Documentation/Emergency Department

Module guide · Clinical

Emergency Department

From the moment a patient arrives to the moment they leave: registration, ESI triage, bed and physician assignment, vitals, alerts, consults, and disposition, plus the operational tools around it, the bed board, ambulance fleet, diversion, and mass casualty response.

Overview Dashboard Visits Bed board Ambulances Diversion Mass casualty (MCI)Metrics Good practices

What this module is for

Front-line staff live on Visits, Bed Board, and Ambulances. Diversion, Mass Casualty, and Metrics are restricted to charge nurses, physicians, and ED leadership, these are hospital-operations-level decisions with real consequences.

Who uses it

ED nurses and physicians register, triage, and treat patients on Visits. Charge nurses and bed coordinators run the Bed Board. EMS coordinators track the fleet on Ambulances. Directors, quality, and HIM staff use Diversion, MCI, and Metrics.

Where to find it

Open Emergency Department from the sidebar. Seven screens: a dashboard, Visits, Bed Board, Ambulances, Diversion, Mass Casualty (MCI), and Metrics.

1
Register & triage
A patient arrives (walk-in, EMS, police…), is registered, and triaged to an ESI acuity level.
2
Bed & physician
The patient is assigned a bed and an attending physician; vitals, notes, alerts, and consults are recorded as care proceeds.
3
Disposition
The visit ends in a disposition, admitted, discharged, transferred, or an exception like LWBS or AMA.
4
Operate the department
Bed Board and Ambulances run continuously alongside; Diversion and MCI are break-glass tools for overcrowding or mass-casualty events.

A few terms you'll see throughout

ESI (Emergency Severity Index) is the 5-level triage acuity scale, ESI-1 Immediate and ESI-2 Emergent are both shown in red, ESI-3 Urgent amber, ESI-4 Less Urgent sky blue, ESI-5 Non-Urgent green. Boarding is a patient with a disposition (e.g. admitted) who is still physically occupying an ED bed because no inpatient bed is ready. LWBS is Left Without Being Seen; AMA is Left Against Medical Advice.

Dashboard

A real-time command-center view of capacity, acuity mix, and active alerts, used to see how the department is doing at a glance.

Stat tiles

Field	What it means
Total Beds / Available / Occupied
Boarding	Turns red with a count if any patient has boarded over 4 hours.
Waiting Triage	Turns red with a count if anyone has waited over 60 minutes, a key ED safety metric.
Waiting Bed	Triaged patients still waiting for a physical bed.
Critical Alerts / Available Ambulances

Red banners appear at the top if ambulance diversion or an MCI is currently active, each with a Manage shortcut. An "Active Patients by ESI Level" panel and an "Active Critical Alerts" list (e.g. a Sepsis Alert with patient and bed) round out the page, alongside quick-nav cards into the other six screens.

Visits

The core clinical screen: register arrivals, triage, assign beds/physicians, record vitals and notes, raise alerts, request consults, and discharge or dispose of patients.

"Register ED Arrival" form

Field	What it means
Patient*
Arrival Mode*	Walk-in, EMS Ground, EMS Air, Police, Private Vehicle, Transfer In, or Direct Admit. Defaults Walk-in.
EMS Unit	Only shown for the two EMS arrival modes.
Chief Complaint*

The visit detail drawer has five tabs: Overview, Vitals, Notes, Alerts, Consults.

Workflow actions (Overview tab, conditional on status)

Field	What it means
Perform Triage	Shown only while Arrived/Waiting Triage. Sets ESI level (1–5), triage nurse, pain scale, trauma level, and vitals.
Assign Bed / Assign Physician	Always available.
Discharge / Disposition	16 disposition options, e.g. Admitted Inpatient/ICU, Discharged Home, Transferred, Expired. Transfer and Admit dispositions each reveal an extra required field (facility, or admission order).
Mark LWBS / Mark AMA	Both prompt for confirmation (AMA also asks for an optional witness name) and are irreversible once set.
Start Boarding	Shown once a disposition exists but boarding time isn't yet tracked.

Discharge/LWBS/AMA/Start Boarding all disappear once a visit reaches a terminal status. Vitals lets staff record a serial reading; any critical value highlights the entry red. Notes supports Triage/Physician/Nursing/Procedure note types, locked notes can't be edited or deleted. Alerts raises a clinical alert (Sepsis, Stroke Code, STEMI, Trauma Activation, and more) with a severity, then Acknowledge or Resolve it. Consults requests a specialist and tracks Requested → Accepted → Arrived → Completed (or Declined).

Arrived / Waiting Triage — just registered

Triaged / Waiting Bed — acuity set, awaiting a bed

In Progress / Waiting Results / Waiting Consult — actively being worked

Ready Discharge / Discharged / Admitted — care concluding or concluded

Expired / LWBS / AMA — terminal exception outcomes

Bed board

A real-time map of every ED bed's cleaning/occupancy status by zone, for finding an open bed or dispatching cleaning.

Each bed card shows its zone, feature tags (Trauma, Resus, Monitor, Vent) where relevant, and, if occupied, the patient's name, ESI level, and how long they've been in the bed. Update Status sets Available, Dirty, Cleaning, Out of Service, Reserved, or Isolation (with an isolation type). Setting a bed to Available automatically records the logged-in staff member as who cleaned it.

Available — ready for a patient

Dirty / Cleaning — needs, or is undergoing, cleaning

Reserved — held for a specific patient

Out of Service / Isolation — not usable / precautions apply

Ambulances

Fleet management: unit status, crew assignments, and maintenance/certification due-dates, for knowing what's available to dispatch.

Unit cards

Each shows type (BLS, ALS, Critical Care, Air Medical, Neonatal), crew lead, base station, and warning badges for expiring certification or overdue maintenance. Status can be changed inline, applied immediately, with no confirmation.

Unit Number, License Plate, and Type are required; crew lead, crew size, base station, radio frequency, and notes are optional.

Available — ready to dispatch

Dispatched → En Route → On Scene → En Route to Hospital → At Hospital — the normal call cycle

Out of Service / Decontamination — not available

Maintenance — scheduled service

Diversion

Formally declares the ED unable to accept ambulance traffic, redirecting it elsewhere, typically due to overcrowding. Management-level only.

Activating diversion is a serious, hospital-wide decision

The Activate button is styled red on purpose. The form only asks for a Reason (free text) and optional Details, the system records who activated it and a snapshot of census/available beds at that moment for later audit. Terminate Diversion requires confirmation. Only one diversion can be active at a time; history is searchable by date range.

Mass casualty incident (MCI)

Activates a formal Mass Casualty Incident response, tracks START triage tag counts, and files the after-action report. Management-level only.

"Activate Mass Casualty Incident" form

Field	What it means
Event Name, Event Type*	Event Type is free text (e.g. "Multi-vehicle collision"), not a fixed list.
Location, Expected Patient Count
HAZMAT involved	Checkbox; shows a HAZMAT warning banner on the active panel if checked.

Once active: a status dropdown (Standby → Activated → Receiving Patients → Surge Capacity → Deactivated → After-Action Review) applies immediately with no confirmation. Record START Triage Tag increments running counts for Red/Yellow/Green/Black-tagged patients as they're triaged. An After-Action Report can be filed or updated from the same panel.

No undo on status changes or tag counts

Activating an MCI changes the department's entire operating posture, treat it and the status dropdown with the same care as Diversion.

Metrics

Throughput and quality benchmarks over a chosen date range, many tied to Joint Commission (TJC) and CMS core measures, with a CSV export.

Stat tiles

Field	What it means
Total Visits / Admitted / Discharged
LWBS Rate / AMA Rate	Percent of patients who left without being seen, or against medical advice, key ED safety indicators.
Avg LOS / Avg Boarding
Diversion Episodes	Count and total minutes for the period.

Time-to-Treatment Benchmarks

Door-to-Provider (≤30min), Door-to-EKG (≤10min), Door-to-Balloon (≤90min), Door-to-CT Stroke (≤25min), Door-to-tPA Stroke (≤60min), Door-to-Antibiotic Sepsis (≤60min), and Sepsis Bundle Compliance, national quality targets shown alongside the department's actual numbers.

Volume charts

Visit volume by ESI level and by arrival mode. A Trauma Activations panel (Level 1 Full, Level 2 Partial, Level 3 Consult) only appears when the period had trauma volume.

No data shows until Run Report is clicked; Export Visits CSV then downloads the underlying visit-level data.

Good practices

Triage promptly

The Waiting Triage tile turns red past 60 minutes, a metric the department is measured against.

Diversion and MCI are break-glass tools

Both are red/destructive-styled on purpose, they change how the whole department operates and should only be used for genuine overcrowding or mass-casualty events.

Mark LWBS/AMA carefully

Both are treated as terminal, care-abandonment events with documentation significance, and there's no undo from this screen once set.

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