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EDIS Outage Processes for Sunshine Hospital Emergency Department (SHED)

This document provides a summary of best practice in relation to EDIS outage processes for Sunshine Hospital Emergency Department (SHED). The summary has been created to support staff during the Sunshine Hospital Emergency Department Redevelopment transition and early post-move period, and has been endorsed by the ED Leadership Team.

 

OUTAGE PLAN – FEBRUARY, 2021

EDIS Outage Overview

An EDIS Outage is when the EDIS system is no longer accessible or functioning in its intended form. Outages can be intermittent or complete. Intermittent outages impact the performance of the application. Complete outages are when the whole system does not function for its intended use. Outage events are either planned or unplanned.

Planned Outage

Planned outages events occur as part of normal system operation, to carry out maintenance actions or minor upgrades that cannot be performed while the system is active.

With a planned outage the date, time and duration of outage is known in advance and is communicated to the Western health Emergency Departments prior to the event.

Unplanned Outage

An unplanned EDIS outage is not a scheduled event. At the time it occurs, neither the cause nor duration will be known.

In the unplanned event the NIC will first call the AHA and after discussion, if required 444 and report a Code Yellow EDIS administration system.

In the event of any unplanned EDIS outage the issue will also be reported to the ICT Service Desk as per WH procedure. The ICT Service Desk will undertake first level investigation and escalate to the appropriate team if required.

When an unplanned outage occurs staff must first undertake a process for diagnosing the extent of the issue. This informs conversations with the IT department, allowing the issue to be resolved. It also informs the incident management team and the decisions they make for managing the situation.

Before a Planned EDIS Outage

Prior to a planned outage, the following actions should be taken to prepare the department for the outage:

  1. SHED Triage Clerk to source pink CAS Cards from EMR or EDIS Downtime Box four hours before the planned outage to ensure sufficient supplies during outage. Pink CAS cards are only to be implemented once outage starts.
  2. Hospital wide-planned ICT disruption notices to be sent by ICT in the 24hrs prior to the outage.
  3. The SHED leadership team are to communicate the planned outage to the senior clinicians of the shift that the outage occurs.
  4. The NIC and EPIC to communicate the planned outage at SHED huddles and handover meetings throughout the day.
  5. AHA (out of hours) – Emergency Medicine Operations Manager (in-hours) to attend (or call) ED 15 minutes prior to outage, to complete ready checks and to confirm the department is good prepared to manage the outage.
  6. NIC to print current patient lists 15 minutes prior to outage and one of each is given to AHA:
  • In EDIS, print x 6 “Department Overview” (go to “Overview” in Main tab then press Print button)
  • In EDIS, print patient “Location Screen” (alphabetical order and Cubicle Number order – go to “Patient Location” under Main tab then press Print button x3)
  • Open intranet “EDIS Dashboard” (search for “EDIS Dashboard” on Windows Search) Print EDIS Dashboard “Bed Request” list X 5.

NIC to ensure SHED Pod Leads are ready for outage:

  • Each pod to have whiteboard and markers to track patients (including a whiteboard for each of AV Arrivals, Adult Wait and Children’s Wait)
  • Triage to have blank pink CAS cards
  • Prepare EDIS downtime box
  • Laminated action cards for:
    • Pod Lead Roles
    • Instructions for printing off EDIS Overview Screen/EDIS Location Screen/EDIS Dashboard screen
  • Pink CAS Cards
  • Pathology Slips
  • Radiology Slips
  • Medication Charts
  • IV Fluid Charts
  • Markers for Whiteboards
  • Red & White ID Bands
  • Sick Certificates
  • ED Progress notes
  • Adult and Paediatric Observation Chart

If there is concurrent iPM or EMR outage also follow the iPM section in the Business Continuity Plan and EMR business continuity plans.

Unplanned EDIS Outage

If possible, screenshot of EDIS tracking screen taken and print EDIS dashboard if able.

NIC to Contact Access/AHA. AHA to attend SHED as for planned outage.

The SHED NIC will announce over the SHED PA system that an EDIS outage.

Access/AHA to call a Code Yellow – via 444. The code yellow should be the EDIS patient administration system.

Bed Manager to attend ED to support SHED flow during EDIS outage.

In-hours – NIC to contact Emergency Medicine (EM) Operations Manager. EM Operations Manager is to assemble available SHED leadership team. EDIS outage ‘Huddle’ to occur in Main Staff base to assess the situation.

AHA/EMA Operations Manager to immediately request a period of infrastructure divert – initially the request should be for 30mins. After 15 minutes the request should be updated, pending on the situation.

Commence assessing the extent of the outage or diagnosing the issues with the IT systems (see Appendix 4).

NIC/AHA/Access to deploy available resources, ensuring allocation of pod leaders and awareness of tasks associated with role.

EDIS outage incident command structure:

Incident Commander: Access Manager (in hours) AHA (out of hours)

Area Incident Commander: Nurse In Charge

Clinical Lead: Senior Medical Officer in Charge

Clerical Lead: Communications Clerk

Environmental Service Leads: PSA/ESA in charge

Pod leads:

Triage: Adult Triage Nurse 1/Clerk Triage 1/Adult Wait Room Nurse

Adult Acute: Paediatric Code Nurse/Comms Clerk

Short Stay Unit: NIC SSU/SSU Clerk

Children’s Area: Children’s Team Leader/Comms Clerk

EDIS Outage Flowchart

Planned or Unplanned EDIS Outage Processes

Each Pod Leader to track patients and their location and status on the Pod whiteboard.

The following actions should be taken across the emergency department

Existing patients:

  • All existing patients need to be placed on the relevant pod/area whiteboard.
  • As existing patients are discharged they should be crossed out on the whiteboard, but not removed.
  • Medication management should occur on paper charts. Pathology, Radiology, IV Fluids and Medication management as per usual via EMR.
  • When transferred to another point of care – any additional paper charts should accompany the patient

New patients:

  • Triage nurse documents Triage notes on pink CAS cards then hands to Triage Clerk.
  • Any new presentations post EDIS Outage should be added to “New Triage Patients” sheet using iPM labels.
  • (Allows for quick reference for putting patients back on EDIS once outage complete)
  • Triage Clerk registers patient on iPM and prints labels and wristbands from iPM and places label on pink CAS card and appropriate ID Band on patient. Pink CAS Card is photocopied.
  • Pink CAS Card photocopy (for re Triage on EDIS) remains at Triage with Clerk, original goes to NIC who will allocate the patient.
  • SHED doctors will write their time seen, clinical notes on the pink CAS cards and on discharge, write time discharged and give the pink CAS card to the SHED clerk. Discharge letters may be printed using MS Word and then a copy left with the pink CAS card with a Bradma label ready for scanning to Bossnet
  • SHED doctors will write on ED Progress notes if there is no pink CAS card.
  • SHED doctors will write on ED Progress notes if there is no pink CAS card. Pathology, Radiology, IV Fluids and Medication management should occur on paper.

General:

  • SHED staff including doctors will utilise and update whiteboard to allocate themselves to patients and inform NIC of status changes such as bed requests or discharges.
  • NIC will maintain a bed request register on the printed EDIS Dashboard sheet.
  • If on EDIS, patients will follow usual processes for pathology and radiology, if not paper based processes are required.
  • If the EDIS Outage last longer than 60 minutes the incident management team should consider calling in extra resources to manage the department and support the stand down – return to normal business processes.

EDIS Outage Stand Down

EDIS Outage completion cannot be called until it is safe to do so. Prior to the standing down of the outage – a huddle of the incident management team should occur. To initiate an EDIS Outage completion the issue impacting the EDIS has been resolved to a point that enables safe patient care to be delivered through EDIS.

Process for outage stand-down:

  • Code yellow stood down (unplanned only).
  • NIC announces outage is complete.
  • Triage Nurse to start triaging new arrivals on EDIS.
  • Clinical lead to ensure all patients medical files are up to date. This includes the transcription of any medication administration of prescribing is completed with the support of the SHED Pharmacist. ED Progress notes will also need to be added to the patient medical file.
  • Resource nurse will collect CAS Card photocopies from triage and enter patient onto EDIS.
  • Triage will be prefixed with “Retrospective entry-EDIS Planned/Unplanned outage (DATE/Time) and triage will be transcribed into EDIS from Pink CAS Card.
  • Triage Clerk updates EDIS by linking patient details using UR as per usual, then prints EDIS Bradma labels and attaches label to all paperwork for that patient’s presentation (unless patient was admitted in which case new admission iPM labels are used as per usual).
  • As patient now will be on EMR, Triage Clerk to print an EMR wristband and replace old wristband with the EMR one.

Medication Reconciliation Processes

Reconciling paper medication charts to EMR:

During business hours –

Clinical pharmacist deployed to Emergency will assist with screening patients currently on paper and will work with an assigned senior Medical Officer to reconcile medication charts for patients who meet the below transitioning criteria.

Out of business hours –

AHA to coordinate transitioning resources. Transitioning to EMR to be postponed until usual business hours if this is near/possible. If transitioning outside of hours, in the first instance this can be performed by a senior Medical Officer and a senior member of nursing staff. If deemed necessary/urgent, the AHA can escalate to the on-call pharmacist for assistance.

Transitioning Criteria:

Inclusion (to be transitioned)

  • Patient is charted for routine administration of medication
  • AND one of;
  • Patient is planned for admission to an inpatient ward at Western Health
  • Patient is not currently planned for admission, but unlikely to be discharged from Western Health within the next 4 hours

Exclusion (to remain on paper)

  • Patients who are planned for discharge from Western Health within the next 4 hours
  • No regular medications currently charted

Patient Care

Please be aware that during the outage we will not be able to access:

  • ED STATUS
  • Department MAP
  • Department Overview
  • SECOND SCREEN
  • MIYA
  • EDIS Dashboard
  • Wait Room Application

Note:

New patients who are triaged on paper will not be registered in EMR and will require medication charting and administration to be complete on the appropriate paper charts (found in the downtime kits). Discharge prescriptions for these patients will also be required to be handwritten on paper script pads.

If EMR is still live, patients already registered in EMR will have their medications continue to be managed in EMR.

 

EDIS Outage Action Cards

 

NURSE IN CHARGE (Area Incident Commander)

Planned EDIS Outage Role

  • Request 6 x copies each from the comms clerk 15 minutes prior to Planned EDIS Outage

(1x NIC, 1x Comms Clerk, 1xAHA and 3x PODS):

  • EDIS Department Overview
  • EDIS Patient Location Screen
  • Bed Request Form (Appendix 3)
  • Notify all SHED staff using PA system 15 minute prior to outage to prepare

Unplanned and Planned EDIS Outage Role

  • EDIS Outage occurs
  • In an “Unplanned Outage” the NIC must attempt to print Department tracking/Overview/Location and EDIS Dashboard BED REQUEST as a first priority
  • Announce over SHED PA that EDIS outage has occurred
  • Notify the EMA Operations Manager and/or Access/AHA
  • If Access/AHA has not yet called – Dial 444 and call a Code Yellow – EDIS patient administration system.
  • If Access/AHA has not yet called – Notify ICT desk on 8345 6777 ASAP to trouble shoot and escalate accordingly
  • Immediately huddle with the area incident response team and assign Pod leadership role.
  • SHED NIC to notify the Pod Leads to commence white board and downtime box use to document patient details.
  • SHED NIC must maintain an overview of status in the SHED Pods and document Adult Acute Area on the whiteboard
  • The following details are to be recorded on the white boards:
    • Name & UR number
    • Location
    • Gender
    • Age
    • Doctor
    • Nurse
    • Chief complaint
    • Plan
  • The Pod Leads are to notify the SHED NIC of all patient movements and provide 30/60 updates via phone.
  • Pink CAS Cards to remain with NIC/Pod Leads and Leads to Manage Waiting Room, Patient Allocation, Treating Doctor and Nurse Times/names on whiteboard
  • Photocopies of Pink Cas Card to remain at Triage for reassessment purposes
  • NIC to provide AHA with 15/60 updates and record a time line of events
  • Every 15/60 the Waiting Room is to reconcile the whiteboard with patient location.

 

ACCESS SUNSHINE

ACCESS MANAGER/AFTER HOURS ACCESS (AHA)

BED MANAGER

Planned EDIS Outage Role

  • Retrieve copies of EDIS documents as per their internal guidelines
  • AHA to attend SHED 15/60 prior to scheduled EDIS outage
  • Collect Department overview and last printed bed request form from NIC

Unplanned and Planned EDIS Outage Role

  • Increased communication and based in the ED throughout the outage period and provide direct support to the SHED NIC
  • Communicate with AV as required
  • Communicate with Footscray and Williamstown
  • Escalate issues to director on call as required
  • Check in with ICT/EDIS team every 30/60 during unplanned outage
  • Systems such as ED Status App, WH Test Page and IPJS will be offline throughout outage period.
  • MIYA will show only INTERHOSPITAL TRANSFERS only, will not update with new patients effected by EDIS outage
  • Communicate every 15/60 with Bed Manager to convey any changes/new requests/cancelled requests/patient requirements on ward
  • Coordinate use of bed request forms and access within the hospital
  • iPM labels must be placed on the Bed Request Form at NIC desk
  • Strict adherence to manually writing Discharge times to Wards and Allocated Wards in order to update EDIS post OUTAGE.

 

EMERGENCY DOCTORS including CLINICAL LEAD (Senior Medical Officer in Charge)

Unplanned and Planned EDIS Outage Roles and processes

Clinical Lead role:

  • Clinical Lead (Senior Medical Officer in Charge) to conduct 30/60 huddles with all medical staff in the Pod
  • Clinical Lead (Senior Medical Officer in Charge) in Pods to reconcile whiteboard with lead staff member every 30/60
  • Clinical Lead (Senior Medical Officer in Charge) to maintain overall medical status with ED NIC

Medical staff processes:

  • NOTE: Second Screen and EDStatus will not be functioning correctly in an EDIS outage.
  • Patients already on EDIS AND EMR prior to outage:
    • Pre-existing EDIS notes for that attendance and past attendances should be available on Bossnet
    • Write further notes on ED Progress paper sheets ensuring patient Bradma is attached.
    • Document time of discharge and disposition on this sheet.
    • These will then go with the paper nursing obs charts with patient to ward after clerks have processed them, or, for those discharged home, to clerks for scanning into Bossnet.
    • Covid screening, pathology/radiology orders, prescribing and ED Interim Admission orders will be on EMR as per usual unless EMR is also down, in which case, follow process as for new patients.
  • New patients NOT recorded in EDIS and will NOT have an ED EMR encounter:
    • These patients will be allocated Pink CAS Cards at triage and clinicians will write their clinical notes on these which will later be scanned into Bossnet.
  • Doctor to collect CAS Card from NIC when picking up next patient to be seen, (this allows NIC to keep track of who has been picked up and putting the doctor name/time next to that patient on the whiteboard)
    • Record time seen/ discharge time/destination on Pink Cas Card Record DOCTORS NAME
    • Document clinical notes and discharge time and disposition
  • Pathology/radiology orders:
    • Handwritten Path/Rad requests must be completed during outage Pathology/Radiology Results to be viewed on EMR or BOSSNet
    • Any outpatient path/rad requests with iPM labels must also be highlighted as an Emergency Department request.
    • Please WRITE CLEARLY at the top of request form “SH Emergency Department” ****stamp to be used
  • Medication and IV orders:
    • These will be on paper medication and IV order charts which may be reconciled into EMR once systems are back up and running if patient is to be admitted or will be in ED for 4 hours or more after outage complete.
  • Discharge Letters
  • Patient discharge letters during the outage will need to be typed on word file and two copies need to be printed. One for the patient and one for the medical record. (A template is available on ozemedicine – link on the main page or direct access via THIS link).
  • Clerk to collect second letter for scanning to Bossnet when outage complete
  • iPM Labels will need to be placed on both Discharge Letters
  • Sick certificates/carer’s certificate – use pre-printed certificates and place Bradma to authenticate.
  • Admissions
  • Any patients for admission needs to be communicated to the NIC who will record bed request time and admit unit.
  • iPM label to be placed on Bed Request Form at NIC desk with decision time to admit.
  • Clerk will then admit the patient on iPM and this will then create an EMR admission encounter. Be aware that when EDIS is back up and running, the patient will be retrospectively entered into EDIS and this will create a duplicate EMR encounter which has the potential to create confusion until the duplicate is manually resolved. Clinicians should AVOID using these EMR encounters until this is resolved otherwise they may order meds on a different encounter to what the nursing staff view.

 

POD LEADS

Pod leads:

Triage: Adult Triage Nurse 1/Clerk Triage 1/Adult Wait Room Nurse

Adult Acute: Paediatric Code Nurse/Comms Clerk

Short Stay Unit: NIC SSU/SSU Clerk

Children’s Area: Children’s Team Leader/Comms Clerk

Planned EDIS Outage Role

  • Retrieve a copy of the following:
  • EDIS Department Overview
  • EDIS Patient Location

Unplanned and Planned EDIS Outage Role

  • EDIS Outage occurs
  • Notified by SHED NIC to initiate whiteboard and downtime box use
  • Communicate with Nursing and medical staff to update and record on whiteboard
  • The following details are to be recorded on the white boards:
    • Name & UR number
    • Triage Category
    • Location
    • Gender
    • Age
    • Doctor
    • Nurse
    • Chief complaint
    • Plan
  • Triage Pod Lead to communicate with Adult Wait Room Nurse and update the white board for both Children’s and Adult Wait Rooms
  • The Triage Pod Lead is required to notify the SHED NIC of all Cat 1 or 2 patients in the Waiting Room
  • The Pod leads are to notify the SHED NIC of all patient movements and provide 30/60 updates via phone.
  • Pink CAS Cards to remain with NIC/Pod leads and leads to manage Patient Allocation, Treating Doctor and Nurse Times/names on whiteboard
  • NIC is to be notified of any patients leaving the Pod and allocation to bed
  • Every 15/60 the Pod is to reconcile the whiteboard with patient location

 

NURSING STAFF – BEDSIDE NURSE

Planned EDIS Outage & Unplanned and Planned EDIS Outage Role:

When first bringing patient into one of your cubicles:

  • The NIC will advise if your patient has not been triaged on EDIS due to the outage
  • In this case the patient will have a Pink Cas card with Triage information including triage Category
  • The NIC will hand you the Pink Cas card and will place our name on the Whiteboard under the Nurse column
  • Please Enter Nurse seen time on whiteboard under Nurse seen time column

PLEASE NOTE: The patient will NOT have an encounter in EMR

Ensure you retrieve the following from the NIC:

  • Paper Pathology Slip
  • Paper Radiology Slip
  • Paper Medication Chart
  • 2 x “Patient on Paper” forms. One for the patient notes and one to place on the back wall of cubicle so it is easily viewed by all staff

Once the EDIS Outage is complete and announced overhead by the NIC, your patient will be retrospectively entered onto EDIS and an encounter will created on EMR.

Please keep all paperwork together with the patient.

If your patient is on paper and is discharged, please take all the patient paperwork to the Comms Clerk as per normal processes.

 

CLERICAL STAFF

Planned EDIS Outage Role

  • Request 6 x copies each from the comms clerk 15 minutes prior to Planned EDIS Outage

(1x NIC, 1x Comms Clerk, 1xAHA and 3x PODS):

  • Department Overview
  • Patient Location Screen
  • Bed Request Form (Appendix 3)

Unplanned and Planned EDIS Outage Role

  • Register patient as required on iPM
  • Print Labels from iPM
  • Photocopy Pink Cas Card and leave copies at Triage
  • All patient paperwork to be kept in The SHED during the EDIS outage
  • When Outage complete – Triage clerk to Enter Patient Data on to EDIS retrospectively.
  • Once information entered on EDIS> PRINT EDIS LABELS and ensure the EDIS labels are attached to ALL paperwork for that patient’s paperwork.
  • Admissions are still to be completed on iPM
  • Patients in Adult and Children’s Waiting Room to be entered on the “New Triage patients” (Located on S DRIVE HERE) sheet by the Triage Clerk to manage the waiting rooms and for cross-checking post outage.
  • Place iPM label on sheet, arrival time, Category and Location. Clerking time to be recorded to ensure EDIS details backdated correctly upon data entry
  • Clerk to collect second letter from discharge letters for scanning into BOSSNet records when outage complete
  • Communicate to other Clerical Staff and escalate issues to the ED NIC
  • Communicate with PSA staff for all patient movements
  • Comms clerk to monitor EMR for duplicate encounters and send online notification for merger via EMR Encounter Error Notification Form.

Patient Transfers to Ward/another WH Campuses

  • For all patients transferred to a ward or to another WH campus – photocopy all patient notes and retain in department for reference as required. Don’t send copies to Medical records, originals will be sent be receive ward upon patient discharge
  • Ensure all patients for transfer both cross-campus and to another hospital have been entered into MIYA

 

Appendix 1: White Board Photo and Locations

Locations:

  1. Children’s Wait Room
  2. Adult Wait Room
  3. AV Wait (Emergency Services Arrivals)
  4. Adult Area Cubicles
  5. Short Stay Unit
  6. Children’s Area

Example of Triage Board:

The whiteboards will include the following information:

  • Name, Age, Gender
  • UR number
  • Time arrived
  • Triage Category
  • Presenting Complaint

Appendix 2: EDIS outage Box:

The EDIS OUTAGE BOX is Located at ED NIC desk in the main staff base

Item Quantity
Laminated Role Cards 1ea role
Laminated Instructions for printing off the following:

1.       EDIS Overview Screen

2.       EDIS Location Screen

3.       EDIS Dashboard Screen

1 ea
Pink Cas Cards 20
Pathology Slips 1 pad
Radiology Slips 1 pad
Medication Charts 1 pack
IV Fluid Charts 1 pack
White Board Markers 10
Red Patient ID Bands 10 ea
White Patient ID Bands 20 ea
ED Progress Notes 1 pack

 

Appendix 3 – SHED BED Request form

SH ED EDIS OUTAGE – BED Requests (post outage)

Please inform Access/AHA (0466 935 621) & Communications Clerk (51596)of new bed requests

Patient details (iPM Bradma) ED Location Date/time of arrival Time of Bed request Time s/b Doctor Admitting Unit-Consultant- Dx incl. comments: eg. COVID Swabbed Ward Allocation & Ward Ready Time Time to ward
 

 

 

 

A:

R:

 

 

 

 

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R:

 

 

 

 

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A:

R:

 

 

 

 

A:

R:

Appendix 4 – Assessing the Extent of the EDIS Outage

Can users log in and log off Citrix?

  • If not then it is either a Citrix or network issue rather than just an EDIS Server outage and this will also mean EMR will not be accessible. If there is concurrent iPM or EMR outage also follow the iPM section in the Business Continuity Plan and EMR business continuity plans.
  • A whole network outage will be evidenced by failure of all apps and inability to access the internet using a browser.

If users can access Citrix can they also access EMR and EDIS?

  • If they can’t access EMR but can use EDIS then it may just be an EMR outage.
  • If they can access EMR but not EDIS then it is likely to be an EDIS Server issue.

If users can use EDIS on Citrix but the problem is they just can’t print from EDIS on fat clients:

  • This is usually because they are using a generic account such as “SH.Emerg” and it has been temporarily locked out by someone entering the password incorrectly three timed in a row – it should self-remedy within 15 minutes or so, if not contact ICT help desk to unlock account or ask users to log in with a different account.

If the only issue is inability to, or very delayed printing:

  • Check the printer, if it seems to be working then contact ICT as it may be a print server problem.

If EDIS is working but the apps such as EDStatus are taking a very long time to run:

  • This is most likely due to the EDIS Reporting server running very slowly – contact ICT to remedy.

 

Document Governance

Title: EDIS Outage Processes for Sunshine Hospital Emergency Department (SHED)
Version: 1.0
Date Published: February, 2021
Date of scheduled review: 01/05/2021
Author: Approver:
SHED Leadership Team SHED Leadership Team

 

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