CPE View

The EDPF LOCATION parameter, which holds your site’s emergency department location or locations, controls this functionality. Parameter settings ensure that only emergency-department check-ins and appointments add patients to EDIS.

From the CPE view, you can create a visit in CPRS, add patients to the application from the Display Board, Worksheet (Visit or Assess) or combined Display Board and Worksheet views.

Create a Visit in CPRS

Adding a provider (or a nurse who has an active person class in the New Person file) in EDIS automatically creates a PCE visit in CPRS — unless EDIS has already created a visit for this particular emergency-department episode of care (through Appointment Management, for example) or the provider does not have an active person class in VistA’s New Person file. To reduce the possibility of creating duplicate PCE visits in CPRS, EDIS checks back one hour for PCE visit entries associated with the emergency department location your site’s IT staff has specified.

(EDPF LOCATION parameter settings and—if applicable—Clinic list selections determine the location EDIS uses to create visits.)

The application creates only one PCE visit in CPRS for each emergency-department episode of care (or encounter).You can avoid creating duplicate visits for the same episode of care by selecting the visit that EDIS creates when you complete patients’ emergency-department encounters in CPRS.

Adding provider assignments in EDIS create PCE visits in CPRS

Add Patients

Click New Patient in the upper right-hand corner of the CPE View. Keyboard: use the <Tab> key to locate the New Patient button and press the <Spacebar> key to select it. The application displays the Add Patient dialog box, which offers the following three selections:

Search for Patient in VistA: enables you to add patients who are already in your local VistA system
Ambulance Is Arriving, Patient Name Is Unknown: enables you to add information for patients whose identities are unknown (EDIS does not create PCE visits for these p atients until someone adds them via a VistA search)
Enter Name, Patient Is Not in VistA: enables you to add patients who are not in your local VistA system (EDIS does not create PCE visits for these patients until someone adds them via a VistA search)

• Adding Patients Using the Search for Patient in VistA Selection
  • If necessary, select Search for Patient in VistA. (Search for Patient in VistA is the application’s default selection; in most cases, you won’t need to manually select this button.) Keyboard: if the Search for Patient in VistA button isn’t already selected, use the <Tab> key to locate the selected button (Enter Name, Patient Is Not in VistA or Ambulance Is Arriving, Patient Name Is Unknown). Use the <Up Arrow> key to locate the Search for Patient in VistA button and use the <Spacebar> key to select it.
  • Type all or part of the patient’s name in the Find Patient box using this format: Surname,Firstname. For example, you can search using the patient’s surname only, or the patient’s surname and the first initial of his or her first name. You can also search using the initial letter of the patient’s surname concatenated with the last four digits of his or her Social Security number (X9999 format), the patient’s entire Social Security number (SSN), or the last four digits of his or her SSN

  Use an underscore to denote spaces in names. For example, if the patient’s name is O Hara, type O_Hara.

  • Click Search or press the <Enter> key.
  • The Add Patient dialog box lists possible matches. Select the correct patient and click Continue or press the <Enter> key. Keyboard: use the <Down Arrow> and <Up Arrow> keys to locate the correct patient. Press the <Enter> key to select the patient or use the <Tab> key to locate the Continue button and then press the <Spacebar> key to select it.

  The application displays the Patient Information pane.

  

• Adding Patients Using the Enter Name Selection
  If the Find Patient search list does not contain a match, add the patient using the Enter Name, Patient Is Not in VistA selection.
  • In the Add Patient dialog box, select Enter Name, Patient Is Not in VistA. Keyboard: use the <Tab> key to locate the currently selected button and use the <Down Arrow> or <Up Arrow> key to locate the Enter Name, Patient Is Not in VistA button. Press the <Spacebar> key to select this button.
  • EDIS automatically populates the Patient Name box with the name you typed to initiate the VistA search. If this name is incorrect or incomplete, type the patient’s full name in the Patient Name box using this format: Lastname,Firstname. Keyboard: use the <Tab> key to locate the Patient Name box.
  • Press the <Enter> key or click Continue.

  The application displays the Patient Information pane.

  
  The Enter Name, Patient Is Not in VistA button

• Adding Unidentified Patients
  When you must add unresponsive patients whose identities you do not know, use the Enter Name, Patient Is Not in VistA selection and follow the naming protocol defined in section 12 of VHA Directive 2006-036: Data Quality Requirements for Identity Management and Master Patient Index Functions. (Use the name UU-UNRESPONSIVE,PATIENT for the first such patient, UU-UNRESPONSIVE,PATIENT A for the second, UU-UNRESPONSIVE,PATIENT B for the third, and so forth. You can find the full text of this directive at http://wwww.domain/123publica123ns/ViewPublication.asp?pub_ID=1434.)

• Adding Patients Using the Ambulance Is Arriving Selection
  EDIS enables you to add unknown patients who are arriving by ambulance or other types of emergency transportation, thereby allowing you to make room, provider, and nurse assignments before these patients arrive.
  • Select Ambulance Is Arriving, Patient Name Is Unknown. Keyboard: use the <Tab> key to locate the currently selected button, and use the <Down Arrow> key to locate the Ambulance Is Arriving, Patient Name Is Unknown button. Press the <Spacebar> key to select this button.
  • Click Continue. Keyboard: use the <Tab> key to locate the Continue button and use the <Spacebar> key to select it.

    The application displays the Patient Information pane.

  EDIS reports do not reflect the number of patients whom users add to the application via this method.

  Also, EDIS creates its Time In timestamps when users identify patients in VistA or create unscheduled appointments for them in Appointment Management. As a result, sites must correct EDIS’s Time In values to reflect the times these patients actually arrived.
  

  
  The Ambulance Is Arriving, Patient Name Is Unknown button

  Update Patient Information from the Display Board

  From the main Display Board, select from one of the following column headers to perform the following functions:
  • Room – to update or add a room or bed
  • Patient – to view or update patient demographics information
  • Visit – a check mark lets the user know that a visit has been created in PCE
  • Status – to change the status of a patient
  • ESI – to change the Acuity of a patient
  • PRV – to assign or change the provider
  • RN – to assign or change a nurse
  • Dispo – to assign or change the disposition
  • Orders – to view orders
  • Comments – to enter comments in free-form text
  • Complaint– to enter complaint in free-form text
  NOTE : The header text is configurable and may be different for certain sites.
  
  Display Board View
• Updating a Room or Bed from the Display Board

  In the Room row, select the patient column whose information you want to view or edit. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to select your Room.

  
  Room/Bed Popup

• View or Update Patient Demographic Information
  In the Patient row, select the patient column whose information you want to view or edit. Select one of the fields to update the telephone number and click the OK button to accept your changes.
  Patient Demographics Popup

• Change the Patient Status
  In the Status row, select the patient column whose information you want to view or edit. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to select your Status
  Status Popup

  Definitions for Status Selections

  The EDIS TWG has provided the following definitions for nationally released status selections:
  • Admitted—the patient is admitted, but is still in the emergency department.
  • ED Boarding [Hold]—the patient is admitted and is designated as a holder (extended time in the emergency department).
  • Discharged—the patient is discharged, but is still in the emergency department.
  • ED Observation Unit—the patient is an observation patient under the emergency department’s care.
  • ED Patient—the patient is an emergency department patient (after triage).
  • En Route/Prearrival—the patient is en route to the emergency department.
  • Awaiting Triage—the patient is at the emergency department and is awaiting triage.
  Other Status-list selections are site configurable.

• Change the ESI Acuity Level
  In the ESI row, select the patient column whose information you want to view or edit. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to select your Acuity level
  ESI Popup

• Assign or Change a Provider
  In the PRV row, select the patient column whose information you want to view or edit. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to select your Provider Name.
  Provider Popup

• Add or Change a Nurse
  In the Room row, select the patient column whose information you want to view or edit. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to select your option.
  Nurse Popup

• Add or Change a Disposition
  In the Dispo row, select the patient column whose information you want to view or edit. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to select your option.
  Disposition Popup

• Entering Comments
  In the Comments row, select the patient column whose information you want to view or edit.
  Comments Popup

• Entering Complaint
  In the Complain row, select the patient column whose information you want to view or edit.
  Complaint Popup

Visit or Assess Worksheet View

Use the Worksheet (Visit and Assess) or combined view to edit or update information that you gather as part of the patient process. From this view, you can:

• update patients’ display-board complaints;
• include additional, not-for-display information about their complaints (optional);
• update their room or area assignments;
• add information about their acuities;
• make nursing, provider, and resident assignments;
• update or add their sources (on-site clinics, nursing homes, and so forth);
• and specify a clinic location for the patient’s emergency-department visit.

Visit Worksheet View

• Visit Worksheet View
  In the Active Patients view, select the patient whose information you want to enter. Keyboard: use the <Tab> key to locate the Active Patients list. Use the <Down Arrow> key to enter the list, and use the <Down Arrow> and <Up Arrow> keys to locate the patient you want to select. The Patient Information pane displays current information for the selected patient.
  • Enter Patient Compliant
    • if applicable, select the <Down Arrow> and <Up Arrow> keys in the Complaint view and enter the complaint in the Complaint for Display Board box. The application will not allow you to add the patient if the Complaint for Display Board box is empty.
    • In the Long Complaint (optional) box, you may type supplementary information about the patient’s display-board complaint.
  • Vitals
  • View / Print vitals information
  • Update Vitals
  • Save vitals information
  • Status/Responsibility
    • If applicable, in the Status/Responsibility option, select the <Down Arrow> and <Up Arrow> keys and enter the Room/Area list and make or update the patient’s room or area assignment. (Room or area information is mandatory; the waiting room is the application’s default selection.) Keyboard: Use the <Down Arrow> and <Up Arrow> keys to select a room or area from the list.
    • Select an acuity value from the Acuity list. Acuity information is mandatory for this view. If you do not select an acuity, the application will not allow you to save your updates or edits. Keyboard: Use the <Down Arrow> and <Up Arrow> keys to select an Acuity from the list.
    • EDIS supports the Emergency Severity Index (ESI) triage algorithm, which ranks patients’ acuities using the numbers 1 (most urgent) through 5 (least urgent). Please visit the Agency for Healthcare Research and Quality ESI Web site for more information.
    • From the Status list, select the patient’s status. Keyboard: Use the <Down Arrow> and <Up Arrow> keys to select a Status from the list.
    • Select a provider from the Provider list. Keyboard: Use the <Down Arrow> and <Up Arrow> keys to select the patients’ provider assignment from the list. The Provider list is also available on the Disposition view.
    • Select a nurse from the Nurse list. Keyboard: use the <Tab> key to locate the Nurse list. Use the <Down Arrow> and <Up Arrow> keys to select the patients’ Nurse from the list.
    • When you make a provider assignment in EDIS, the application automatically creates a Patient Care Encounter (PCE) visit in CPRS—if it hasn’t already done so, or unless the provider does not have an active person class in VistA.

      EDIS does not create visits for patients you’ve added using the Enter Name, Patient Is Not in VistA and Ambulance Is Arriving, Patient Name Is Unknown selections. It does not create visits when you enter only resident or nurse assignments. However, EDIS does create visits in CPRS for nurse assignments if the nurses in question are listed in VistA’s Provider file.

      EDIS does not register patients.

  • Disposition
    
    • Open the Disposition list and select a disposition. Depending upon your site’s configuration, the application may require a disposition before allowing you to remove a patient from the display board. Keyboard: use the <Tab> key to locate the Disposition list. Use the <Down Arrow> and <Up Arrow> keys to select a disposition from the list.
    • Click Save to save your changes or click Cancel to close the Patient Information pane without saving your changes. Keyboard: use the <Tab> key to locate the Save or Cancel button. Use the <Spacebar> key to select the button.

      The Save button is available only after you’ve added or updated information in the Disposition pane.

  • Definitions for National Dispositions
    The EDIS TWG offers the following definitions for nationally released dispositions:
    
    • Admitted to VA Ward—the patient was admitted to an inpatient location, not including an ICU, telemetry, or psychiatric unit.
    • AMA—the patient left against medical advice after signing a form; the patient may or may not have been medically evaluated before leaving.
    • Sent to Urgent Care Clinic—the patient was discharged from the emergency department and referred to another evaluation clinic at the same site; some degree of triage is necessary to make this judgment.
    • Deceased—the patient is dead.
    • Eloped—the patient left the emergency department and his or her disposition is unknown; a nurse or physician may have seen and evaluated the patient.
    • Patient Name Entered in Error—the patient’s name was entered in error; this disposition removes the patient from the board.
    • Home—the patient was discharged to his or her previous living arrangement.
    • Admitted to ICU—the patient was admitted to an inpatient critical care unit.
    • Left Without Being Treated/Seen—the patient left the emergency department before receiving treatment and before signing the form; this is not the same as AMA, which assumes the patient signed a form before leaving.
    • Sent to Nurse Eval / Drop-in Clinic—the patient was discharged from the emergency department and referred to another on-campus same-day evaluation clinic; some degree of triage is necessary to make this judgment.
    • Admitted to Psychiatry—the patient was admitted to an inpatient psychiatric unit.
    • Admitted to Telemetry—the patient was admitted to an inpatient telemetry unit.
    • Transferred to a Non-VA Facility—the patient was discharged from the emergency department and sent to another, non-VA, facility.
    • Transferred to VA Facility—the patient was discharged from the emergency department and sent to another VA facility.

      Sites can activate and inactivate these dispositions. The application allows your site to configure additional, site-specific dispositions.

      To capture admission-delay times for reporting, you must change patients’ statuses to Admitted and then immediately select Admitted to VA Ward as their dispositions. Unless you intend to remove patients from the board, click Save. Do not click Save & Remove from Board, which will prematurely remove your patients from the EDIS tracking application.

      Click Save to save your edits and updates or click Cancel to close the Patient Information pane without saving your changes. The Save button is available only after you’ve added or updated information i n the Patient Information pane.

  Select a Reason for Delay

  • If the Delay Reason list is available, open it and select a reason for delay. Depending upon your site’s configuration, the application may require a reason for delay when patients’ emergency-department visits have exceeded a specified number of minutes. Keyboard: use the TAB key to locate the Delay Reason list and use the DOWN ARROW and UP ARROW keys to select a reason from the list.
    The Delay Reason list is available only under the following conditions:
    • Your site requires a delay reason and
    • The patient’s stay has exceeded the site-determined limit and
    • The patient is not in an observation ward

    If your site requires a reason for delay and the patient’s stay has exceeded your site’s maximum number of minutes, the application will require you to enter a delay reason before it allows you to remove the patient from the display board.

    Defining National Reason-for-Delay Selections

    The EDIS TWG offers the following definitions for nationally released reason-for-delay selections:

    Obtain Accepting Physician—the delay was caused by the inability to find an accepting physician to admit the patient. This selection includes the elapsed time between determining the patient’s need for admission and obtaining an accepting physician.
    Admit Physician Writing Dispo—the delay resulted from the physician’s failure to write the patient’s admit or discharge order. This selection includes the elapsed time between when the patient was ready for his or her disposition and when the physician wrote the order to admit or discharge the patient.
    Admitting Physician Evaluation—the delay was related to the admitting physician’s evaluation and confirmation of the patient’s disposition. For this selection, delay time begins when the physician sees the patient and ends when:
    

    • H&P is done
    • Ancillary studies that are necessary for disposing the patient are done and resulted
    • The patient is ready to be disposed
    Patient Admitted to Observation—the delay resulted from the patient’s admission to observation. This selection includes the elapsed time between when the patient was ready to be disposed and the time the physician wrote an order to admit the patient to 23 hours of emergency-department or floor observation.
    Obtain Ambulance Services—the delay resulted from the time it took to obtain ambulance services. This selection includes the elapsed time between when emergency department staff requested ambulance services and the time the ambulance service arrived.
    Obtain Consultant—the delay resulted from an ordered consultation’s lack of completion. This selection includes the elapsed time from when a physician ordered a consultation to the time the physician obtained the consultation.
    ED to Hospital Bed—the delay represents the difference between the time the patient was assigned a hospital bed and the time the patient was transported from the emergency department; for example, this delay could represent the time emergency department staff spent waiting for an escort, for a bed to be cleaned, for a nursing report, or for staffing.
    Obtain Escort—the delay resulted from the time it took to obtain an escort for the purpose of transporting the patient (not including transport to a hospital bed—use ED to Hospital Bed for this reason). This selection includes the time that elapsed between when the emergency department called an escort and the time the escort arrived to transport the patient to a clinic, radiology, or another ancillary department.
    Patient Transport Home—the delay resulted from an inability to find transportation for a discharged patient or from the time it took the identified source of transportation to arrive at the emergency department. This selection includes the elapsed time between when the patient was ready for discharge and the time the patient left the emergency department.
    Obtain Imaging Results—the delay resulted from time spent waiting to obtain imaging results. This selection includes the elapsed time between when the imaging study was completed and the time the study was resulted.
    Obtain Imaging Studies—the delay resulted from time spent waiting for imaging studies. This selection includes the elapsed time between when the physician ordered the imaging study and the time the study was done and ready for interpretation.
    Obtain Inpatient Bed—the delay resulted from the time spent waiting for an impatient bed assignment. This selection includes the elapsed time between when the physician wrote the admission order and the time bed control or the house supervisor assigned the patient to a bed—the time an ICU patient waited for an ICU bed to open up, for example.
    Interfacility Transfer—the delay was caused by an inability to transfer the patient to another facility in a timely manner.
    Obtain Lab Results—the delay was caused by the lack of a timely turnaround for laboratory tests. This selection includes the elapsed time between when labs were drawn or obtained and the time the labs were resulted.
    Obtain Lab Studies—the delay was caused by an inability to get labs drawn in a timely fashion. This selection includes the elapsed time between when the physician wrote the lab order and the time the lab test was drawn.
    On-call Staff—the delay was caused by an inability to contact on-call staff.
    Overcrowding of ED—the delay resulted from waiting for an emergency department bed to become available (includes hallway beds and beds that were unavailable because of staffing issues); no beds were available for inbound ambulances, including hallway beds.
    Obtain Drugs/Pharmacology—the delay was caused by an inability to get ordered drugs from the pharmacy. This selection includes the elapsed time between when the physician ordered the medications and the time the emergency department received the medications.
    ED Physician Limits—the delay resulted from time the physician spent seeing patients. This selection includes the elapsed time between when the patient was placed in a bed and when the physician saw the patient. For example, this reason for delay might apply if five patients presented with chest pains, all within 10 minutes.
    ED Staff Limits—the delay resulted from a failure to process the patient (see the patient or accomplish orders, for example) in a timely manner because of insufficient staffing. This selection includes the elapsed time between when the physician wrote an order (splint a broken ankle, for example) and the time the order was accomplished.
    Obtain Medical Supplies—the delay resulted from an inability to obtain medical supplies (splints, crutches, and c-line kits, for example) in a timely manner. This selection includes elapsed time from when emergency department personnel ordered the supplies (or identified the need for them) and the time the emergency department received the supplies.
    Arrange Emergency Surgery—the delay resulted from the time it took to get the patient (who needed surgery) to the operating room.
    Patient Transport Other—the delay resulted from the time it took to find transportation for the patient to a location other than home. This selection includes the elapsed time between when the patient was ready for transport to the time the patient left the emergency department.  

    Enter ICD-9-CM Diagnoses

    • Type a diagnosis in the Diagnosis search box and click Search or press the <Enter> key. The application lists possible matches from VistA’s ICD-9-CM code base. Keyboard: use the <Tab> key to locate the Diagnosis search box. Type a diagnosis in the box and press the <Enter> key.
    • Select an ICD-9-CM diagnosis from the Diagnosis search list and click Add or press the <Enter> key. The application adds this diagnosis to the Selected Diagnoses list. Keyboard: use the <Down Arrow> and <Up Arrow> keys to locate the diagnosis you want to select. Press the <Enter> key to select the diagnosis. To select another diagnosis from the same search list, use the <Tab> key to reenter the list. Use the <Down Arrow> and <Up Arrow> keys to locate the additional diagnosis, and press the <Enter> key to select this diagnosis. You can also select diagnoses by using the <Tab> key to locate the Add button, then pressing the <Spacebar> key to select the button.
    • To remove a diagnosis from the Selected Diagnoses list, select the diagnosis and click Remove or press the <Delete> key. Keyboard: use the <Tab> key to locate the Selected Diagnoses list. Use the <Down Arrow> and <Up Arrow> keys to locate the diagnosis you want to remove. Press the <Delete> key to remove the diagnosis. You can also simultaneously press the <Shift> and <Tab> keys to locate the Remove button, and then press the <Spacebar> key to remove the selected diagnosis.
    • Repeat first 3 steps as needed.
    • In the Selected Diagnoses list, select a primary diagnosis and click Set as Primary Diagnosis. Keyboard: in the Selected Diagnoses list, use the <Down Arrow> and <Up Arrow> keys to locate the primary diagnosis. Use the <Tab> key to locate the Set as Primary Diagnosis button, and use the <Spacebar> key to select this button.
    • Click Save to save your changes or Cancel to close the Patient Information pane without saving your changes. Keyboard: use the <Tab> key to locate the Save or Cancel button. Use the <Spacebar> key to select the button.

      Saving an ICD-9-CM diagnosis in EDIS adds the diagnosis to the patient’s emergency-department visit in CPRS. If EDIS hasn’t already created a PCE visit for this patient, it will also create a visit at this time. The application does not add free-text diagnoses to the patient’s visit in CPRS.

    Enter Free-Text Diagnoses

    You can type in free-text diagnoses only if your site has set the parameter that enables you to do so.
    • Type a diagnosis or procedure in the Diagnosis box and click Add or press the <Enter> key. Keyboard: use the <Tab> key to locate the Diagnosis box. Type a diagnosis in the box and press the <Enter> key. You can also press the <Tab> key to locate the Add button and press the <Spacebar> key to select the button. The application displays your diagnosis or procedure in the Selected Diagnoses list.
    • To remove an item from the Selected Diagnoses list, select the item and click Remove or press the <Delete> key. Keyboard: use the <Tab> key to locate the Selected Diagnoses list and use the <Down Arrow> and <Up Arrow> keys to locate and select the diagnosis you want to remove. Use the <Delete> key to remove the diagnosis. You can also remove the diagnosis by simultaneously pressing the <Shift> and <Tab> keys to locate the Remove button, then pressing the <Spacebar> key to select the button.
    • Repeat steps 1–2 as needed.
    • In the Selected Diagnoses list, choose a primary diagnosis, then click Set as Primary Diagnosis. Keyboard: use the <Tab> key to enter the Selected Diagnoses list and the <Down Arrow> and <Up Arrow> keys to locate the primary diagnosis. Use the <Tab> key to locate the Set as Primary Diagnosis button and use the <Spacebar> key to select it.
    • Click Save to save your changes or click Cancel to close the Patient Information pane without saving your changes. Keyboard: use the <Tab> key to locate the Save or Cancel button. Use the <Spacebar> key to select the button.

  Related Topics

  General Information

  Index

  Table of Contents