Emergency Department Clerical Best Practices & Workflows

Master essential ED clerical processes, including the 4-hour rule, medical record tracking, First Nations streaming, and leave application guidelines.

#emergency-department#clerical-training#medical-records#healthcare-operations#hospital-workflow#patient-streaming

Quarterly Clerical Update

Emergency Department | Q1 2026

Process Improvements & Operational Reminders

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Agenda & Overview

• Process 1: The 4-Hour Rule (EMER/ESSU) • Process 2: Streaming First Nations Patients • Process 3: Moving vs. Receiving Medical Records • Leave Application Guidelines • Standard Dress Code Reminders

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Process 1: The 4-Hour Rule

The '4-hour rule' defines the time elapsed between the moment the EMER bed slip is entered and the admission time.

RELEVANT FOR: EMER, EMER GERIS, and CLINICAL TOX patients only.

Do NOT stop the clock for patients arriving to ESSU/Swing beds under other specialties. They are Capacity patients only.

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The 4-Hour Rule: Step-by-Step

1. Entry & Timestamp

Clerks enter bed slip into EDIS immediately. This timestamp starts the 4-hour rule.

2. Stop The Clock

If patient moves to ESSU/Swing: Nursing stops the clock on EDIS. This captures actual physical entry time.

3. Admission

4 hours after bed slip: Admit in WebPAS using the 'stopped clock' time. Ensure patient is still EMER.

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Process 2: Streaming First Nations Patients

Mandatory Question:

Ask every patient: "Do you identify as Aboriginal or Torres Strait Islander?"

ACTION: If YES: Update stream to FN immediately.

• Ensures culturally safe care. • Directs to appropriate area. • Flags Aboriginal Liaison Officers (ALOs) for support.

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Process 3: Medical Records

Moving vs. Receiving Physical Paperwork

The goal is to accurately track where the physical record is located within the hospital.

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Records: Essential Workflows

Admitting to ESSU/EASS/CSSU

1. Go to 'Tracking & Functions' > 'Receive Medical Records'. 2. Select specific Ward. 3. Reason: 'Receive Direct' -> 'Inpatient'. 4. Input UMRN, Tab, Select File.

Discharging Home

1. 'Tracking Functions' > 'Single Record Movement'. 2. Destination: '1 HIMS'. 3. Reason: 'Return to Medical Records Dept'. 4. Verify '(T)' symbol appears (in transit).

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Annual Leave Applications

RULE 1: CHECK THE CALENDAR

Review the 'Available AL Calendar' on SharePoint BEFORE submitting any request.

RULE 2: NO AVAILABILITY?

Approval cannot be granted if no leave is available, unless circumstances are unforeseen + significant (e.g., surgery).

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Urgent Leave Requests

Within 2 Weeks of Current Roster?

You must speak DIRECTLY to:

• The Coordinator • Or Rostering Supervisor

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Standard Dress Code

• Maintain a neat, professional appearance. • ID Badges must be visible at all times. • Closed-toe shoes are mandatory for safety in clinical areas. • Adhere to department uniform policy.

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Summary & Questions

Key Takeaways:

✔ Stop the Clock correctly for ESSU/Swing admissions.
✔ Always ask the First Nations identification question.
✔ Track medical records: 'Receive' (Admit) vs 'Move' (Discharge).
✔ Check the Leave Calendar before applying.

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