User Guide — Physician Workflow (Emergency Department)

athenaOne for Hospitals & Health Systems

Workflow overview

Registration (nurse) or staff)

Either a member of the registration staff or a nurse handles the registration process of the patient.

 

Once registered, the patient's name appears at the bottom of the Tracking Board, under the waiting room section. If a chief complaint was entered during registration, it appears in the Chief Complaint column of the Tracking Board.

 

Triage (nurse)

During triage, the nurse enters or updates the chief complaint, assigns acuity, places the patient into a treatment or trauma room, and signs the triage note. This information is displayed on the Tracking Board, and the patient's name moves to the top section of the Tracking Board.

 

Next, the nurse performs an initial assessment and documents any history and findings.

 

The patient is now ready for you.

 

Provider Assessment (physician)

To begin the Provider Assessment, click the patient's name in the Tracking Board to access the patient chart, and then select Add Provider Assessment from the green workflow menu.

 

Typically, a nurse performs the patient triage and initial assessment first, and then you perform the Provider Assessment, but you can perform the Provider Assessment even if triage has not been completed.

 

You record your assessment using a navigation bar that guides you through these steps: History, Exam, Results, and A&P. The Sign Off button appears in the upper right corner.

As you scroll up and down the provider assessment, the navigation bar reflects the current step. You can also click a step name to jump directly to that step.

 

As you proceed through the provider assessment, you can access ED course notes, review and update a patient's vitals, and add a patient's recent results. You can enter information into free-text fields or use structured templates to capture the information you need. To select a template, click the plus icon .

 

Additional orders, notes and discharge (physician)

 

After you complete the Provider Assessment, you can enter additional orders, notes, create an ED course, and enter and sign discharge orders.

 

The Tracking Board

The Tracking Board appears when you first log in to an emergency department that uses athenaOne for Hospitals & Health Systems. The Tracking Board is the starting point for the ED physician workflow and provides direct access to patient charts.

 

The top of the Tracking Board lists all the rooms in the emergency department, with the patients currently assigned to each room. The lower section lists the patients checked in to the emergency department waiting room.

 

These Tracking Board columns provide quick insight into patient status:

 

STATUS

The patient's status: Triage, Discharging, or Transferring. If no status is recorded, the cell is blank.

 

ALERTS

The patient's allergies, and 72-hour alerts, populated from the patient's precautions list in the Diagnoses section of the patient chart.

 

VITALS

The last time the patient's vitals were recorded. You can pause your cursor over the vitals to see the vital readings.

 

These columns show the status of the patient's ordered tests and medications:

 

LAB

Click the icon to access the patient's lab orders in the Results section of the patient's chart.

 

— Lab orders are placed, and all results are returned.

— Lab orders are placed, and some results are returned.

— Lab orders are placed, and no results are returned.

 

IMG

Click the icon to access the patient's imaging orders in the Results section of the patient's chart.

 

— Imaging orders are placed, and all results are returned.

— A returned imaging order is critical.

— Imaging orders are placed, and no results are returned.

 

ORD

Patient's orders.

You can click the link to view the orders list in the patient's chart.

A plus icon indicates there are no orders for this patient.

You can click the plus icon to add orders directly to the patient's chart.

 

MED

Patient's medications.Click the link to view the medications list in the patient's chart.

Provider assessment

To access the provider assessment, you must have the Inpatient Physician role.

1. In the patient's chart, click the arrow in the green workflow menu (at the upper right) and select Add Provider Assessment. (The options available in the green workflow menu depend on your user role.)
   The History stage of the add provider assessment workflow appears.

History step

2. First Contact with Patient — Check the best option to indicate the time you performed the initial medical screening for this patient.
   You can select Custom to enter an exact time.
   If you were previously assigned to the patient on the Tracking Board, the provider assignment time option also appears.
   A blue checkmark will appear next to the patient's ID on the Tracking Board to indicate that you recorded first contact.
   Note: athenaOne uses this time to calculate the door-to-doc metric for emergency department visits.
3. Chief complaint — During triage, the nurse typically enters or updates the chief complaint.
   Note: athenaOne may offer suggestions or populate this field automatically, based on the frequency of your past selections To dismiss an automated suggestion click the X icon.
   
4. History of Present Illness —
5. Problems — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
   You can click the note icon to enter a free-text note.
6. Home Medications — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
   If the patient has no home medications, check None recorded.
   You can click the note icon to enter a free-text note.
7. Allergies — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
   If the patient has no known allergies, check NKDA.
   You can click the note icon to enter a free-text note.
8. Surgical History — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
   You can click the note icon to enter a free-text note.
9. Social History — Complete the smoking-related history.
   Next, click the plus icon to search for and select the templates you need. When you do, the template questions appear below the smoking questions.
   Note: To remove the template questions, click the plus icon and uncheck the template.
10. Family History — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
    Alternatively, you can check the box to indicate the patient has no first-degree relatives with known problems, or check the box to indicate family history is unknown.
    You can click the note icon to enter a free-text note.

Exam step

11. Scroll to the Exam step or click Exam in the navigation bar.

12. Review of Systems — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
    Alternatively, you can check ROS as noted in the HPI.
    Tip: To save the text you entered as a template, click the star icon to the right of the text field, enter a name for the template in the Shortcut field, and click Save.
    Note:To delete a template added in error, click the icon that appears immediately to the right of the template title.
    
13. Physical Exam — Click the plus icon to search for and select the template you need, or enter the desired text in the field.
    Tip: To save the text you entered as a template, click the star icon to the right of the text field, enter a name for the template in the Shortcut field, and click Save.
    Note:To delete a template added in error, click the icon that appears immediately to the right of the template title.
    
14. Vitals — The vitals are populated from the vitals flowsheet data, usually entered by the triage nurse.  
    You can click the Flowsheet tab (at the far right) to access the flowsheet, and then click the plus icon to enter new vitals data. 
    If you record new vitals, a message with an UPDATE link appears. You can click UPDATE to include the latest vitals in the provider assessment summary. 
    You can check the Include vitals in summary box to include the patient's vitals in the summary.
    
    

Results step

15. Scroll to the Results step or click Results navigation bar.

16. You can click the linked result to view the original order.
    All results are checked by default and will appear in the provider assessment summary. If there are any results that you don't want to appear in the provider assessment summary, clear that checkbox.
    Note: New patient results continue to appear in the Results section of the ovider assessment A&P as long as the visit is open.
17. Order Entry — Click the plus icon to search for and select the order type you need. In the search results, relevant pharmacy formulary medications, as well as off-formulary medications appear.
    
18. Click the order to expand the details.
19. Enter the sig and order details in the fields provided. Click outside of the order to close the form.
20. Click Sign Orders.
21. Recent Changes —
22. Labs and Imaging — Any lab and imaging test results appear listed here.

Assessment & Plan step

23. Scroll to the Assessment & Plan step or click A&P in the navigation bar.
    
    
24. ED Course Notes — Enter a note for the ED course ad click Add. The ED course note entry appears below, listed with a time stamp.
    To edit an ED course note, click it and enter the revised note.
    To delete an ED course note, pause your cursor to the right of the note and click the X icon .
    Note: You cannot delete ED course notes once the provider assessment has been signed.

25. Medical Decision Making — Click the plus icon next to DIAGNOSIS. Search for the diagnosis and select it in the list of possible matches.
    
    
26. Check the Primary diagnosis box if applicable.
    
27. Onset date — Click the calendar icon to change the onset date if necessary.
28. NOTE — Click the note icon to enter notes about this diagnosis.
29. Click Add.

Sign the provider assessment

30. Click Sign Off in the upper right corner. The Summary window appears.
31. Review the Summary information.
32. Click Sign Note. The Provider Assessment appears on the patient briefing under Recent Notes.

Additional order entry

You can still enter additional orders after signing the Provider Assessment.

1. Display the patient's Order Entry page: In the patient chart, click the arrow in the green workflow menu (at the upper right) and select Go to Orders. (The options available in the green workflow menu depend on your user role.)

2. Click the plus icon next to Order Entry to display the search tool.
3. Search for and select the type of order you need.
   
   
4. Click the new order form to expand the order details.
5. Ordering provider — (This field does not appear for physicians) Select the ordering provider, and then use the menu to the right to select how the order was given (verbal, phone, written, etc.).
6. Priority — Select the priority for this order:
   • STAT: urgency to administer order.
   • now: intended to be given within the next 30 minutes.
   • routine: based on routine for that frequency in the facility, for example, twice a day.
   • schedule - start first order by specific time.

Complete the order details

7. Complete all the fields. The order detail fields vary depending on the order type.

8. PRN — Select this option for orders that will be administered as needed.
   Note: If PRN is checked, enter additional instructions in the Notes field.
   If PRN is checked, the Priority selected for the order should be either routine or scheduled.
   

Signing orders

Note: Orders can be entered by a nurse, but must be signed by a physician, according to hospital and legal guidelines.

9. To sign all orders for this patient, scroll to the top of the page and check Select all.
   
   
10. To sign only selected orders, check the box for each order to sign.
11. Click Sign Orders.

The new order appears in the patient's MAR.

If no orders were added, click Sign Note.

The note appears listed on the patient briefing, labeled ED provider note.

Notes

After you complete the Provider Assessment, you can add notes directly into the patient's chart.

 

Use this free-text note field to record any observations made after the Provider Assessment has been completed. To add orders from within the note, click Orders in the navigation bar.

1. In the patient chart, click the arrow in the green workflow menu (at the upper right) and select Add Note. (The options available in the green workflow menu depend on your user role.)

Under ED Stay

2. Diagnoses recorded for the ED visit are displayed here.
3. Note — Enter a free-text note.
   
   

Under Vitals

4. If vitals were recorded during the ED visit, the most recent reading is displayed here.
5. Click Next.

Enter orders (optional)

6. Click the plus icon next to Order Entry to display the search tool.
7. Search for and select the type of order you need.
   
   
8. Click the new order form to expand the order details.
9. Ordering provider — (This field does not appear for physicians) Select the ordering provider, and then use the menu to the right to select how the order was given (verbal, phone, written, etc.).
10. Priority — Select the priority for this order:
    • STAT: urgency to administer order.
    • now: intended to be given within the next 30 minutes.
    • routine: based on routine for that frequency in the facility, for example, twice a day.
    • schedule - start first order by specific time.

Complete the order details

11. Complete all the fields. The order detail fields vary depending on the order type.

12. PRN — Select this option for orders that will be administered as needed.
    Note: If PRN is checked, enter additional instructions in the Notes field.
    If PRN is checked, the Priority selected for the order should be either routine or scheduled.
    

Signing orders

Note: Orders can be entered by a nurse, but must be signed by a physician, according to hospital and legal guidelines.

13. To sign all orders for this patient, scroll to the top of the page and check Select all.
    
    
14. To sign only selected orders, check the box for each order to sign.
15. Click Sign Orders.

The new order appears in the patient's MAR.

If no orders were added, click Sign Note.

The note appears listed on the patient briefing, labeled ED provider note.

Note: After a note is opened, it must be signed. Open notes prevent the coding of the chart. Only the physician who opens the note can sign the note.

The Discharge Plan and patient disposition

Once the patient has been seen and is ready to leave the ED, you can either discharge the patient, or enter a transfer order.

 

Once you create the Discharge Plan, and enter and sign orders, you or a nurse can complete the Discharge Plan.

To discharge a patient from the emergency department

1. Display the Tracking Board: Click the athenaOne logo in an emergency department that uses athenaOne for Hospitals & Health Systems.
2. On the Tracking Board, click a patient's name.
   The patient chart appears.
3. In the patient chart, click the arrow in the green workflow menu (at the upper right) and select Go to Discharge Plan. (The options available in the green workflow menu depend on your user role.) Alternatively, in the patient chart, click the Discharge chart tab at the left side of the page.

Record discharge order information

4. Click Discharge Order.
5. Ordering physician — Select the ordering physician. (This field appears for nurses only.)
6. Final diagnosis — Search for and enter a final diagnosis.
7. Condition — Enter the patient's condition the time of discharge.
8. Disposition — Select the disposition of the patient after discharge.

Enter discharge orders

9. Click Post-Discharge Orders.
10. Order Entry — Search for and select orders. If given a verbal order, a nurse can search for and select orders.
    Tip: To order referrals, search for "referrals" and include summaries of care. You can search for "after your visit" to locate patient education orders.
    Note: Some order types may require a diagnosis.

11. To mark an order as not given, click Not Given when, for example, the patient refused the order, or a medication wasn't available. This action ensures that quality measures are not affected negatively.
    You must then select a reason for not giving the order.
    You can also include a note to the patient and an internal note.
    
    Orders marked as Not Given are listed in the Medications Not Given section of the Discharge Summary, but not in the medication list or the Patient Portal. This ensures that the patient does not accidentally view an order or take a medication that was explicitly refused.

Reconcile the medications list

12. If the Reconcile medications for discharge link is visible, click this link to review the patient's home and inpatient medications.
    The patient's home medications are listed on the left, inpatient medications are listed in the center, and the discharge medication list appears on the right.
13. For each medication on the list, use the arrow icon to indication continue or use the X icon to discontinue upon discharge. The list of home medications marked continue produces the Discharge Home Medications list.
14. Click Reconcile Medications to create the Discharge Home Medications list.
    (All medications in the list must be acted upon before the button appears green.)
15. Discharge Home Medications — Review the list of medications to be continued upon discharge. Click a medication to view or edit the details, or to remove it from the list.
    Note: In the patient's chart, the medications flowsheet will reflect the changes made when medications are reconciled.

Enter discharge instructions

16. Click Next or click Instructions in the navigation bar at the top of the page.
    
17. Nursing Summary of Care — Enter the nursing summary of care.
18. Patient Goals — Enter the patient goals.
19. Patient Instructions — Enter the patient instructions.
20. Portal Registration — You can register the patient for the Patient Portal, if the patient consents.
    Note: After discharge, patients registered for the Patient Portal can access their summary of care record on the My Health page of the Patient Portal.
21. Click Enter Instructions.

Review and add letters

22. Letters — Click the Letters plus icon to display the Add Letter form, complete the fields provided, and select a delivery option.
    If the patient has Patient Portal access, you can select Close and Email Patient. athenaOne may close certain Patient Care Summaries when you sign and approve them, so they do not appear in the Clinical Inbox unnecessarily.
    
    Note: athenaOne automatically generates and sends the Summary of Care Record (SCR) via DIRECT to the Primary Care Physician (PCP) and Receiver Facility on record when you complete discharge and click Discharge Complete. The patient can access the Summary of Care record on the My Health page of the Patient Portal.
23. Review the information under the Discharge Summary heading.
24. Click Done to complete the Discharge Plan.
    Note: The discharge plan stays open until all steps are signed.
    After discharge, patients registered for the Patient Portal can access their summary of care record on the My Health page of the Patient Portal.
25. After the patient leaves the hospital, on the patient briefing, enter the date and time that the patient left, and click Discharge Complete to close the stay. This removes the patient from the Patient List (or Tracking Board).
    
    Note: If the patient has Patient Portal access, athenaOne automatically moves signed Patient Information orders and Patient Care Summaries from Review status to Notify by Portal status, and to Close status for other patient correspondence.
    If the patient does not have Patient Portal access and the Paper option is selected in the Patient care summary and patient letter delivery preference field (under the Registration Information heading) on the Quickview, you should select Close manually.

To enter a transfer order from emergency to surgery

1. Click the patient's name on the Tracking Board to display the patient's chart.
2. In the patient chart, click the arrow in the green workflow menu (at the upper right) and select Add Patient Transfer. (The options available in the green workflow menu depend on your user role.)
   
3. Transfer date and time — Enter the date and time for the transfer.
   Tip: You can enter "now" in the time field to input the current time and date, or you can enter "t" in the date field for the current date.
4. Transfer reason — Enter the reason for transferring this patient.
5. Attending physician — Select the attending physician who is ordering the transfer.
6. Department — Select the receiving surgery department.
7. Level of Care — Select the level of care to be provided.
8. Service — Select the service to be provided to the patient.
9. Telemetry — Click Yes, No, or Remote.
10. Condition — Select the patient's condition.
11. Precautions — Click the plus icon to add a precaution.
12. Click Enter Transfer (nurse) or Sign Transfer (physician).
    The patient status (at the top of the patient briefing and on the Tracking Board) shows that the patient is transferring.
    The patient's name is added to the surgery department's Patient List with a status of Checked in.

Record that the patient has departed the emergency department

13. At the top right of the patient briefing, enter the time and date the patient departed the emergency department.
    
    Tip: You can enter "now" in the time field to input the current time and date, or you can enter "t" in the date field for the current date.
14. Click Mark as Departed.

Note: You can delete a transfer order that was not entered by a provider, as long as it has not yet been signed by a provider. You can cancel a transfer order (signed or unsigned) if a provider has not yet marked the patient as "Arrived" in the new department. To delete or cancel transfer orders, you must have the Inpatient Clinicals: Transfer/Discharge Sign-off permission.

To enter a transfer order from emergency to inpatient

From the Emergency or surgery department

1. In the Patient List, click the patient's name to display the briefing.
2. In the patient chart, click the arrow in the green workflow menu (at the upper right) and select Go To Admission Order. (The options available in the green workflow menu depend on your user role.)
   

3. Admission date and time — Enter the time and date of admission.
   Tip: You can enter "now" in the time field to input the current time and date, or you can enter "t" in the date field for the current date.
4. Department — Select the admitting or receiving department.
5. Admitting physician — Select the admitting physician.
6. Attending physician — Select the attending physician.
7. Service — Select the service.
8. Telemetry — Click Yes, No, or Remote.
9. Level of care — Select the level of care.
10. Primary diagnosis — You can click the plus icon to add a diagnosis, or click the X icon to delete a diagnosis.
11. Condition — Select the patient's condition.
12. Precautions — You can click the plus icon to add a risk, or click the X icon to delete a risk.
13. Expect patient to be discharged or transferred within 96 hours — Click Yes or No.
14. Elective admissions — Click Yes or No.
15. Enrolled in clinical trial — Click Yes or No.

16. Click Sign Order.
    The patient appears in the Patient List of the inpatient department as "Transferring from Emergency."
17. In the Patient List, click the patient's name to display the briefing.
18. Time of departure — Enter the departure time and click the calendar icon to select the departure date.
19. Click Mark as Departed.
    Note: For reporting purposes, the clock stops on the patient's total ED length of stay.

From the Inpatient department

20. In the Patient List, click the patient's name to display the briefing.
21. Time of arrival — Enter the arrival time and click the calendar icon to select the arrival date.
22. Click Mark as Arrived.