Triage and referral in Tasy: the emergency department workflow

In the emergency department, the record has to move with the patient. When it lags, waiting times become fiction and the admission's account starts incomplete. The ED workflow in Tasy and what to measure.

Clic Health teamUpdated July 12, 20264 min read

The emergency department is the hospital's most unpredictable door and, in many hospitals, the main source of admissions. In Tasy, the challenge is to record at the pace of care: when recording is left for later, waiting times become fiction, risk classification stops helping to prioritize, and the admission that comes from the ED starts with an incomplete account.

The workflow in the system

Step	What is recorded	The time that starts here
Arrival and opening	Emergency encounter, identified or unidentified patient	Arrival time
Risk classification	Priority, vital signs, complaint	Time to classification
Physician visit	History, examination, plan, requests	Door-to-doctor time
Tests and medication	Requests, collections, administration	Time to results
Observation	Patient in an observation bed	Observation time
Outcome	Discharge, admission, transfer, death	Total ED length of stay

Risk classification

Classification decides who is seen first. In Tasy it is recorded on the encounter with the color or level and the time. Two points of care:

record it on the spot, not at the end of the shift; otherwise the time to classification is lost;
reclassify when the condition changes, recording the new level and time.

The classification protocol is clinical and belongs to the hospital; the system only records it.

Unidentified patients

An unconscious patient or one without ID enters through an unidentified-patient workflow, with a temporary identifier. As soon as possible, registration is completed and the front desk searches for the person's existing record before creating another. Without that care, the ED is the hospital's biggest source of duplicates (patient registration in Tasy).

Observation is not admission

ED observation beds are not inpatient beds. A patient under observation remains in the emergency encounter and does not enter the census. If observation turns into admission, the hospital's workflow defines whether the encounter is converted or a new inpatient encounter is opened. What cannot happen is a patient staying "under observation" for days when, in practice, they are admitted: the account and the KPIs end up wrong.

From the ED to admission

The physician decides to admit and records the request.
Bed management reserves the bed (bed management in Tasy).
Payer: admission authorization, when required.
Admission to the bed, at the real time.
What was done in the ED (tests, medication, procedures) goes to the account according to the payer's rule (on the admission's account or on a separate ED account).

See inpatient admission in Tasy.

The times management should track

Door to classification: from arrival to risk classification.
Door to doctor: from arrival to the first physician contact, by classification level.
Time to results for lab and imaging.
ED length of stay: from arrival to outcome.
Boarding time: from the decision to admit to the actual admission. It is the KPI that shows when the ED is paying for the hospital's occupancy.
Left without being seen: patients who leave before the visit.

All of them depend on timestamps being recorded on the spot. An average door-to-doctor time of two minutes usually means late recording, not an exceptionally fast ED.

Mistakes that stall the ED account

ED encounter left open after admission or discharge.
Medication and supplies administered and not charted.
Tests done and not posted, or posted on the admission when the payer requires them separately.
Payer not checked at entry and changed later.

The link with occupancy

When hospital occupancy passes a certain point, boarding time rises and the ED becomes an improvised ward. Following both KPIs together shows the problem before the crisis; see hospital occupancy rate.

Who writes this

Domínio has worked for more than 20 years with hospitals that run Tasy and follows, from the management side, the times and accounts of the emergency department. To talk about your hospital's ED, reach us on WhatsApp or at comercial@dominiocontabil.com.br.

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