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Disposition View

## Disposing Patients and Removing Patients from the Display Board

##### Select a Disposition | Select a Reason for Delay | Enter ICD-9-CM Diagnoses | Enter Free-Text Diagnoses | Remove Patients Entered in Error | Remove Patients from the Display Board

The Disposition view enables you to enter patients’ dispositions and either free-text or International Classification of Diseases-9-Clinical Modifications (ICD-9-CM) diagnoses, depending upon how your site sets the application’s parameters.

If your site has enabled coded diagnoses, entering a diagnosis in EDIS adds the diagnosis to the emergency-department visit EDIS creates in CPRS. Conversely, adding a diagnosis for this visit in CPRS automatically adds the diagnosis in EDIS. (EDIS creates the visit when you select a physician, resident, or nurse in the Update view, or a nurse in the Triage view, or when you add a diagnosis in the Disposition view.)

Also depending on your site’s configuration, the Disposition view may require you to select a disposition or a delay reason (for patients whose emergency-department stays have exceeded your site’s specified time limit.) In addition, this view enables you to add or update provider and resident assignments, update room and area assignments, update patients’ statuses, save your changes, and remove patients from the display board.

Disposition view with ICD-9-CM diagnoses enabled.

### Select a Disposition

1. Select a patient in the Active Patients list. The system displays the Patient Information pane. Keyboard: use the TAB key to locate the Active Patients list. Use the DOWN ARROW and UP ARROW keys to select a patient from the list.
2. 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.

#### Defining National Disposition Selections

The EDIS TWG offers the following definitions for nationally released disposition selections:

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 evaluation clinic at the same site; 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.

### 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

  1. 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.
  2. Select an ICD-9-CM diagnosis from the 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 and press the ENTER key to select this 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 it.
  3. 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.
  4. Repeat steps 1–3 as needed.
  5. 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.

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

  > ### 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.

  > 1. 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.
  > 2. 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.
  > 3. Repeat steps 1–2 as needed.
  > 4. 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.

  > The Disposition view with free-text diagnoses enabled.

  > ### Remove Patients from the Display Board

  > - Click Save & Remove from Board to save changes and remove patients from the display board. Keyboard: use the TAB key to locate the Save & Remove from Board button. Use the SPACEBAR key to select the button.
  >   This button is available only after users have entered all of the disposition information your site’s EDIS implementation requires. If you haven’t entered a provider or acuity, the application alerts you to do these things before it allows you to save your changes and remove your patient from the board—unless your patient’s disposition is Patient Name Entered in Error, Left Without Being Treated / Seen, or Sent to Nurse Eval / Drop In Clinic.
  >   Clicking the Save & Remove from Board button removes patients from the display board and saves previously unsaved changes. While the application retains information about the visits of patients you’ve removed from the display board, only users who have access to the Edit Closed view will have direct access to this information. Users who have access to the Reports view will have indirect access to this information.

  > ### Remove Patients Entered in Error

  > 1. Open the Disposition list. Keyboard: use the TAB key to locate the Disposition list.
  > 2. Select Patient Name Entered in Error. Keyboard: use the DOWN ARROW key to select Patient Name Entered in Error.
  > 3. Click Save & Remove from Board. Keyboard: use the TAB key to locate the Save & Remove from Board button and press the SPACEBAR key to select it.

  > ### Save Changes

  > - Click Save to save your changes and exit the Patient Information pane, or click Cancel to exit the pane without saving your changes. Keyboard: use the TAB key to locate the Save or Cancel button. Press the SPACEBAR key to select the button.

  > Note: | The Save button is available only after you’ve added or updated information in the Patient Information pane.

  > ### Related Topics

  > General Information

  > Index

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