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I have started a new job, in which I will be teaching clinical staff in A&E how to use the new software package the hospital has bought.

The problem is, I do not have a medical background. I need a flowchart (or similar) to tell me what the patient's 'journey' is when they arrive in A&E.

I hate the word 'journey' in this context, but I can't think of a better one. The point is, it's hard for me to train people on the new software when I don't really know what they're doing with the physical patient in front of them. What are the decision points?

Some scenarios

1) Someone walks into A&E with a painful but non-critical injury, like a broken toe. What happens to them?

2) Someone arrives in an ambulance. What happens to them?

3) What are the other common scenarios I haven't thought of?

For context, this is a large, NHS general hospital in a medium sized city, in England.

  • Wow, very broad, probably too broad. You can't just ask things like what happens when someone arrives in an ambulance because the answer depends on what's wrong with them. Obviously, a stabbing victim and a heart attack will follow vastly different paths. There are about 5000 other "common scenarios" you haven't thought about. They can be categorized to make it simpler (trauma, cardiology, respiratory, OB/gyn, etc), but there are still a lot of categories. I think you need to rethink this question, and perhaps your whole approach. – Carey Gregory Aug 9 '17 at 0:07
  • Also, what kind of software, and to what clinical staff? The charting of different roles (e.g. RN vs MD) is quite different. Carey is right that there are many different paths of patient flow (also called clinical flow) through A&E (called ED or ER in the US). – DoctorWhom Aug 9 '17 at 5:09
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I suggest you get your employer to arrange for you to spend a few days observing in an actual A&E. You will be able to see the answers to these questions, the actual words the doctors and nurses use, and how they perform particular tasks (recording and communicating patient observations, deciding what room or cubicle to go to, telling a patient what room or cubicle to go to, and so on) with the system (which may be pen and paper) they have in place today.

Then when you deliver the training not only will you understand the flow of various kinds of patients through the system, you will use the same words for the process as your clinical staff use, and you will be able to say things like "instead of scribbling the vitals on a piece of paper and reading them aloud to the next staff member, you can [whatever your software does.]" You will not only do a better job of training them, because you use their words and connect it to their current process, but you'll also do a better job of selling the software to them, getting them to enjoy using it and seeing it as an improvement. Since it's been bought, it would be good if they liked it, and a lot of that is in your hands.

This small investment of your time to make your training more effective should bring a good reward to your employer. I have trained a lot of people on a lot of software, and written a lot of software for people, and a day or two watching them work is an incredible way to be sure you will do a better job.

  • It's a good suggestion. Although I didn't say so in the question, I've already arranged to do that. It will be helpful, but having the workflow will make it easier to make sense of what I see, and ask intelligent questions about what doesn't make sense to me. – Ne Mo Aug 8 '17 at 17:54
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As mentioned above, there are MANY different clinical flows in the ED.

But very grossly generalized, for the majority of walk-in cases to EDs (at least in the US) the flow might go:

  1. registration

  2. triage, usually by an RN

  3. wait forever (depends on the availability of rooms/RNs/physicians based on what other cases are present in the ED at the time)

  4. placed in "room"

  5. physician sees pt, formulates differential diagnosis, places orders (tests, treatments)

  6. testing or treatments done, results come in, monitoring of response to treatment, etc

  7. differential diagnosis refined based on results

-- (rinse and repeat 5/6/7 until stabilized or resolved)

  1. disposition determined (admit to inpatient vs discharge for outpatient followup)

  2. discharged with instructions (and possibly prescriptions etc)

OR

  1. An admitting service will assess patient and admit to inpatient service, then pt will wait in ED until a bed on the inpatient floor is available.

These are just a generalization. Flow differs a lot depending on many factors. Some examples of factors include:

  • "Acuity" determined in triage. For example, a stroke is generally highest acuity, whereas broken toe will likely be low.
  • When a higher acuity case arises, it will delay the steps of lower acuity cases often
  • Steps 1-3 are skipped when brought in by ambulance, as they're triaged by EMT/medics on the way
  • Trauma, strokes, heart attacks, codes and other emergencies have unique flows
  • 2
    Actually, #3 "wait forever" can go in between any 2 given steps – DoctorWhom Aug 9 '17 at 5:25

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