ED Resident Workflow Process
Start of shift
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Log in. Sign in; answer shift length question
Go to All Patients tab on the ED track board and sort by age to identify all ED patients 0-18 years.
For Patient Care
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Take sign-out from leaving resident. Check to assure appropriate patients have been assigned to
your Treatment Team. NOTE: all additional documentation for patients signed out to you should be
made as a PROGRESS NOTE. Do NOT start a new H&P Provider Note.
Check which patients are waiting to be seen. Also remember to check BHED and other Team tabs to
identify any pediatric psych patients waiting to be seen. Assign yourself to a new patient. (TIP: once
you do this clock starts re: time to provider)
Highlight patient and select Review Visit tab. Review content (triage, chief complaint, etc.); mark as
reviewed for each section if completed by nurse. Much of this content will be auto populated into
your note. Update as appropriate and refresh your note. You are responsible for making sure this
information is accurate. (TIP: If you do this before RN completes charting then updated information
may not transfer into your note. You can, however, review and mark as reviewed after they enter
the information, then refresh your screen, and this updated info will transfer into your note. Good
sources for patient information, especially vital signs and PAS, include the Snapshot Tab and the
Patient Timeline.
See patient then staff patient with attending; assign attending if not already assigned
ORDERS: Highlight patient and select Order tab. Enter orders; always use order sets and order
preference lists to identify appropriate PED orders. To access the preference list click on the green +
sign in the order search box; do not type into the box.
This ensures that orders, especially medication orders, are appropriate for the ED setting.
Use auto-calculation function of Epic to calculate medication does and fluid bolus volumes; avoid
manual calculation. Review orders in the order composer in Epic before accepting. (TIP: Use
Pediatric Lexicomp on screen to check ordering doses)
Highlight patient and select Provider Note. Create note using Notewriter; limit free text except to
record Course. Specify date or number of days (vs. name of day) when documenting history.
Document relevant patient course under ED Course section and use the smart phrase .TIMESTAMP
to record time. Document PAS using the Peds Asthma Score document under Progress Notes.
Document your initial impression, differential diagnosis, planned workup and need for consultation
under the ED Assessment/Plan section. This, along with the sections under the Coding Tab, is the
medical decision making portion of the chart. Use the coding tab and enter appropriate patient
information. Return to Review Visit tab and modify information as appropriate, then refresh the
screen. Every time you enter info in the Review Visit tab you need to refresh your provider note so
the new information is updated in your note. Review Lab and X-ray RESULTS as they return and, if
Revised 11/10/2015 CWK
you personally view images, document your read in the relevant section under the coding tab. Place
Consult Order Request whenever Consult is called and go to Consult Update link on Track Board –
click “called” and then “Accept”. (TIP: This triggers the timer for when team or consult has been
called). Add your clinical impression in the discharge or admission navigator and then refresh your
provider note; this will draw the clinical impression into the chart. Select as many clinical impressions
as are appropriate and include active co-morbidities. (TIP: Double click on an item in the problem list
and it will pull that diagnosis in as one of your clinical impressions).
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If you are the first provider at UNC PED to see a transfer patient from Hillsborough-create a blank
provider note (the ONLY exception to the rule that Notewriter template must be used and that a
patient can have only one provider note) but use the smart phrase “EDPROVHBTOUNCACCEPT” to
document.
If a PROCEDURE is done, EVEN IF UNSUCCESFUL: highlight the patient and select the Procedures
tab. Assign the appropriate Supervising Attending if requested. Create note; use templates if
available to ensure you are capturing key elements for documentation and billing. Ensure that the
date and time documented are the actual date and time the procedure was performed.
For PSYCHIATRY/MEDICAL CLEARANCE patients perform your usual ED assessment and
documentation as outlined above. Orders: There is a nursing order set for pediatric psych patients. If
no nursing orders have been placed select ED NURS PEDS PSYCHIATRIC_OVERDOSE.
Place an order for an Inpatient Consult to Psychiatry (not Pediatric Psychiatry). Call consultant.
Once they return the call, go to the Consult tab and update your consult order by clicking “returned
call” to stop the timer. Place a sticky note on the track board when medically clear. Use the smart
phrase .RGMPSYCHHPI to document your history.
For DISCHARGED patients select the Discharge tab and complete the discharge navigator segments.
o Enter a CLINICAL IMPRESSION (discuss with your attending if unsure what is appropriate).
o Check off discharge in the Disposition.
o Review the patient’s home medications and make recommendations. (TIP: Be sure to
enter any prescriptions into the prescription section and not the ED Order section).
o Review AVS and PRINT.
o Discuss discharge instructions with the family, give them discharge papers and discharge
them from the ED. Type LEFT @ time in the STICKY NOTE.
o Have parent SIGN, date and time the discharge. Place signed and dated page in basket next
to printer. It will be scanned into the Epic chart.
For ADMISSIONS select the Admit tab and complete the admission navigator segments: a) record
CLINICAL IMPRESSION, b) ORDERS – enter an order for ED BED REQUEST. This is the ADT 9 order, c0
AFTER placing the order CALL the PAC and ask whether the patient can be an Express Patient, name
of attending and service, d) CALL Pediatric Nursing Supervisor at 4-5402 to notify re: need for bed;
indicate whether this patient is an Express Patient or not, and e) Place STICKY NOTE on the patient
tracking board with the following: Admit to XXX (service code)/Attd = Dr. X/Dx =XYZ/LOC=floor
status or PICU, etc. If patient is an EXPRESS patient also note that on the sticky note.
End of shift
Revised 11/10/2015 CWK
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Complete all charts; make sure that the chart is assigned to the first attending you staffed the
patient with. All resident provider notes must be signed within 24 hours of seeing the patient.
Check CODING NARRATOR and assure all coding elements are in place, AND THEN sign the chart.
Check your In Basket and complete any outstanding items.
Assign any of your remaining patients to the incoming resident.
Revised 11/10/2015 CWK