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Outpatient (OPD) & Emergency Triage Intake

This section describes the workflows for managing scheduled outpatient clinic arrivals, walk-in consultations, emergency department intake, and clinical triage acuity stratification.

1. Before You Begin​

  • Authorized Roles: Hospital Receptionist, Triage Nurse, Emergency Medical Officer, Doctor.
  • Clinical Principle: Outpatient cases follow scheduled appointments or queue check-in sequence; Emergency cases are prioritized strictly by clinical acuity (triage category), bypassing standard queues.

2. Step-by-Step Intake & Triage Workflows​

graph TD
    Arrival[Patient Arrival at Hospital] --> Routine[Routine / Scheduled Clinic]
    Arrival --> Emergency[Acute / Emergency Intake]
    Routine --> ClinicQueue[Assign to Doctor Consultation Queue]
    Emergency --> Triage[Triage Vitals & 5-Tier Acuity Scoring]
    Triage --> STAT[Level 1 & 2 Red/Orange: Immediate Resuscitation]
    Triage --> Urgent[Level 3 to 5 Yellow/Green: Priority Urgent Care]

Workflow A: Scheduled OPD & Clinic Queue Check-In​

  1. Open Appointments or Patients.
  2. Locate the patient's scheduled consultation booking.
  3. Click Check-In Patient:
    • Status updates from Scheduled → Checked-In.
    • The system calculates the estimated wait time based on active physician queue length.
    • The patient's name appears on the assigned Doctor's active worklist.

Workflow B: Emergency Department Intake​

  1. On the top navigation bar or Dashboard, click + Emergency Case.
  2. Select whether the patient is an Existing Patient (search MPI) or Unidentified Trauma Patient.
  3. Record Arrival Specifics:
    • Arrival Mode: Ambulance, Walk-In, Police Escort, Inter-Facility Transfer.
    • Accompanying Person / Paramedic Details.
  4. Record Presenting Complaints & Initial Observations:
    • Primary symptom (e.g., Severe chest pain radiating to left arm, Major motor vehicle trauma, Acute shortness of breath).
    • Symptom onset time.
  5. Capture Immediate Triage Vital Signs:
    • Blood Pressure (Systolic/Diastolic mmHg), Pulse / Heart Rate (bpm), Respiratory Rate, Oxygen Saturation (SpO2 %), Temperature (°C), Glasgow Coma Scale (GCS / 15), Blood Glucose (mmol/L).

3. MEWS Deterioration Score & Safety Alert​

The system calculates a Modified Early Warning Score (MEWS) from the 5 baseline triage vital signs: Heart Rate, Blood Pressure, SpO2, Temperature, and Respiratory Rate.

⚡
IMPORTANT:

Patient Safety Checkpoint: MEWS ≥ 5 — Automatic High-Priority Alert When triage vital signs produce an aggregate MEWS score of 5 or more:

  1. A HIGH-priority deterioration alert fires immediately across the clinical team's dashboard.
  2. An active Clinical Decision Support (CDS) entry is generated.
  3. Clinical staff must acknowledge the alert in the system, attend the patient immediately, and escalate to the emergency physician. Note: MEWS alerts fire on the COMBINED aggregate score — a single abnormal vital does not trigger the high-priority alert.

4. Five-Tier Clinical Triage Acuity System​

Moana validates the 5-tier triage classification for clinical prioritization:

Triage CategoryVisual BadgeTarget Doctor ResponseMandatory Clinical Scenarios
Resuscitation (STAT / Level 1)🔴 RedImmediate (0 Minutes)Cardiac / respiratory arrest, major exsanguinating trauma, status epilepticus, severe anaphylaxis.
Emergency (Level 2)🟠 OrangeWithin 10 MinutesAcute myocardial infarction, severe respiratory distress (SpO2 < 90%), stroke symptoms within window.
Urgent (Level 3)🟡 YellowWithin 30 MinutesOpen fractures, moderate asthma, severe localized pain (Score 7-10), acute abdominal peritonitis.
Semi-Urgent (Level 4)🟢 GreenWithin 60 MinutesSimple closed fractures, minor lacerations requiring suture, mild fever in stable adult.
Non-Urgent (Level 5)🔵 BlueWithin 120 MinutesMedication refills, chronic joint pain, minor rash, medical fitness certificates.
Emergency Triage Vitals and Acuity Stratification Form
Emergency Triage Vitals and Acuity Stratification Form🔍 Click to enlarge

5. Common Issues & Troubleshooting at Intake​

SymptomProbable CauseMandatory Corrective Action
OPD encounter cannot be openedPatient has an active Emergency or Inpatient encounterResolve or close the existing open encounter first; verify you have selected the correct patient.
Same-day OPD visit refusedSystem strictly enforces one OPD encounter per patient per calendar dayIf a second visit is clinically necessary, contact the Hospital Administrator for manual override.
Doctor assignment failsTarget user does not hold the Doctor role in the systemVerify the clinician's role assignment in Staff Management; contact IT Administrator.
MEWS score not calculatingIncomplete vital signs entryAll five triage vitals (Heart Rate, Systolic BP, SpO2, Temperature, Respiratory Rate) must be entered for the score to calculate.

6. Workflow Result & Departmental Handoff​

✅
Expected Result:

The emergency encounter is initialized. Red and Orange priority cases trigger real-time audio-visual alert chips on the Doctor Emergency Worklist and Bed Command Center, immediately locking holding bay allocations.