Disposition a Patient

Disposition is the decision that closes an ED visit and says what happens to the patient: are they admitted, sent home, moved elsewhere, referred to a team, or did they leave before being seen. It is the last thing the ED does for a patient, and it hands them off to whoever takes over next — a ward, another hospital, a specialty team, or themselves.

Who / when: the ED physician records the disposition once the patient’s ED workup is done. We follow Dr Tunde Adeyemi deciding outcomes at the end of his shift.

1. ED physician — open Emergency → Disposition. The worklist is every active visit, each showing its acuity and either a decision or Pending. The readouts at the top count how many are still awaiting a decision.
2. ED physician — open a patient and press “Decide”. Choose the decision and fill the destination:
   • Admit — pick the destination ward, then complete the admission in Veona Ward with “Admit To Ward”.
   • Discharge — set the follow-up (GP follow-up, fracture clinic, OPD review, or none).
   • Transfer — pick where (cath lab, tertiary centre, theatre).
   • Refer — pick the team (surgical, paediatrics, cardiology, psychiatry).
   • LWBS — Left Without Being Seen, for a patient who left before a clinician saw them; this needs no destination and closes the visit.
   • Mortuary — a death in the ED; record the receiving mortuary.
3. ED physician — add a clinical summary and “Confirm Disposition”. The downstream teams are notified.

Note

Admit creates an admission on the shared clinical spine and, where a free bed in the chosen ward can be addressed, occupies it — but the admit is completed by the Ward module, and the bill is deliberately left open so the inpatient stay keeps accruing. Discharge is different: it settles all the visit’s accrued charges into one final bill and generates the visit summary and any take-home prescription.

Caution

LWBS and Mortuary are tracked separately as pathway dispositions because they matter for ED quality and reporting — an LWBS rate that climbs is a sign the department is overwhelmed.

What happens next

The visit closes and the patient flows where the decision sent them. An admission becomes a ward stay; a discharge becomes a final bill and summary; the dispositions feed Pulse, where the ED admission rate, breach rate and door-to-doctor times are tracked over time.

Follow the trail

• Previous: Hold a Patient in the Observation Unit
• Next: Handle a Surge and Ambulance Pre-Alerts
• Related: for an admission, continue with Admit a Patient to a Ward Bed · for the discharge bill see the Billing journey