ADT System
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Table of Contents INTRODUCTION ➢ The Definition and Historical Perspective of the ADT system ○ The Admission Stage ○ The Transfer Stage ○ The Discharge Stage DATABASE DESIGN ➢ Database Design (Conceptual Diagram) ➢ What Data is Captured? ➢ What are the Database Functions? ➢ How Data, Information and Knowledge is presented to the User DATABASE QUERIES ➢ Query 1 ➢ Query 2 ➢ The Usefulness of ADT System in Health Practices ○ Introduction ○ Integration ○ Accessibility ○ Organization and Storage CONCLUSION
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INTRODUCTION The Definition and Historical Perspective of the ADT system The admission, discharge and transfer (ADT) system is a system that verifies when a patient is admitted, released or transferred between their designated hospital. All hospitals need this system in order to organize and keep track of their patients’ records, from the time of admittance to where they are either discharged or transferred from to another hospital. “This system is used to collect and store client identification and demographic data that are verified and updated at the time of each visit (Hebda & Czar 2013, p.128). The ADT system can be used to identify a patient by using a patient's own unique identification code that can be linked to other hospital’s information system. These identification codes can enable accurate client identification, supporting the development of a longitudinal client records that contains all clinical information available for the client (Hebda & Czar 2013, p.128). The ADT systems are separated into 3 main stages: the admission, discharge and transfer stages. There has not been any big change in the ADT system in many hospitals or clinics in recent years. The ADT system has always been implemented from the establishment of hospitals as institutions. When a patient enters the hospitals, they would have to sign-in in order to meet their doctors, proceed with treatment and procedures, and, inevitably be discharged. However, there has been a change in the evolution of technologies, where instead of patients signing in with writing utilities, they would either use touch pads or computers. This lead to the creation of the Electronic Health Record (EHR) coming into fruition. The Admission Stage The initial admission stage is where the patient is admitted or visits the hospital or clinic. During the admission stage, the administration of the hospital must identify who their client is
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and other personal information that is related to the reason why they want to be admitted. For example, from a nurse’s perspective, “the admission process includes performing the initial interview and obtaining a full history of the patient and family; the assessment of vital signs and performance of a full physical assessment; identifying nursing diagnoses and formulating goals and a care plan for the patient; and documenting all findings and the care plan in the computerized nursing documentation system” (Giangiulio et al. 2008, p.66-67). In an inpatient hospital setting, the availability of the number of inpatient beds and rooms is very important to keep track because of hospital overcrowding. By the time the patient is admitted to the hospital, the nurses and doctors are expected to give a report of the patients’ situation in order to initialize and provide the care the patient needs. The Transfer Stage This stage is an optional process where the patient can be transferred to another hospital. During the transfer stage, the patient can choose to be relocated to another hospital from the current hospital in which they are staying. When the patient arrives at the designated hospital, the previous hospital must transfer the information of the patient’s medical records in order to update and file it into the current hospital system. “Once the patient and family are settled into their new hospital and room, the ADT nurse provides an updated report related to the patient to the unit nurse who assumes the care of the patient” (Giangiulio et al. 2008, p.67). The Discharge Stage This discharge stage is the last stage where the patient has permission to leave the hospital. The patient is not immediately discharged because the nurse or doctor must review the patient’s medical record and follow a set of instructions, such as assign their prescription, and medication instruction to the patient and their family members. “The ADT Nurse also assesses
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the legal guardian’s verbal understanding of the discharge instructions, confirms the plan for any follow-up education or appointments for the patient/family, ensures that all discharge documents are signed by legal guardians, and documents the patient’s and family’s response to the discharge teaching in the electronic nursing documentation system” (Giangiulio et al. 2008, p.67-68). Once these procedures and responsibilities are completed, the patient is free to leave. DATABASE DESIGN – Conceptual Diagram
What type of data does the Admission, Discharge, and Transfer System capture? The admission, discharge, and transfer system (ADT) is a core and complex system that plays a significant role in all major health centers and hospitals. It contains and captures all of the
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important demographic and clinical information for each patient. Upon a patient entering a clinic or hospital, the system will obtain data pertaining to that individual patient, such as name, address, phone number, date of birth, sex, medical record number, and bill/account number (Hanan & Durgin, 2015). The ADT system captures data that informs connected systems of the patients’ status or present location. For example, the ADT system will keep the pharmacy system informed as to which ward a patient is located in. This information will be updated regularly since the patient can be discharged or transferred elsewhere (Hanan & Durgin, 2015). The information captured will be used by the pharmacy system to know which ward the patient reside in, where to send the medication orders, where to send reports concerning patients, and to inform the system if the patient was discharged, so that no other prescription orders are filled. The ADT system also provides other systems with critically essential information, which assists in managing and maintaining the streamline processes within the hospital. For example, insurance information that is captured during the admission stage is used to facilitate the billing process. In addition, the ADT system provides the means for the hospitals to gather additional valuable information such as referral information, whether the patient has a will, if the patient has a power of attorney, as well as the name of the patient’s physician (Hanan & Durgin, 2015). In the case where a patient is transferred to another hospital or ward within the hospital, the ADT system will ensure that all of the information that is captured during the time of the patient’s previous stay would be sent over to their new transferred location. This further allows for the patient to receive the most efficient and effective care, since the new doctors would now be informed and better prepared for the patient’s past and present conditions.
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What are the Database functions? Main functions include: ● Patient Search Engine with various filters – including ID number, name, address, date of birth, OHIP Number, admission date and discharge date ● Patient identification – creation and editing of each patient's related information, including, for example: name, address, gender and age etc. ● Prevents Duplication mechanisms such as Primary Key ID validation and the duplications of two identical patient records, etc. ● Ability to correlate patients between different facilities through a PIX (Patient Identifier Cross-referencing) system ● Insurance verification and validation ● Patient admission – documentation of data related to the episode that made the patient seek the facility (Outpatient and Inpatient settings) ● Real time Patient Information – according to admission time, location, specialty and room, among other ● Follow-up of patients from the episode's creation until discharge – including care time and location, ordered and completed tasks ● Management of waiting lists for Inpatient and Operating Rooms/Ward with prioritization based on severity and symptoms (uses Patient Record)
How is the Data, Information and Knowledge presented to the user? Information becomes accessible to users after data is entered into the database in different fields or columns of a table. The combination of characters make up a patient’s information or
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record. This information provides the end users, such as doctor and nurses, with overall knowledge of the patient’s they are treating. For example, the Patient ID, name, date of birth, admission date, discharge date, allergic reactions, and vital signs, among other fields, are information that make up a patient record. Creating a database offers a method for managing large amounts of information, which makes it easier for users to access the information they need. In the ADT system, users are usually members of the healthcare team in a specific facility. These members of the healthcare team consist of doctors, nurses, admission clerks, pharmacists and laboratory personnel. The users of ADT database are assigned a username and password in order to access patient information that is within their security clearance. This aids with the privacy and confidentiality of patient medical records. Information is presented in the form of a graphical user interface (GUI) that is accessed through web-based applications and software. The ADT system’s information is outputted via Electronic Medical Record (EMR) system interface. The interface allows for a natural, accurate recording of patient-related information while simultaneously permitting seamless requests and retrieval of reports from a variety of sources related to a patient’s broader EHR. Using EMR interface will permit end users, such as physicians and nurses, to record and retrieve the details of a patient’s condition, reasons for admission, treatment while hospitalized, reasons for discharge, and where a patient may be transferred to. Using this interface will preserve the user’s overview of a patient’s record so that any aspect of the patient’s health can be effortlessly queried and inspected (Craig & Farrell 2010). The ADT system may also utilize Laboratory Information Management System (LIMS) and other Information Management systems. LIMS are information management systems that
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process, store, and manage data from all stages of medical processes and tests. Part of the ADT database captures patient treatment records that include laboratory studies. DATABASE QUERIES: Query 1 /* List All Patients who have a Cardiologist (Patient and Doctor) */ SELECT Patient_FName, Patient_LName, Doctor_FName, Doctor_LName, Doctor_Specialization FROM Patient, Doctor, Encounter WHERE Doctor.Doctor_ID = Encounter.Doctor_ID AND Encounter.Patient_ID = Patient.Patient_ID AND Doctor.Doctor_Specialization = 'Cardiology'; OUTPUT:
Query 2 /* List all inpatients that are associated with Empire Life insurance company */ SELECT Patient_FName, Patient_LName, Provider_Name FROM Inpatient, Patient, Insurance_Company, Admission_Desk, Insurance_Policy WHERE Patient.Patient_ID = Admission_Desk.Patient_ID AND Admission_Desk.Admission_ID = Inpatient.Admission_ID AND Patient.Patient_ID = Insurance_Policy.Patient_ID AND Insurance_Policy.Provider_ID = Insurance_Company.Provider_ID AND Insurance_Company.Provider_Name = 'Empire Life'; OUTPUT:
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The Usefulness of ADT System in Health Practices Hundreds of people shift through doctor’s offices and thousands more enter hospitals on a weekly basis. Many patients have an EMR that captures their personal information, as well as medical history. In the age of technological evolution, many health practices have started to use databases to facilitate these records. Databases in a clinic or a hospital have significant usefulness for all users and, therefore, are a focal point in daily operation. ADT databases, specifically, are useful because they integrate departments, provide accessibility of information for staff, and store large volumes of data in a secured, organized manner. Integration Facilitating an ADT system must have all members of a health practice on the same page to run efficiently. Healthcare workers, information technicians and other workers are directly involved with healthcare services and the use of ADT systems at some point and must be able to input information accurately. As a patient moves through admission and transfers to different departments, said departments must collect data for “every patient-care transaction from all clinical support subsystems” (Collen, 2012, p.47) . Providing this continuity of service and data collection depends on everyone working cohesively so the patient can progress in the practice as well as in health. Accessibility Accessing the ADT system anywhere and anytime is a major advantage in healthcare practices. New technologies such as tablets, are being utilized for accessing EMR. Furthermore, in large healthcare practices, such as a hospital and clinics, thousands of patients are seen weekly and their EMRs must be viewed, manipulated and shared (with a patient or healthcare worker) without a moment’s notice. The ADT’s easy accessibility helps nurse’s input and query
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information easier and can even “provide alerts and alarms for possible adverse events such when medication is administered untimely” (Collen, 2012, p.109). The ADT system’s fast access to a patient’s EMR allows timely, efficient and accurate health care. Organization and Storage Paper records are starting to make the transition to digital copies because databases are able to store huge volumes in a more organized fashion. Querying for information through hardcopy files can be meticulous, but electronically it is more time-saving as patients are encoded with unique codes to distinguish their EMR from the other million EMRs in the database. The structure of an ADT database is also facilitated with the use of security protocols to keep EMRs confidential and private. Legally, all databases have to uphold security practices to protect their patients. For example, the Health Insurance Privacy Act (HIPA) established and enforces security standards for client information (Collen, 2012, p.112). ADT systems, therefore, help organize the information and provide security to EMR databases.
CONCLUSION The admission, discharge, and transfer system (ADT) is a core and complex system that plays a significant role in all major health centers and hospitals. It contains and captures all the important demographic and clinical information for each patient. The admission stage is where hospital administration identifies the patient and the reason the patient is visiting the hospital. These reasons may include emergency care, follow-up appointment, or laboratory tests among other things. This stage also verifies the patient as either an inpatient or an outpatient. The ADT system captures data that informs connected systems of the patients’ status or present location. The transfer stage is an optional process where a patient may want to undergo as this process
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exists to transfer the patient from one facility or room to another, either on or off-site. If a patient were to be transferred to another hospital or ward within the hospital, the ADT system will ensure that all the information captured during that patient’s stay would be transferred to the new location. The discharge stage is the final stage where the patient has the permission of their doctor to leave the hospital. They are given instructions on how to proceed with their care and are, thereby, responsible for their own care. The primary functions of the ADT Database system include; patient identification, insurance validation, and patient admission, among other features. The ADT Database system also allows for the elimination of data redundancy and inaccurate information as all patient information is available in real-time. Users of the ADT database will be assigned a username and password in order to access data. This aids with privacy and confidentiality. Also, it will allow access to those who have the security clearance to access some or all of the information. Facilitating an ADT system must have all members of a health practice working in cohesion. Providing this continuity of service and data collection depends on every individual working cohesively so the patient can progress in the practice as well as in health. ADT database systems organize EMR data in mass quantities, but do it safely and securely so that minimal data is lost and security is not put at risk.
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References Collen, M. F. 1., & Springer E-books - York University. (2012). Computer medical databases: The first six decades (1950-2010). London; New York: Springer-Verlag London Craig, D., & Farrell, G. (2010) Designing A Physician-friendly Interface for an Electronic Medical Record System. Retrieved April 9, 2015, from https://www.med.mun.ca/getdoc/baaa5ba1-cee7-4df1-a96e-177e3a7d414e/craig-farrellHEALTHINF_2010_98_CR.aspxLtd. Giangiulio, M., Aurilio, L., Baker, P., Brienza, B., Moss, E., & Twinem, N. (2008). Initiation and Evaluation of an Admission, Discharge, Transfer (ADT) Nursing Program in a Pediatric Setting. Issues in Comprehensive Pediatric Nursing, Informa Healthcare USA, Inc. 31: 61-70. Hebda, T., & Czar, P. (2013). Health Information Systems. In Handbook of informatics for nurses and health care professionals (5th ed.). Upper Saddle River, N.J.: Pearson Prentice Hall. Zachary, Hanan., & Jane, Durgin. (2015). Pharmacy Practice for Technician (5th ed.) Clinton Park, NY: Stephan Helba Publishing.
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