Connect Care Manual - Patient Attachments

Patient Attachments

Sometimes clinicians need to find patients associated with a particular provider, or a particular hospital, service, ward or clinic. The Patient Lists activity supports browsing of system, team, shared and personal lists. When greater precision (e.g., admitted patients associated with a specific provider during a specific time interval) is required, attachment reports can be generated. In all cases, it is important to understand the different attachments that a patient can have, as well as the functional significance of those attachments.

Provider Attachments

Physicians, nurse practitioners, clinical associates and other "prescribers" can be attached to patients. The type of attachment roughly represents the prescriber's accountability for patient care in a particular context.

Inpatient
- Admitting Prescriber
  The admitting prescriber is the one whose name is (optionally) entered to a patient’s admission order. Given on-call and complex bed-allocation challenges in some facilities, the admitting prescriber is usually not emphasized. The important accountability is the attending (most responsible) prescriber, often different from the admitting prescriber. A most responsible (attending) prescriber must be assigned on admission (hard-stop on admission orders).
- Attending Prescriber (Most Responsible Healthcare Provider, MRHP)
  The attending prescriber is the prescriber of record with overall management responsibility for the care of an admitted patient at any given point in time. There must be at least one attending assigned, and only one at at time, but there can be a series of attending prescribers assigned during a facility stay.
- Authorizing Prescriber
  The authorizing prescriber is the prescriber under whose authority an order is placed. This person can be an admitting, attending or trainee prescriber but not a student prescriber.
- Referring Prescriber
  A referring prescriber is the person referring a patient for an encounter. This information is important for professional billings. If an inpatient was seen by an emergency department prescriber who requested the admission, that person should be listed as the referring prescriber (acceptable for billing purposes). If the admission was direct to an inpatient service, then the referring family physician, specialist or external emergency specialist suffices for billing purposes.
- Consulting Prescriber
  A consulting prescriber is a prescriber asked to see a patient by an authorized provider. On consulting services, the consulting prescriber is also the authorizing prescriber.
Outpatient
- Encounter Prescriber
  The encounter prescriber is the prescriber of record responsible for managing an outpatient, scheduled, virtual or telephone encounter with a patient. There can be only one encounter provider per encounter.
- Authorizing Prescriber
  The authorizing prescriber is the prescriber under whose authority an order is placed. This person can be an encounter prescriber or trainee prescriber but not a student prescriber.
- Referring Prescriber
  A referring prescriber is the person referring a patient for an encounter. This is important for billing purposes and should correspond to the provider who referred for the outpatient assessment.

Prescriber-patient attachments can be encounter-limited (e.g., persisting only for the duration of an inpatient admission), time-limited (e.g., consultant without follow-up outpatient visits falls off the patient team after a set number of months) or function-limited (e.g., primary provider for a particular specialty). Some attachment types are easily managed using the "Care Teams" activity.

Tip: Managing Prescriber-Patient Attachments
Tippy: Managing Attachments from within Patient Lists
Key Concepts: Clinician - Practitioner- Prescriber (includes tables defining provider-patient attachments for different care contexts)

Provider Team Attachments

The Care Team management tools work well for quick adjustments to both prescriber and provider team patient attachments.

Provider team attachments can also be changed for one or many patients (batch updates) by using the Patient Lists inpatient tools.

Tip: Managing Prescriber-Patient Attachments

Service Attachments

The inpatient service to which a patient is admitted is important to bed-planning and reporting activities. Post-admission, the service assignment can get out of sync if a patient is transferred (e.g., ward to critical care) without updating the inpatient service. When prescribers become aware of this, the fastest fix is to place an “Update Patient Status” order and select the correct inpatient service.

Each inpatient ward should make sure that nurses, managers, clerks and prescribers have a reliable protocol implemented to make sure that the inpatient service is checked and updated at every intra-facility transition.

Facility Attachments

Finding patients linked to a particular facility is relatively straightforward and is best done with Patient Lists. System lists, combined with the "Search My Lists" (top-right corner of any patient list) facilitate searching for patients who have a facility (e.g., inpatient, hospital day ward) relationship but not yet a personal prescriber relationship.

Facility (Patient) Class

Patients attached to a particular facility (i.e., hospital, program or service) can be subgrouped according to the "Class" of care that they receive. The most common care classes are: Inpatient, Outpatient, Emergency, Home Care, Continuing Care, Community Rehabilitation, Day Surgery and Virtual Home Hospital. The care class affects things like navigator availability (e.g., admission navigator), ordering mode (i.e., inpatient vs outpatient) and defaulted templates for summative or progress documentation.

Facility (Patient) Status

Patients attached to a particular facility (i.e., hospital, program or service) can be subgrouped according to the "Status" of their encounter. The usual options are: Preadmission, Admission, Leave of Abscence, Hospital Outpatient Visit and Discharged. The Status variable is normally set and controlled by ADT (admission/discharge/transfer) staff and workflows. Clinicians can consider whether the Status is appropriately updated if expected navigators or other tools are not available in the expected way for a particular patient encounter.

Facility (Patient) Level of Care

Patients attached to a particular facility (i.e., hospital, program or service) can be subgrouped according to the "Level of Care" (LOC) that they are designated to receive. The most common levels are: Acute, Labour and Delivery, Critical Care, Emergency and Alternate Level of Care. The level of care rarely affects workflows or tool availability but commonly affects things like metrics and reminders.

Patient Attachment Reports

Prescribers may want to generate snapshots of their patient attachments for a particular period of time or sphere of activity. For example, it could be helpful to list all patients for whom one was an attending physician during a particular week, or all patients that one discharged during that period, or all that one worked with for a particular procedure. These needs are best addressed with Reporting Workbench, which offers an ability to create, save and share reports listing patients matching one or more criteria.