Patient Movement Guide - FS - EpicTogetherNY
Patient Movement GuideUse this click-by-click guide to review the steps taken by different staff during common patientmovement workflows. Click on hyperlinks to jump within the document.Get Started!Version 1.8
Patient’s Current LocationSupplemental InformationExternal Transfers/Direct AdmitsADT Orders MatrixMilstein HospitalFacility Structure TableMSCHONYPatient Flow SMEsThe Allen HospitalPatient Flow EpicTogether LeadsWeill Cornell HospitalDavid H. Koch CenterDischarge/Readmit vs Leave ofAbsence (LoA)Alexandra Cohen Hospital (ACH)PMG Version InformationLower Manhattan HospitalWestchester Behavioral HealthCenterReturn to StartVersion 1.8
External Transfers/Direct Admits Ambulatory Clinic (Direct Admit)Outside HospitalNYP HospitalVersion 1.8
Patient is moving from Milstein Hospital Emergency DepartmentInpatient UnitOperating RoomRadiologyInterventional RadiologyCath/EP LabPediatric Hematology/Oncology/BMTOther Procedural AreaInpatient RehabInpatient PsychAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from MSCHONY Emergency DepartmentInpatient UnitOperating RoomRadiologyInterventional RadiologyCath/EP LabPediatric Hematology/Oncology/BMTOther Procedural AreaAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from The Allen Emergency DepartmentInpatient UnitOperating RoomRadiologyInterventional RadiologyPediatric Hematology/Oncology/BMTOther Procedural AreaInpatient PsychAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from Alexandra Cohen Hospital Inpatient UnitOperating RoomL&DReturn to StartVersion 1.8
Patient is moving from Weill Cornell Hospital Emergency DepartmentInpatient UnitOperating RoomRadiologyInterventional RadiologyCath/EP LabPediatric Hematology/Oncology/BMTOther Procedural AreaInpatient RehabInpatient PsychAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from David H. Koch Center Operating Room GI SuiteRadiologyInterventional RadiologyCath/EP LabPediatric Hematology/Oncology/BMTOther Procedural AreaAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from Lower Manhattan HospitalEmergency DepartmentInpatient UnitOperating RoomRadiologyInterventional RadiologyPediatric Hematology/Oncology/BMTOther Procedural AreaAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from Westchester Behavioral HealthCenter Inpatient PsychAmbulatory Clinic (Direct Admit)Return to StartVersion 1.8
Patient is moving from Emergency Department to Operating RoomInpatient UnitL&D UnitRadiologyInterventional RadiologyCath/EP LabEndoscopyOther Procedural AreaPsychInpatient HospiceEmergency DepartmentMobile Stroke Unit (MSU)Return to StartVersion 1.8
Emergency Department to Operating RoomEDSurgery DepartmentsWhoEDProviderOR SurgeonED ProviderOR SchedulerED NurseED NurseOR TransporterPeriop NurseReturn to StartAffected DepartmentsWest EDEast EDWest OREast ORDoes WhatPlaces Consult to General Surgery Order [CON4] and contacts OR surgeon.Assesses patient in the ED and then places a Case Request Order [SUR1], which auto-creates a new case.Select Admit for Disposition, then place the Send to OR [NUR1601] order. This automatically changes Patient Statusto "Send to OR."Schedules the surgery from the Case Depot.Creates Transport request (only if transport is used).Places the patient in the Off the Floor care area upon the patient’s physical departure.Completes Transport request.Case tracks the patient into the OR departments, which automatically transfers the patient into one of the surgerydepartments.Version 1.8
Patient is moving from ED to ED LMH Between Peds & AdultGreenberg Between Peds & AdultAll Other ED to EDReturn to StartVersion 1.8
Patient is moving from Emergency Department to Inpatientat Milstein/AllenMSCHONY HospitalWeill Cornell HospitalLower ManhattanAlexandra Cohen HospitalPsychiatryReturn to StartVersion 1.8
Milstein/Allen Emergency Department to Inpatient UnitEDAffected DepartmentsAll EDsInpatient UnitsMedical/Surgical UnitIntensive Care UnitWhoDoes WhatED ProviderIf Patient Is Moving To Inpatient Unit Within The Same SitePlaces Bed Request Order [ADT9], which includes question for Service assignment.Assigns patient (found in unassigned tab of bed planning) to appropriate provider team and marks provider team asprimary, which updates patient’s treatment team if applicable.Sees provider team assignment for patient on ED track board and contacts provider team to come down and seepatient.ED ProviderOnce the acceptance is verified, the ED Provider will complete Provider Endorsement in the Dispo Activity. This willmark the patient as Ready to Move.Sends secure chat message to PPOC confirming endorsementPPOCAssigns patient to room/bedEvaluates patient and places Orders for Inpatient care, using admission order set, including Admit to Inpatient OrderAdmitting Treatment Team[ADT1].Once bed is assigned (seen on track board/ED manger). Completes RN handoff, via Disposition activity andED Nurse / UACreates Transport requestED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes transport request and ADT Transfer event auto-completes. In the event that transport is not used toTransportertransport the patient, the Receiving unit UA/RN will arrive the patient to the unit via the Complete Transfer workflowPPOCED ProviderPPOCED ProviderIf Patient Is Moving To Inpatient Unit Within the Same Service Area (New Site)Places Bed Request Order [ADT9] and Transfer Center Order [ADT21], with Request Type of “Intra-HospitalTransfer”. This will ensure only one encounter is used.Assigns patient (found in unassigned tab of bed planning) to appropriate provider team and marks provider team asprimary, which updates patient’s treatment team if applicable.Sees provider team assignment for patient on ED track board and contacts provider team to come down and seepatient.Version 1.8
Once the acceptance is verified, the ED Provider will complete Provider Endorsement in the Dispo Activity. This willmark the patient as Ready to Move.Sends secure chat message to PPOC confirming endorsementPPOCAssigns patient to room/bedEvaluates patient and places Orders for Inpatient care, using admission order set, including Admit to Inpatient OrderAdmitting Treatment Team[ADT1].ED Nurse / UAOnce bed is assigned (seen on track board/ED manger). Completes RN handoff, via Disposition activityED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes Transfer workflow from Unit Manager upon the patient’s arrival, which causes patient to fall off the OffFloor Nurse/UAthe Floor care area on the ED track board.If Patient Is Moving To Inpatient Unit Different Service Area (Columbia to Cornell or Cornell to Columbia)Places Transfer Center Order [ADT21], with Request Type of “Cross Campus”, which generates a new encounterAssigns patient (found in unassigned tab of bed planning) to appropriate provider team and marks provider team asPPOCprimary, which updates patient’s treatment team if applicable.Sees provider team assignment for patient on ED track board and contacts provider team to come down and seepatient.ED ProviderOnce the acceptance is verified, the ED Provider will complete Provider Endorsement in the Dispo Activity. This willmark the patient as Ready to Move.Sends secure chat message to PPOC confirming endorsementPPOCAssigns patient to room/bedAdmittingUpdates pending preadmission, pends out of admission workflowEvaluates patient and places Orders for Inpatient care, using admission order set, including Admit to Inpatient OrderAdmitting Treatment Team[ADT1].ED Nurse / UAOnce bed is assigned (seen on track board/ED manger). Completes RN handoff, via Disposition activityED Nurse / UADischarges the patient upon the patient’s physical departure.Completes Admission workflow from Unit Manager upon the patient’s arrival, which causes patient to fall off the OffFloor Nurse/UAthe Floor care area on the ED track board.ED ProviderReturn to StartVersion 1.8
MSCHONY Emergency Department to Inpatient UnitEDAffected DepartmentsMSCHONY EDInpatient UnitsMedical/Surgical UnitIntensive Care UnitWhoDoes WhatPediatric MedicineContacts Peds Gen Hospitalist and Peds Admitting Team via Secure Chat.For admissions to pediatric sub-specialties – Place IP Consult to [Service] OrderED ProviderED ProviderPlaces Bed Request Order [ADT9], which includes question for Service assignment.Contacts the Peds Admitting Provider Team.Admitting/ Bed Coordinator Assigns patient (found in unassigned tab of bed planning) to appropriate provider teamED ProviderOnce the acceptance is verified, the ED Provider will complete Provider Endorsement in the Dispo Activity. This willmark the patient as Ready to Move. Sends secure chat message to PPOC confirming endorsement.AdmittingIF patient is going to an ICU Unit, Admitting will Pre-assign the patient to the unit.IF the patient is going to an inpatient floor, Assigns patient to room/bedEvaluates patient and places Orders for Inpatient care, using admission order set, including Admit to Inpatient Order[ADT1].Once bed is assigned (seen on track board/ED manger). Completes RN handoff, via Disposition activityRequests Transport.Places the patient in the Off the Floor care area upon the patient’s physical departure.Completes transport request and ADT Transfer event auto-completes.Admitting TX TeamED Nurse / UATransporterPediatric ICUED ProviderContacts Peds ICU Fellow via Secure ChatPICU FellowSees patient in the ED, determines if admission will be accepted and provides the ICU Attending name to ED ProviderED ProviderPlaces Bed Request Order [ADT9], which includes question for Service assignment.ED ProviderED Provider will complete Provider Endorsement in the Dispo Activity. This will mark the patient as Ready to Move.Sends secure chat message to PPOC confirming endorsementVersion 1.8
PPOCAdmitting Treatment TeamED Nurse / UAAssigns patient to room/bed, assigns the indicated provider teamEvaluates patient and places Orders for Inpatient care, using admission order set, including Admit to Inpatient Order[ADT1].Once bed is assigned (seen on track board/ED manger). Completes RN handoff, via Disposition activity andcreates Transport requestED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.TransporterCompletes transport request and ADT Transfer event auto-completes. In the event that transport is not used totransport the patient, the Receiving unit UA/RN will arrive the patient to the unit via the Complete Transfer workflowReturn to StartVersion 1.8
WCM Emergency Department to Inpatient UnitEDInpatient UnitsAffected DepartmentsGBG Adult and Peds EDWCM Inpatient UnitsWhoDoes WhatWCM Adult MedicineSelects Admit for Disposition. Places Bed Request Order [ADT9] and selects the appropriate service.Assigns patient (found in unassigned tab of bed planning) to the appropriate Inpatient Provider Team and marks thatPPOCteam as primary, which updates the Treatment Team.PPOCCreates Secure Chat group with ED Provider and Inpatient Provider Team for handoff.Calls Inpatient Provider Team member for handoff, then completes Provider Endorsement in the Dispo Activity withED Providerthe name of the Inpatient Provider Team member (this marks the patient as Ready to Move). Replies in Secure Chatgroup created by PPOC to confirm endorsement.PPOCAssigns patient to room/bed.Admitting Treatment Team Evaluates patient and places inpatient orders using admission order set, including Admit to Inpatient Order [ADT1].Once bed is assigned (seen on track board/ED manager), completes RN handoff via Dispo Activity andED Nurse / UAcreates Transport Request.ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes transport request and ADT Transfer event auto-completes. If transport is not used to transport theTransporterpatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.ED ProviderED ProviderConsulting ProviderED ProviderED ProviderPPOCAdmitting TeamED Nurse / UAWCM Adult Consulting Service (Medical ICU, Stepdown, Surgical Sub-Specialties, Medical Sub-Specialties)Places IP Consult to [Service] Order.Calls the ED Provider for the consult and sees the patient as needed.Selects Admit for Disposition. Places Bed Request Order [ADT9], and selects the appropriate service.Completes Provider Endorsement in the Dispo Activity with the name of the consultant (this marks the patient asReady to Move).Assigns patient (found in unassigned tab of bed planning) to appropriate provider team and marks provider team asprimary, which updates patient’s treatment team. Assigns patient to room/bed.Evaluates patient and places inpatient orders using admission order set, including Admit to Inpatient Order [ADT1].Once bed is assigned (seen on track board/ED manager), completes RN handoff via Dispo Activity andcreates Transport Request.Version 1.8
ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.TransporterCompletes transport request and ADT Transfer event auto-completes. If transport is not used to transport thepatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.WCM Inpatient BurnPlaces Inpatient Consult to Burn Order.Calls the ED Provider for the consult and sees the patient in the ED. Determines if the patient will be admitted.Selects Admit for Disposition. Places Bed Request Order [ADT9], selecting Surgery-Burn for service.Completes Provider Endorsement in the Dispo Activity with the name of the consultant (this marks the patient asED ProviderReady to Move).Assigns patient (found in unassigned tab of bed planning) to appropriate provider team and marks provider team asPPOCprimary, which updates patient’s treatment team. Assigns patient to room/bed.Admitting Treatment Team Evaluates patient and places inpatient orders using admission order set, including Admit to Inpatient Order [ADT1].Once bed is assigned (seen on track board/ED manager), completes RN handoff via Dispo Activity andED Nurse / UAcreates Transport Request.ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes transport request and ADT Transfer event auto-completes. If transport is not used to transport theTransporterpatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.ED ProviderBurn Provider/ NurseED ProviderWCM Inpatient HyperbaricED ProviderProvides pre-screening and places both Hyperbaric Oxygen Treatment order [PRO228] and Inpatient Consult toBurn Order [CON144].Burn Provider/ NurseAssesses patient in the ED and determines if the patient qualifies for an emergency Hyperbaric Oxygen Treatment.Completes consent form for HBO treatment.ED ProviderPlaces Bed Request Order [ADT9], selecting Surgery-Burn for service.Completes Provider Endorsement in the Dispo Activity with the name of the consultant (this marks the patient asED ProviderReady to Move).Assigns patient (found in unassigned tab of bed planning) to appropriate provider team and marks provider team asPPOCprimary, which updates patient’s treatment team. Assigns patient to room/bed.Evaluates patient and places Orders for Inpatient care, using admission order set, including Admit to Inpatient OrderAdmitting Treatment Team[ADT1].Once bed is assigned (seen on track board/ED manager), completes RN handoff via Dispo Activity andED Nurse / UAcreates Transport Request.Return to StartVersion 1.8
ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.TransporterCompletes transport request and ADT Transfer event auto-completes. If transport is not used to transport thepatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.WCM General Pediatrics or Pediatric Stepdown (Patients 18 Years Old Only)ED ProviderSends Secure Chat to the Ped Gen Hospitalist and Ped Admitting Resident roles.ED ProviderED attending speaks with the Ped Gen Hospitalist and ED resident speaks with the Peds Resident.ED ProviderSelects Admit for Disposition. Places Bed Request Order [ADT9], selecting the appropriate service.Completes the Provider Endorsement in the Dispo Activity with the name of the Ped Gen Hospitalist or PedsED ProviderResident (this marks the patient as Ready to Move).PPOCAssigns patient to room/bed and assigns the indicated provider team.Admitting Treatment Team Evaluates patient and places inpatient orders using admission order set, including Admit to Inpatient Order [ADT1].Once bed is assigned (seen on track board/ED manager), completes nursing handoff via Dispo Activity andED Nurse / UAcreates Transport Request.ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes Transport Request and ADT Transfer event auto-completes. If transport is not used to transport theTransporterpatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.WCM Pediatric Medical Sub-SpecialtiesPlace IP Consult to [Service] Order.Speaks with the consulting service to confirm admission and obtains the name of the admitting provider.Selects Admit for Disposition. Places Bed Request Order [ADT9], selecting the appropriate service and entering theED Providername of the admitting provider.ED ProviderSends Secure Chat to Peds Admitting Resident for handoff.Completes the Provider Endorsement in the Dispo Activity with the name of the Peds Admitting Resident (this marksED Providerthe patient as Ready to Move).PPOCAssigns patient to room/bed and assigns the indicated provider team.Admitting Treatment Team Evaluates patient and places inpatient orders using admission order set, including Admit to Inpatient Order [ADT1].Once bed is assigned (seen on track board/ED manager), completes nursing handoff via Dispo Activity andED Nurse / UAcreates Transport Request.ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes Transport Request and ADT Transfer event auto-completes. If transport is not used to transport theTransporterpatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.ED ProviderED ProviderReturn to StartVersion 1.8
WCM Pediatric Surgery and Surgical Sub-Specialties (Urology, Neurosurgery, Burns)Place IP Consult to [Service] Order.Calls the ED Provider for the consult and sees the patient as needed.Selects Admit for Disposition. Places Bed Request Order [ADT9], selecting the appropriate service and entering theED Providername of the admitting provider.Completes the Provider Endorsement in the Dispo Activity with the name of the consultant (this marks the patient asED ProviderReady to Move).PPOCAssigns patient to room/bed and assigns the indicated provider team.Admitting Treatment Team Evaluates patient and places inpatient orders using admission order set, including Admit to Inpatient Order [ADT1].Once bed is assigned (seen on track board/ED manager), completes nursing handoff via Dispo Activity andED Nurse / UAcreates Transport Request.ED Nurse / UAPlaces the patient in the Off the Floor care area upon the patient’s physical departure.Completes Transport Request and ADT Transfer event auto-completes. If transport is not used to transport theTransporterpatient, the receiving unit UA/RN will Arrive the patient to the unit via the Complete Transfer workflow.ED ProviderConsulting ProviderWCM Pediatric ICUCalls or sends Secure Chat to PICU Fellow.Sees the patient as needed, determines if the admission will be accepted, and provides the name
Patient Movement Guide Use this click-by-click guide to review the steps taken by different staff during common patient . primary, which updates patient’s treatment team if applicable. ED Provider Sees provider team assignment for patient
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o Additif alimentaire. 41 Intrants alimentaires: o Matière première : matière unique ou principale soumise à la transformation Unique : blé en minoterie, betterave ou canne en sucrerie Principale en volume : lait pour le yaourt, eau pour les boissons gazeuses Principale en valeur : sucre pour les boissons gazeuses 1. Chapitre introductif 1.4- Intrants et produits des IAA. 42 o Ingrédient .
