I was curious if anyone is in a system that participates in pre-hospital registration of the patient prior to their arrival in the ED via software apps (i.e. Pulsara, Twiage, or E-bridge) or takes information via some other form of communication. What, from an EMS provider, prospective have you found to be the benefits and/or challenges to this process?
Pre-hospital Patient Registration
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We trialed it as an ED. Trying to get local agencies to actively participate was difficult, but on the emergency and complex patients it was almost impossible (even though it would have had the most benefit). With a sick patient there is just too much to be done in the back of the truck. When I worked 911 most of our reports were written in their entirety after the call.
CANMAN
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This..... When I work my field medic gig I am the solo medic for the entire county sometimes. If I board a unit for a priority 1 patient I am too task saturated to do anything other then write down a name and DOB. Our local community ED makes us call in for a "info only" consult even if we don't need orders, which is a huge pain and sometimes you may not even have enough time to squeeze that in. I am lucky if by the time I show up the BLS providers have patient demographics written down and vital signs, most of the time I don't even get that.
Depending on the system and manpower I could see it working, but I also see hospitals pushing a lot of extra tasks off on EMS workers. Many of the local ER's here want you to walk over to this station to get registered, then get a set of vitals on the hospital machine, oh btw did you draw us labs, fill out this triage form, etc. while people chat at the nurses station and are shopping on Amazon.
NomadicMedic
I know a guy who knows a guy.
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I guess I've got it good... the registration folks follow us to the patient's room with their computer on wheels and register the patient's as we're moving them to the ED bed or giving report at the bedside.
Occasionally, if I've got time and it's a patient that was recently at the facility, I'll give the person taking the phone report a name and dob and they'll have records pulled up when I get there. For example, I recently had an unresponsive patient that is a frequent polypharm OD and on my way to the ED I called and told them it was Jane Doe, DOB 1/1/1900, and they that gave them some idea as to what was coming.
Occasionally, if I've got time and it's a patient that was recently at the facility, I'll give the person taking the phone report a name and dob and they'll have records pulled up when I get there. For example, I recently had an unresponsive patient that is a frequent polypharm OD and on my way to the ED I called and told them it was Jane Doe, DOB 1/1/1900, and they that gave them some idea as to what was coming.
E tank
Caution: Paralyzing Agent
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Sounds like the hospital, unwilling to hire personnel to do it's job is very willing to pass it off to ambulance personnel to do it for free...or did I miss the part where they paid you guys?
DrParasite
The fire extinguisher is not just for show
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Back in the day (IE, 7 years ago), we used to have to stop at registration for every patient, except for an alert (trauma, stroke, OB, or STEMI). helped the ER, but it caused backups when you had EMS stretchers lining up waiting to get registered.
Our charts were (in theory) supposed to be finished before we left the ER; by policy, all of your charts needed to be finished by the end of your shift. Realistically, on a stable patient, I could get the majority of my chart done before we hit the ER doors if I was working in the suburbs, and all but the narrative in the city.
From a practical standpoint, with electronic charting, I think it makes a lot of sense to pre-register the patient. electronically transmit the info, and the armband is waiting for you as you walk in the door. But on a complex or sick patient, I can see the crews not having any documentation done, because they are trying to prevent the patient from dying. but for the other <80%, I can see it as feasible. I can also see an ER getting annoyed that you bring in a train wreck, and didn't bother to preregister them in the system.....
Our charts were (in theory) supposed to be finished before we left the ER; by policy, all of your charts needed to be finished by the end of your shift. Realistically, on a stable patient, I could get the majority of my chart done before we hit the ER doors if I was working in the suburbs, and all but the narrative in the city.
From a practical standpoint, with electronic charting, I think it makes a lot of sense to pre-register the patient. electronically transmit the info, and the armband is waiting for you as you walk in the door. But on a complex or sick patient, I can see the crews not having any documentation done, because they are trying to prevent the patient from dying. but for the other <80%, I can see it as feasible. I can also see an ER getting annoyed that you bring in a train wreck, and didn't bother to preregister them in the system.....
NomadicMedic
I know a guy who knows a guy.
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Fixed that for you
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Where I'm at, we do not do field prehospital registration of patients. In our system, we're somewhat lucky in that only 2 EMR systems are in use: Cerner and Epic. I have no idea what prehospital chart systems are in use but they'd all only have to deal with those 2 hospital EMR systems. Probably the most difficult thing would be determining which patient you're referring to when you have multiple patients with the same or similar names and similar birthdays. If you choose the wrong one, then registration has to find a way to "fix" the problem. This is an issue (rare but happens enough) in the ED when registering patients in a "standard" manner.
Frankly, patient registration doesn't take much time as it's done concurrently with triage at all the facilities I'm aware of around here. It's essentially a "quick registration" done at triage and more info can be gathered later if necessary.
Frankly, patient registration doesn't take much time as it's done concurrently with triage at all the facilities I'm aware of around here. It's essentially a "quick registration" done at triage and more info can be gathered later if necessary.
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What would the benefit to EMS or even the patient be doing this? Obviously it benefits the hospital, but it would take more than that for EMS to get behind it.
DesertMedic66
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One of our hospitals has started meeting us in the ambulance bay with registration so they can start getting info as we are walking to the patient‘s room. That’s about all we get out here and while it isn’t much it is a big help. Otherwise we have to physically walk around and search for someone from registration which can take a while and often ends with us telling the nurse “Hey, I looked bit couldn’t find anyone. Bye”
With ImageTrend Elite Bridge, which is what I am assuming is E Bridge, they can see a lot of things we've typed so far. We are suppose to input that information, select the hospital we are transporting to, and post it for them to see it. My experience is NONE of the hospitals use it or even know how to access it. It's pretty unfortunate because they made a big push for us to do it, but it isn't even utilized. Some hospitals have asked me how they can access it and I have ZERO idea.
The only form of pre registration we do is tell in the phone ringdown the patient's name, birthday, and medical record number, if the patient is Kaiser. For every patient we transport to Veteran Affairs, we can do the same thing (name, birthday, social security number). In some counties I've worked in, we'll put their name and birthday on the 12-lead before transmitting it. Oddly, I did that in the county I currently work in, the county complained that was a HIPAA violation, and told me to stop.
I was pretty surprised. I told them my experience with other counties and how I was trying to help get STEMI patients registered, that I would think it meets one of the criteria to give protected health info (just like it does in other counties) for treatment, operations, and payment, but they told me no.... so I don't do it anymore in my current county... weird.My county can be dumb sometimes. Our protocol also says to put the dose, route, and frequency of medications the patient take, but they removed our ability to put that in. I sent an e-mail asking them to put that back in, but they never replied. For a short while, I was putting it in the narrative. Seems like everyone else just doesn't bother.
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I suspect that the biggest benefit would be to the patient, if the hospitals actually use that info and if the info exchange is duplex. A hospital should be able to see, in nearly real-time, what has been done and know upon arrival what they likely still have to do. If the patient has been "preregistered" then it should be even easier for the hospital to assign a room, pull meds, do labs, and all that other stuff without having the patient wait for a quick reg and triage to be done once they've arrived. If there's several patients lined up in queue for triage, if they've all been registered, their "account" is already available for a provider to input orders immediately instead of waiting for registration to create an account. The downside of this is since the patient is preregistered, you'd have to find a way to accurately record actual arrival time in the ED. This could have the effect of exposing how long "wall times" can actually be.
DrParasite
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Likely none to EMS; however, I can see it benefitting the patient. and isn't that what us patent advocates are supposed to do, help out the patient?
DrParasite
The fire extinguisher is not just for show
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Based on what I have read on EMTLife, I am pretty sure most hospitals don't care what wall times are; that's EMS's problem to deal with.
DrParasite
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That was my experience when we transitioned from paper charts to EMScharts. the ER staff kept asking for a copy of our run sheet (not unreasonably), and our management said they could go online and download it, as all of the hospitals were given access to the system; none of the staff I spoke to knew how to do that, or that they had that capability.
CANMAN
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I miss the days of coming in with a priority 1 and the ED staff was quick to get to work on the patient, and someone would jot information down on a paper towel and actually treat the patient first, enter info in later. Any information in the computer can certainly be helpful at some point, but it isn't during the first few minutes of stabilizing a critically ill patient. ED folks have lost touch of this, and if the computer is having problems, they can't login in, patient isn't registered, etc. it's like the entire flow ceases and no one will touch a patient until the problem is alleviated. I see it all the time, at multiple hospitals, in multiple states we go to. Technology has paralyzed us in many ways.
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Where I work, if we have someone that's in need of immediate continued care on arrival, we put that patient into a room and start working on them. Once the patient has been registered, we can later backchart. The one benefit of preregistration from the field is that basic patient info (name & DOB) is forwarded to the receiving facility and an account is created right then. This way things like associating a monitor to an account can be easily done, orders can be easily inputted via CPOE if needed, meds can be pulled under that account instead of "floor charge" and so on.
Technology advances can paralyze us if we let it. So can administrative issues/concerns that want to have all patient care "stuff" done and recorded on the computer and discourage us from providing care if the patient account isn't active yet...
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Our system uses Pulsara for STEMI and stroke activations. If possible (and it usually is since I can give my phone with the app on it to the Lt writing demographics) we are supposed to include name, DOB, and a photo of their license. The app has access to the camera so it's really pretty easy. This should make it possible for the patient to be fully registered on our arrival. In practice, if the charge nurse does not let the reg folks look at the ipad they get the alerts on, that does not happen. Our facilities are super good about meeting us at the door to grab one of our run sheet copies and get the patient registered on their mobile station anyway though.
We can also use Pulsara in lieu of a radio or phone report. You can take a picture of the paper quick report that our EDs want done anyway and basically fire that off to the ED and they'll get an alert and a bed for you. I forget we have that option and just use the radio mostly. They will not pre-register non-alert patients however.
We can also use Pulsara in lieu of a radio or phone report. You can take a picture of the paper quick report that our EDs want done anyway and basically fire that off to the ED and they'll get an alert and a bed for you. I forget we have that option and just use the radio mostly. They will not pre-register non-alert patients however.