Select Scheduling => Rounds Schedule => Patient Admissions and Rounds

Transcription

1 Patient Admission and Rounds Introduction The Rounds Module allows providers to track patients who are being seen in off-site locations, keeps a record of all admissions and charges posted during those stays. Patient Admissions information can be added or modified using Patient Admission and Rounds. This module creates a list of patients to be seen for rounds. It can also be used to send charge information to the Charge Posting Interface within e-medsys. Add a New Patient Select Scheduling => Rounds Schedule => Patient Admissions and Rounds

2 Add a new Admission Select the desired patient using the normal emedsys search crieria. All previous admissions will be displayed in the top grid. Check New Admission to create a new admission for this patient. Complete the Patient Hospital Stay tab Hospital/Location - select the location where the patient is being admitted or treated. This selection pulls from Hospital File Maintenance. ****Note: Once rounds have been created for this admission, the Hospital/Location cannot be changed. If the location needs to be changed, the user will need to discharge the patient and create a new admission for the new location.**** Inpatient/Outpatient - use the radio buttons to select the appropriate type of admission Floor/Wing - enter a description of the floor or wing, ex: Pediatrics.

3 Room/Bed - enter the assigned room or bed number Admit/Start - enter the admission date or the date treatment for this location started Discharge/End - enter the discharge or end date if known Comment - enter a comment relevant to this admission Department - the department entered should correctly reflect the billing department for which charges will be tracked. If the hospital entry is linked to a department in Hospital File Maintenance, the billing department will default. Folder - this option will only display if EHR is enabled. Enter the folder/category in the chart folders where this admission should appear. This will default from setup in EHR Admin. Provider - enter the provider who will be doing rounds during the hospital stay or treatment. Referring Provider - enter the referring provider. This pulls from the Referring Provider File Maintenance. Schedule - select the schedule during the stay/treatment that provider(s) will see the patient. Options are Daily, M/W/F, T/R/S, Every other Day, Weekly (once a week starting with the admit date), or None. The default is Daily. This option tells the system when the patient should show up on the Rounds List for this provider and how often the patient should be seen. Shift - select the shift or time period the patient should be seen. This list pulls from General Codes => Rounds Shift. Rounds Grid The grid shows all the times that the providers have seen the patient during the hospital stay or treatment. The grid also contains any manually entered scheduled visits for visits that are not part of the normal rounds schedule. It will also display the scheduled rounds visits for the patient for the week. Each row will allow direct edit of the rounds information for unsigned rounds. Once a round is signed, the row will be 'readonly.' To add procedure and diagnosis codes to a particular round, click on the CPT/ICD icon to enter.

4 Select the status from the dropdown: Not Seen Yet - this is the starting status assigned. The rounds cannot be signed while at this status Seen - this indicates the provider saw the patient and the round was completed Transferred - this indicates the patient is no longer in the same location. New rounds should be completed and a discharge date set for this admission No Show indicates that the patient did not show up. This could be used for outpatient treatment center rounds. Did not see - this indicates that the provider did not get a chance to see the patient during rounds. Vacation/Off -indicates that the patient is on vacation and not doing treatment today. Add Round/Delete Round Select Add Round to add a row to the grid for new rounds if needed. The user will be prompted for a date. Select Delete Round to remove a selected row. A rounds visit cannot be deleted once the round visit has been signed. Rounds Schedule The rounds schedule can be accessed from Scheduling =>Rounds Schedule or from the main appointment scheduling screen, rounds button. This will include all rounds scheduled for the date range specified. It will search for all patients who have been admitted and not yet discharged for the selected date(s), providers, location, and status. Left Side filters: Date Range - the date will default to the current date but can be changed to any range to view rounds for those particular days. Provider(s) Select desired provider(s). If the rounds are accessed from the main appointment screen, the provider will default based on the current selection. Hospital/Location Select the location for which to view rounds. By default it will show all hospital locations. Status Select which statuses to view. Defaults to All Statuses. Scheduled for Rounds/All Patients at Facility radio buttons - the default is set to Scheduled for Rounds." If All Patients at Facility is selected, you will view all patients at the facility, even if they are not scheduled to be seen on that particular day.

5 Rounds Grid displays list of patients per selections and filters. Double click on a rounds visit to open the patient s Admissions and Rounds screen with the patient selected and the specific rounds visit opened. Fields that can be edited include: Provider, CPT/ICD9, Document, Status, Comment, and Sign. The grid contains the following columns: Rounds Date Hospital/Location Patient Name Schedule - Shift Floor/Wing Room Provider scheduled to see the patient. CPT/ICDs button. Click to select the ICDs/CPTs for this round. Hover/tooltip will show currently selected ones. Status Comments: free text comment about this particular rounds visit. Signed By - when this visit is signed it will display the username of the user who signed off the round visit. ***Once signed, the row will be read-only, The charges will show in the EDI => Charge Posting Interface under Rounds***