Pediatric Informatics: Computer Applications in Child Health (Health ...

72 M.A. Del Beccaro et al.
7.3.1 PEM Workflow and Information Distinctions
The management of PEM patients and information generally consists of three
phases:
Pre-hospital/pre-emergency-department:
This topic is broad and beyond the
scope of this text32 and many field communications issues are already standardized.
Pediatric EDs, PICUs, and NICUs are parts of regional emergency
networks that are connected and coordinated for patient allocations that are
regulated. Each part of the network is accessed through a central communication
network that connects community providers with emergency medical and
transport services. ED information systems must communicate with the field on
multiple levels (voice, telemetry, visual) and with other nodes in the network and
must be able to maintain an audit trail of communications.
Emergency department management:
Patients transported to the ED are triaged
and admitted according to the acuity of their need. Patient information is collected
and entered into the ED information system for identification, diagnostic
testing and therapy, and billing. ED patient identifiers and data are linked to
inpatient systems as required. ED information systems must match the pace of
clinical work.
Disposition:
Patients may be discharged home, observed in the ED or in a
“short-stay” unit, admitted to an inpatient floor or higher level of care (critical
care unit or operating room), transferred to another facility or in some cases,
they may die in the ED. Each of these cases is associated with ED creation,
organization, and communication of information for care transition. ED information
systems must be able to facilitate the packaging of information in each
of these diverse outcomes.
7.3.2 PCC Workflow and Information Distinctions
PICU management can similarly be divided into three phases:
Pre-PICU management:
Patients may come from a variety of sources, including
the pediatric ED, the pediatric inpatient floor, the operating room or postanesthesia
recovery room, another critical care unit (such as the NICU) or in
some institutions direct admissions from field responses—often “life flight”
scenarios. In each case, the pre-PICU care of the patient must be summarized
and organized according to a problem list for management in a PICU information
system.
PICU management (NICU covered in Chapter 4) : This topic is broad and
beyond the scope of this text, but IT is essential to managing the large volume
of data used in PCC. 33
Post-PICU management:
This is similar to ED disposition, however, the volume
of information that must be processed may be much larger, since the pre-PICU
management must be summarized in addition to that from a prolonged PICU stay.