead on Arrival to A&E
8.2Patients who die in A & E
9Contacts
10Managers Procedures
10.1Sample Checking
10.2Dealing with Data Quality Reports
10.3Completeness Report
10.4Case Note Tracking
11Appendices
11.1Appendix 1 - Highlighting Possible Duplicates/Multiples/Old Prefix’s Memo
11.2Appendix 2 – Patient Update Details Form
11.3Appendix 3 - Application for Additional GP’s on the PAS
11.4Appendix 4 – Recoding Patients Ethnic Category
11.5Appendix 5 – Doctors Names and Identification Codes
11.6Appendix 6 - ‘Non Urgent Case-note to be called’
11.7Appendix 7 – Fracture Appointment List (Example)
11.8Appendix 8 - Review Clinic Appointment List (Example)
11.9Appendix 9 - Case-note Tracking Slip
11.10Appendix 10 – Request for Personal Information
11.11Appendix 11 – Casualty card Sample Checking Sheets
Written By:
Elin Williams – Assistant General Manager for Emergency Care
Julie Reid – A&E Team Leader
Jackie Standford – A&E Receptionist
Lyndee Peters – Data Quality Manager
Nicola Gould – Data Accreditation Facilitator
1Introduction
1.1.1The Accident and Emergency Department provides care to patients who arrive following an accident or with an emergency medical condition. In the case of serious injury or accident, the treatment offered by the department will consist of vital resuscitation or other essential care before the patient is admitted to a hospital bed.
1.1.2Patients’ either refer themselves to the Accident and Emergency Department or have been seen by their GP (General Practitioner) first. In the latter case, the department is used as the admission point for pre-arranged admissions, which are emergency admissions. If these admissions go straight to a ward, they should not be counted as lodged patients. If these admissions remain in the nursing care of the Accident and Emergency (A&E) department, they are accommodated as lodged patients from the time of arrival until a bed on a ward is available. Such patients occupy space and require nursing attention, and information about them is needed for assessing the quality of care and the workload of staff in the A&E department.
1.1.3Each patient attending an A&E department will have a casualty card. The casualty card is a paper record of any treatments and procedures undertaken by medical staff whist the patient is in the A&E department, it also contains the patients demographic details and discharge/admission details.
1.2Purpose
1.2.1The purpose of this procedure is to give detailed instructions on how to process patients who come into the Accident & Emergency Department on the Patient Administration System (PAS).
1.2.2The purpose of this procedure is to give detailed instructions on how to ensure that the Trust’s Emergency care information is accurate, up-to-date and complete. This procedure document also provides detailed instructions on how to process the patient on the PAS within the A&E function of the PAS.
1.2.3This procedure is written to provide staff guidance when using the Inpatient function of the PAS. Staff should also refer to the PAS Training Manuals for:
- Master Patient Index
- Case-note Tracking
- Discharges and Transfers
- Admissions for Inpatients
- PAS Codes and Key Strokes Booklet
- Outpatient Booking
- A&E
2General Procedure
2.1Unknown Patients
2.1.1For patients where the date of birth is not known, a universal temporary date of birth must be entered – 08/08/1888. A temporary case-note number will be automatically created.
The temporary case-note number is a seven digit number i.e. 0000001, 0000002 etc.
Note: If the universal temporary date of birth is entered, further information about the patient must be entered as soon as possible, in particular the patient’s correct date of birth must be entered.
Note: Every effort should be made to identify the patient by checking belongings, checking with police if they accompanied the patient etc. before the patient is registered.
2.1.2As soon as the patient’s details are known, the PAS must be updated with the correct details. A search for the patient must be undertaken. Even when it is thought the patient has been found the search must continue to check for duplicates and then pick up the right case note number.
2.1.3If the patient is found to already be on the PAS this will mean a duplicate record has been produced, medical records must be informed that there is a duplicate registration on the PAS (Appendix 1).
2.2Patients brought in by Ambulance
2.2.1Details of patients who arrive by ambulance are contained within the ‘Ambulance Sheet’ this will have been completed by the ambulance crew and must be passed to the A&E reception staff.
2.2.2The patient is booked in as per the instructions starting at section 2.4Locating a Patient on the PASusing the information from the ‘Ambulance Sheet’ and any additional information from the Ambulance Personnel.
2.2.3When a patient arrives by ambulance and is taken straight into the ASU (Ambulatory Specialty Unit), a front sheet must be produced by reception staff and passed to the ASU to attach to the casualty card.
Note: Any discrepancies/missing data must be confirmed with the patient or relative at the earliest opportunity.
2.3See and Treat
2.3.1Once a patient has been booked onto the PAS, the trust operates a new system. Each patient will be seen by a senior nurse in the A&E reception area to assess the patient’s condition.
2.3.2When the senior nurse has assessed the patient’s condition, the nurse will direct the patient to the most appropriate area for treatment.
2.3.3Resuscitation patients or children are treated immediately and do not need to be assessed by the senior nurse.
2.4Locating a patient on the PAS
Enter Unit No, name, ‘=’ for current – at this prompt enter the patient’s case-note number, or search for the patient.
2.4.1To locate a patient on the PAS, the following steps must be followed:
2.4.2First Attempt: enter the patient’s case-note number if known, press return.
2.4.3Second Attempt: enter the patient’s Surname, followed by a comma, followed by only the first 3 letters of the first name, press return.
Example:smith,alb (Searching for Smith, Albert)
2.4.4Third Attempt: if the patient has not been found on the first search, search again using the patient’s date of birth only, press return.
Example:&12011965 (Searching for patients born 12/01/1965)
Note: The PAS will search two years either side of this date, retaining the same day and month. Patients with exactly the same date of birth as that entered will be displayed first (highlighted), followed by those either side of the year (starting with the earliest first).
Note: In general, do not be too specific with the search criteria, as this will potentially exclude patients from the selection list.
Note: The main reasons for duplicate patient records on the PAS are:
- When Crawley and East Surrey PAS were merged
- Poor searches for the patient on the PAS
- Patient has got married/divorced
- Patient has two names i.e. Joseph James and uses second name
- New born baby registrations, where the child could be on the PAS under either mothers or fathers surname
2.4.5All staff must ensure that they DO NOT add a patient unless it is absolutely certain that the patient is not already on the PAS.
Note: In most cases, it is very likely that the patient will have been treated at the Trust previously, so will have a record on the PAS.
2.5Overseas Patient
2.5.1Overseas Patient - Any person who has not resided in this country for a continuous twelve months.
2.5.2All patients must be asked, where possible, when they present themselves at the Trust, if they have resided in this country for longer than 12 months.
2.5.3Any overseas patients must be clearly identified, this is done by placing an ‘Overseas patient sticker’ in the top right corner of the casualty card. Overseas patient stickers are available from the Income Recovery Manager.
2.5.4Emergency care is free to all people, regardless of where they live. If an overseas patient is seen in A&E, the front of the casualty card must be photocopied and sent to the Income Manager, Maple House, East Surrey Hospital.
2.5.5If a decision to admit an overseas patient is made, within working hours (9am - 5pm Monday - Friday) the Income Recover Manager must be contacted on extension 1702.
2.5.6If no-one answers the telephone or it is outside of office hours, a message must be left on the answerphone, stating the ward the patient is being admitted and the patient’s case-note number.
2.5.7The Income Recovery Manager will inform the overseas patient that they could be charged for their treatment.
2.6Multiple/Duplicate/Old Prefix records on the PAS
2.6.1If when searching the Master Patient Index (MPI) for a patient and the PAS displays either a:
2.6.2Multiple Patient Record - more than one case-note with different prefix’s i.e. A, B, E, K, S, F, X, new trust number.
Note: In these circumstances record the attendance against the record that is located in the same area as the patients’ address.
2.6.3Duplicate Record - more than one record for a patient on the PAS system are identified.
Note: In these circumstances record the attendance against the record with the most recent activity.
2.6.4Old Case-note prefix number - these are case-notes that are prefixed by K, S, F or X on the PAS.
Note: These numbers are only to be selected if there are no other records on the PAS.
2.6.5A patient is identified as having duplicate records, multiple entries or a record with an old prefix, either when the patient search was undertaken or, if the patient was registered as ‘Unknown’ and later found to have attended the Trust on a previous date.
2.6.6To highlight this to Medical Records a front sheet for each of the entries must be printed off and attached together with a covering memo (Appendix 1) and then sent to the Medical Records Manager at the appropriate site.
2.7Updating Patient Details on the PAS
2.7.1Staff must ensure that they update patient details on the PAS as soon as possible.
2.7.2This will ensure that the PAS contains the most up to date information.
2.7.3Therefore, when checking case-notes against the PAS, staff would take the information that is on the PAS as the correct information, and should check with the patient before changing any details on the PAS.
Example: Patient has been sent an Outpatient appointment letter to their old address, the patient has telephoned the Trust to inform them of a change of address, but the old address is still detailed in the case-notes.
3Booking in Patients
3.1Patient Type
3.1.1Each patient that arrives at the A&E department will fall into one of the following categories:
- Review Appointment – section 3.2 Booking in Review Patients
- Minor Operation Appointment - section 3.3 Booking in Minor Operations
- Patient sent by their GP –section 3.4 Booking in Lodged Patients
- Patient with a new complaint - this can be broken down into:
- 3.5 Booking in NewAttendances (patients that have not previously attended the Trust.
- 3.6 Booking in New Attendances(patients that have previously attended the Trust).
3.2Booking in Review Patients
3.2.1Definition: Review Appointment – When a patient is treated in A&E, the patient may be asked to return at a later date, so the treatment they received can be monitored.
Note: A review appointment will either be booked or the patient is asked to attend A&E at a later date (e.g. to return in a couple of days) for follow up treatment.
3.2.2A patient can turn up for their treatment to be reviewed at a different A&E department from the one they were originally treated at. When this happens the patient must be booked in as a new appointment. The PAS does not allow the patient details to be updated or corrected.
3.2.3If any of the patient details need to be updated/corrected the A&E receptionist must complete to ‘Update Patient Details’ form (Appendix 2) and send the form to the A&E department that originally treated the patient.
3.2.4For all booked review appointments, the patient’s casualty cards should be pulled the day before the appointment using the appointment list sheet.
3.2.5Once the casualty cards have been pulled they should be placed ready for the patient’s appointment.
3.2.6When the patient arrives at A&E they may have an appointment card, the patient must be asked the following details:
- Name
- Date of Birth
3.2.7Once the patient’s details have been provided either collect or pull the patient’s casualty card.
3.2.8Using the details on the casualty card confirm with the patient their details (e.g. name, address, date of birth etc) to ensure the correct card has been selected.
Note: The reception staff must ask the patient for their details rather than asking them to confirm the details on the casualty card.
Select menu ‘A&E Follow Up Attendance’, press return.
The PAS will display a message ‘Enter A&E number or ’M’ for MPI search’. If the patient’s A&E number is known, type it in, press return. If the patient’s A&E number is not known, type ‘M’, press return.
Locate the patient on the PAS; using the search criteria outlined in section 2.4 Locating Patients on the PAS System.
3.2.9Once the patient’s details have been found on the PAS any A&E attendances for this patient will be listed. Select the last A&E attendance that matches the casualty card and record the new attendance as follows:
Screen 1
- Arrival Date – enter the date the patient arrived at the hospital, press return.
- ArrivalTime – enter the time the patient arrived at the hospital, press return.
- Planned Visit – type ‘Y’, press return. This is always completed ‘Yes’ as the patient has a pre-booked appointment
- Triage Priority – type ‘-‘ to display the drop down list, select, ‘Review Clinic’, press return.
- New Patientlocation – type ‘-‘ to display the drop down list, select, ‘Waiting Room’, press return
PAS will display a message ‘Accept this screen? Y/N’, type ‘Y’ or ‘N’, press return as appropriate.
3.2.10AS will display a message ‘Print Labels (L) A&E Sheet (S) Both (B) or None (N)’, type ‘S’, press returnto print a front sheet for the casualty card.
3.2.11A new front sheet will be produced (White for Adults, Yellow for Children) and attached to the previous casualty card.
3.2.12The casualty card is then passed to the Review Clinic Nurse along with any x-rays.
3.2.13At Horsham, the front of the casualty card is stamped with the Follow up stamp. The time the patient arrived is written in the appropriate box.
3.3Booking in Minor Operations (Crawley)
3.3.1A list of arranged appointments for minor operations is supplied to the A&E reception on the day of the clinic along with the case-notes for these patients. Case-notes for these patients are pulled by Medical Records Department.
3.3.2When patients arrive at A&E reception, they must be manually marked on the appointment list and the case-notes for the patient should be passed to the Minor Operations Nurse.
Note: A label from the patient’s case-notes should be placed on the minor operations checklist.
Note: East Surrey do not run Minor Operations, any minor operations are dealt with by the Appointments Office and seen at the DTC (Diagnostic Treatment Centre). Horsham do not run Minor Operations, any minor operations are dealt with as a Review Appointment under Mr Mabrook’s clinic.
3.4Booking in Lodged Patients (East Surrey & Crawley)
3.4.1Lodged patients – These are patients that have been to their GP. The GP will have contacted the hospital and arranged for the patient to be seen as an emergency by a specialty. The GP should write a letter referring the patient to the relevant specialty. The patients then arrive at hospital via the A&E department.
3.4.2The ‘white board’ within the A&E Department should have a list of the patients that are expected by the various specialties, this can be checked when a patient arrives and does not have a referral letter from their GP.
3.4.3All lodged patients that have attended the Trust before must have their case-notes requested from the Medical Records Department.
Note: If the patient’s set of case-notes are not available (e.g. at the off site storage) and case-notes are required, a ‘Temporary Set’ must be made up see section 6.5 Temporary Case-notes.
3.4.4If the patient was not located on the PAS, go to section 3.5 Booking in New Attendances (that have not previously attended the Trust).
3.4.5If the patient was located on the PAS, go to section 3.6 Booking in New Attendances (that have previously attended the trust).
3.4.6The nursing staff must inform the relevant specialty that the patient has arrived in A&E.
3.5Booking in New Attendances
(that have not previously attended the Trust)
3.5.1If the patient is not on the PAS, the patient must be registered on the PAS, the following details must be recorded:
Screen 1
- Surname
- Christian name
- Title
- Sex
- Birth Date
- Registered GP - If the indicated GP is not on the PAS enter ‘9995’ (Unknown GP Code) and complete the ‘Application for Additional GP on the PAS’ (Appendix 3).
- Ethnic Category – Whenever possible staff should ask the patient their Ethnic Category (Appendix 4) is designed to assist staff explain to patient’s why the Trust requests this information.
If the question is not asked, ‘Not asked’ must be selected from the drop down list.