Patient Arrives Emergency Department

Workflow chart criticism: "A patient arrives in the ER" First and foremost, this workflow could benefit from a clearer title. The flow does not merely delineate what happens when a patient is admitted to the ER but rather what transpires when a patient with a suspected cardiac condition is admitted via emergency medical services. As well as a more coherent title, this workflow could benefit from greater description in the different boxes of the flow.

While it is true that a workflow chart is designed to be relatively economical in terms of verbiage, this workflow needs greater explanation of acronyms such as 'CP via EMS.' It is unclear what CP refers to at first. Presumably it refers to a suspected cardiac patient but the meaning of the acronym is ambiguous given the title and the fact that CP could refer to a variety of different things.

The next square notes that the nurse conducts the initial interview, after which the patient is taken to the registration desk or to triage where he or she is submitted to an EKG and an assessment of his or her vital signs. The reason for such a split could be more clearly noted.

For example, instead of "registration desk," it could be stated "non-emergency patient without cardiac condition (abbreviated non-CP) is sent to the registration desk" and instead of "triage EKG, VS" the box could more explicitly read "suspected cardiac patient triage, EKG, VS," to indicate the reason one patient is moved from one area of the 'flow' versus the other. For patients who do not have cardiac distress based upon their data, the box labeled "waiting room non-cardiac CP" is an excellent, explicit instruction.

However, the other two boxes indicate that in some instances a doctor will be called in to review the cardiac patient's data while in other instances the patient will be taken to a room with a primary RN to monitor his or her heart without explanation of the distinction between the two components of the flow Another problem is that the meaning of 'white' versus blue boxes is not clear. This becomes relevant in the second part of the chart.

Once the patient is being monitored by the nurse, next it is noted that the nurse will take a blood sample, send the sample to the doctor to be assessed, and finally the need for medications will be determined as noted in the box marked "assessment NTG and medications." The white box with the two lines is presumably a predefined process but precisely why this is the case is unclear (versus the other stages of patient assessment beforehand).

After this there will be a doctor's assessment or a portable CXR but once again, the specified criteria for why these different choices may be made are ambiguous. Finally, the workflow ends in a series of boxes regarding 'decision points' for patient care but placement into these different categories is determined and who performs these actions is not stated except for patients requiring a cardiac consult. Writing.