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ADT A03 Discharge Patient / End Visit

Patien's will get discharged from hospitals after recieving care. This signals end of patient's stay in healthcare facility.
In HL7, ADT A03 event is used to trigger dischange for an admitted patient. This can alos end visit fro non-admitted patients.

Let's understand the scenario:
Patient A was admitted to a hospital and assigned some physical location
When we receive an A03 message, we record patient's discharge date & allocated physical location becomes available for other patients.

There could be many fields in HL7 message or in your system which can identify patient's discharge (This depends on your EMR configuration or system which mangaes your Admission/Discharge/Transfer).
Common fields are PatientClass(PV1.2), AssignedPatientLocation(PV1.3), AccountStatus, DischargeDate etc. and all of these values would be very meaningful for Healthcare Systems.

In real world, a hospital system would receive many messages for a patient before A03, but to understand A03 scenario we will discuss only important one - A01 (Admission)
I will include only those fields in example which are required to describe the A03 discharge message.

Suppose, we have received an A01 message for a patient with following details

PatientClass (PV1.2) - E (Important & Requred field)
AssignedLocation (PV1.3) - PointOfCare - IR, Room - 101, Bed - A
AccountStatus (PV1.41) - REG
AdmissionDate (PV1.44) - 1/1/2012

after processing this A01 message, we have following details in our system:

PV1.2 AssignedPatientLocation PV1.3 PV1.41 PV1.44 PV1.45
PatientClass PointOfCare Room Bed AccountStatus AdmissionDate DischargeDate
I IR 101 A REG 1/1/2012  

 

Now suppose, patients has received care & need to be discharged from facility.
Now, we have received a discharge request by A03 message with following details

PatientClass (PV1.2) - E (Important & Requred field)
AssignedLocation (PV1.3) - PointOfCare - IR, Room - 101, Bed - A
AccountStatus (PV1.41) - DIS
AdmissionDate (PV1.44) - 1/1/2012
DischargeDate (PV1.45) - 1/5/2012

after processing this we have following details in our system:

PV1.2 AssignedPatientLocation PV1.3 PV1.41 PV1.44 PV1.45
PatientClass PointOfCare Room Bed AccountStatus AdmissionDate DischargeDate
I IR 101 A DIS 1/1/2012 1/5/2012


You can see the magic of A03, the patient's physical loation has been restored to his prior location.

Important:

Patiet's location before discharge should be in PV1.3
A03 will be important for billing system to notify that patient's billing period has ended
If patient expired during hospital stay, it should be indicated in PID.29 & PID.30 fields of A03 message


Note:

ADT messages always contain current information except MRG segments
Process all the fieds in PID & PV1 & other segments in message as normal A08 upate message unless specified by source system.
It is recommended not to send any updated fields except required ones in A03. A08 should be used to update any other fields.