Quirino Memorial Medical Center

Department of Emergency Medicine

Procedure Manual
Procedure on Cancelled Consultations at the Emergency Department
Prepared by: Recommending Approval Approved by:
by:
EVELYN VICTORIA E.
MA. JOJO M. MERCADO, RESIDE, MD
MD Medical Center Chief II
Deputy – QMR
Quality Management Unit

I. OBJECTIVE:

To give guidance on the process of Patient Consult Cancellation in the Emergency Department.
(ED) of Quirino Memorial Medical Center

II. SCOPE:

This guide is limited to the process flow in the conduction of ED Consult Cancellation for Urgent and
Non-Urgent consults.

III. DEFINITION OF TERMS

Cancelled Consult – Patient’s informed decision of discontinuation of ER assessment.

Disposition – Terminal decision of clinical management at the ED. Clinical disposition to patient
treatment plans are narrowed down to 1) Admission, 2) Transfer, or 3) Discharge.

Triage - Established sorting system according to patient acuity. Patients are classified as to
Emergent, Urgent, and Non-urgent in terms of the prioritization of interventions and management.

webHOMIS. Web Hospital Operation and Management Information System (webHOMIS) is a

computer-based information system and electronic medical records system designed and
modified by Quirino Memorial Medical Center (QMMC) Integrated Management Information
System Section (IMISS) from the Integrated Hospital Operation and Management Information
System (IHOMIS) developed by the Department of Health.

IV. PROCEDURE OUTLINE:

RESPONSIBLE ACTIVITY PROCESSING TIME INTERFACE

ED Triage Officer Conducts triage 5-15 minutes ED Triage Form
assessment
ED Triage Encoder Encodes patient 5-10 minutes webHOMIS
registration
ED Patient Record
ED Treatment Officer 1. Conducts ED 6 hours from ED Patient Record
Assessment and assessment to
Management clinical disposition webHOMIS
2. Provides clinical
disposition

ORIGINAL SIGNED. The online version of this manual is the updated version and takes
precedence over any printed copy. UNCONTROLLED and UNOFFICIAL when printed.
Passing on, communicating and copying the contents of this manual are
Prohibited without written consent from the Director and the QMR.
 Quirino Memorial Medical Center
Department of Emergency Medicine
Procedure Manual
Procedure on Cancelled Consultations at the Emergency Department
Prepared by: Recommending Approval Approved by:
by:
EVELYN VICTORIA E.
MA. JOJO M. MERCADO, RESIDE, MD
MD Medical Center Chief II
Deputy – QMR
Quality Management Unit
3. Encodes final
disposition in system

V. PROCEDURE DETAILS

RESPONSIBLE DESCRIPTION INTERFACE

ED Triage Officer 1. Conducts customary triage assessment as to ED Triage Form
Emergent*, Urgent, and Non-Urgent aided by
Triage Nurse (obtaining vital signs) and
Designated ED Care Navigators (patient
registration)
ED Triage Encoder 2. Receives properly filled out ED Triage Form webHOMIS
and encodes patient into system

3. Prints ED Record and endorses patient ED Patient Record

record to Triage Nurse
ED Triage Nurse 4. Wheels in patient with ED Record to
designated clinical area

5. Endorses case to receiving treatment officer

ED Treatment 6. If patient / designated guardian does not ED Patient Record
Officer consent to continue with ER assessment upon
reaching designated treatment area, the patient
is dispositioned as CANCELLED

7. Treatment officer obtains written narrative of

patient’s informed request for discontinuation of
ED consult; this is subsequently documented in
the patient chart duly signed by patient and/ or
guardian as a release of responsibility

8.Treatment officer endorses to ER Nurse of

cancelled consult

9. Informs ED Care Navigator and requests

assistance in patient exit navigation

10. ED treatment officer inputs final disposition webHOMIS

of patient as CANCELLED

ED Care Navigator 11. Accompanies patient to exit ED premises

from the ED main entrance

ORIGINAL SIGNED. The online version of this manual is the updated version and takes
precedence over any printed copy. UNCONTROLLED and UNOFFICIAL when printed.
Passing on, communicating and copying the contents of this manual are
Prohibited without written consent from the Director and the QMR.
 Quirino Memorial Medical Center
Department of Emergency Medicine
Procedure Manual
Procedure on Cancelled Consultations at the Emergency Department
Prepared by: Recommending Approval Approved by:
by:
EVELYN VICTORIA E.
MA. JOJO M. MERCADO, RESIDE, MD
MD Medical Center Chief II
Deputy – QMR
Quality Management Unit

Special Concerns:
1. The process of Cancellation of Consult is upheld by the given Right of the Patient to Self-
determination in their treatment choices.
2. As stated in the Magna Carta of Patient’s Rights and Obligations of 2008 – Senate Bill 237
Section 4:
a. The patient has the right to refuse diagnostic and medical treatment procedures;
b. The patient has the right to leave hospital or any other health care institution regardless
of his physical condition;
- Provided that the following conditions are satisfied:
 The Patient is of legal age and is mentally competent;
 The Patient is informed of the medical consequences of his/her refusal;
 The Patient releases those involved in his care from any obligation relative to the
consequences of his/her decision; and
 The Patient’s refusal will not jeopardize public health and safety.
3. Patient triaged as Emergent are not included in the process of Consult Cancellation as the
intervention required for Emergent consults are IMMEDIATE – entailing life-saving or life
sustaining stabilization. Any refusal to the provision of said management by patient or appointed
guardian will be upheld as patient’s given right, but is not considered as a Consult Cancellation.
Any informed refusal will be documented per standard procedure.
4. The patient who wishes to cancel consultation shall no longer go through the procedural steps of
billing process of discharge (i.e. supplied with billing slip by ER nurse and requiring subsequent
clearance from billing/cashier), as the patient has not undergone any transaction for
management as implied by the cancellation of consult.

VI. QUALITY RECORDS:

ED-Triage Form Rev 0 12 January 2014

ED Record Rev 1 02 April 2014
QMMC Patient’s Rights and Responsibilities

VII. REFERENCES:

ORIGINAL SIGNED. The online version of this manual is the updated version and takes
precedence over any printed copy. UNCONTROLLED and UNOFFICIAL when printed.
Passing on, communicating and copying the contents of this manual are
Prohibited without written consent from the Director and the QMR.