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As-Is Process Modelling Brief
6.1 Scope & Boundaries

The As-Is process model must capture the end-to-end patient journey through Perth’s emergency healthcare system, from the moment a patient or bystander recognises a medical emergency through to the patient’s final disposition (discharge or admission). The model must also capture the parallel and intersecting processes of the ambulance service, hospital operations, and administrative funcions.

6.2 Process Scope Definition

Element Definition Process

Start Patient or bystander recognises medical emergency / decides to seek emergency care Process

End Patient is discharged from ED, admitted to ward, or transferred to another facility

Primary Process Emergency patient journey through the 000 / ambulance / ED system

Sub-Process A Ambulance dispatch and response operations (St John WA)

Sub-Process B ED bed management and patient flow coordination

Sub-Process C Clinical diagnostics and results management .

Sub-Process D Discharge planning and community handover

Out of Scope Inpatient ward processes post-ED admission; elective care pathways; GP consultations

6.3 Required Swim Lanes

Your BPMN 2.0 As-Is model must include the following swim lanes, representing distinct organisational actors in the process:

Patient / Bystander actions taken by the patient and those assisting them 000 Emergency Communications Centre call handling, triage questioning, dispatch St John Ambulance dispatch coordination, crew response, scene management, transport, ramp wait, clinical handover

ED Triage Nurse patient reception, triage assessment, category allocation, streaming

ED Charge Nurse / Patient Flow Coordinator bed management, ramp coordination, escalation

Emergency Physician / Registrar clinical assessment, investigation ordering, diagnosis, treatment, disposition planning Allied Health & Support Services radiology, pathology, pharmacy, social work (relevant touchpoints only)

Ward / Inpatient Services bed availability notification, patient acceptance, transfer completion Hospital Administration / Clinical Systems registration, record retrieval, documentation

6.4 Key Process Steps to Model

As a minimum, your As-Is model must accurately represent the following process steps and decision points:

Emergency Recognition & 000 Call Phase

7. Patient / bystander recognises emergency and dials 000

8. Emergency Communications Officer answers and conducts initial triage questioning (manual script-based protocol)

9. Severity category determined Priority 1 (life-threatening), Priority 2 (urgent), Priority 3 (nonurgent)

10. Nearest available ambulance identified and dispatched (based on GPS proximity does NOT currently account for ramp status at destination hospital)

11. Patient/bystander given pre-arrival instructions

Ambulance Response Phase

12. Crew notified and vehicle en-route

13. Crew arrives on scene; initial patient assessment

14. Clinical treatment commenced on scene

15. Transport decision made: which hospital? (current system: based on clinical suitability and geography, not real-time ramp data)

16. Patient loaded; transport commenced; pre-notification call to receiving ED (manual phone call) 17. Arrival at hospital; check for ramp availability (DECISION POINT: space available vs. must wait on ramp)

18. [IF RAMP WAIT] Patient cared for in ambulance; crew unavailable for new calls; periodic manual check with ED

19. Ramp space cleared; ambulance moves to handover bay 20. Clinical handover to ED triage nurse (verbal + paper form)

21. Ambulance crew restocks and returns to service ED

Reception & Triage Phase

22. Patient registered – manually in patient administration system; ID verification; next-of-kin details; insurance/Medicare

23. Triage assessment by nurse – vital signs recorded; chief complaint documented; pain score; triage category assigned (15 on Australasian Triage Scale)

24. Triage data entered into ED information system (often duplicated from paper triage form)

25. Patient streamed to appropriate area: Resus / Acute / Sub-Acute / Fast-Track (DECISION POINT: stream assignment based on triage category)

26. Patient allocated to ED bed or cubicle – or placed in waiting room if no space (DECISION POINT: space available?)

27. [IF WAITING ROOM] Patient waits; periodic reassessment; risk of deterioration undetected

Clinical Assessment & Treatment Phase

28. Doctor assigned to patient (or patient added to doctor queue)

29. Doctor reviews triage notes (limited information; no full history visible if cross-hospital presentation)

30. Doctor attempts to access patient medical history (DECISION POINT: records available in current system? Phone call to other hospital? GP? Family?)

31. Clinical assessment conducted; investigations ordered (bloods, ECG, imaging)

32. Specimens collected; sent to pathology (physical transport in many cases)

33. Results generated in pathology / radiology systems

34. Doctor manually checks for results – not pushed to doctor; must log in to separate system

35. Results reviewed; clinical decision made (DECISION POINT: further investigation needed? Treatment commenced? Admit? Discharge?) 36. Treatment administered or arranged

37. Specialist consultation if required (phone call; consultant may or may not come to ED)

Discharge / Admission Phase

38. Disposition decision made by doctor (DECISION POINT: admit to ward / discharge home / transfer to another facility)

39. [IF ADMIT] Bed request raised – manual call to bed manager; ward confirms or declines

40. [IF ADMIT] Patient waits in ED bed for ward bed to become available (often 26 hours; patient occupies ED space during this time)

41. Patient transferred to ward; physical handover; notes transferred (paper or verbal)

42. [IF DISCHARGE] Discharge letter generated; medications prescribed; follow-up arranged

43. Patient given verbal instructions; discharge paperwork printed and given

44. Discharge completed; bed marked as available (OFTEN DELAYED – manual update required) 45. Cleaning crew notified; bed turnaround time averages 45 minutes

6.5 Data Flows to Capture

In addition to the process flow, students must identify and represent the key data flows in the As-Is model, including: Clinical data flows (triage assessment, test orders, test results, clinical notes, medication records)Communication flows (phone calls, faxes, paper forms, verbal handovers and their inherent reliability limitations)

ANALYSIS QUESTIONS FOR AS-IS MODEL

46. Where are the longest waiting times in the process? What causes them?

47. At which points does information fail to transfer reliably between actors?

48. Which process steps could, in principle, be executed in parallel but are currently sequential?

49. Where are the key decision points? What information would ideally be available to support each decision and is it currently available?

50. Which process steps have the highest error rate or most significant consequences when they fail?

51. Where does the ‘work’ performed have zero direct value for the patient?

Notes: Students can use the Call outs function within Visio to annotate analysis findings on the As-is and To-be models.

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