ADT System

Table of Contents
INTRODUCTION
The Definition and Historical Perspective of the ADT system
The Admission Stage
The Transfer Stage
The Discharge Stage
DATABASE DESIGN
Database Design (Conceptual Diagram)
What Data is Captured?
What are the Database Functions?
How Data, Information and Knowledge is presented to the User
DATABASE QUERIES
Query 1
Query 2
The Usefulness of ADT System in Health Practices
Introduction
Integration
Accessibility
Organization and Storage
CONCLUSION

INTRODUCTION
The Definition and Historical Perspective of the ADT system
The admission, discharge and transfer (ADT) system is a system that verifies when a
patient is admitted, released or transferred between their designated hospital. All hospitals need
this system in order to organize and keep track of their patients records, from the time of
admittance to where they are either discharged or transferred from to another hospital. This
system is used to collect and store client identification and demographic data that are verified
and updated at the time of each visit (Hebda & Czar 2013, p.128). The ADT system can be used
to identify a patient by using a patient's own unique identification code that can be linked to
other hospitals information system. These identification codes can enable accurate client
identification, supporting the development of a longitudinal client records that contains all
clinical information available for the client (Hebda & Czar 2013, p.128). The ADT systems are
separated into 3 main stages: the admission, discharge and transfer stages.
There has not been any big change in the ADT system in many hospitals or clinics in
recent years. The ADT system has always been implemented from the establishment of hospitals
as institutions. When a patient enters the hospitals, they would have to sign-in in order to meet
their doctors, proceed with treatment and procedures, and, inevitably be discharged. However,
there has been a change in the evolution of technologies, where instead of patients signing in
with writing utilities, they would either use touch pads or computers. This lead to the creation of
the Electronic Health Record (EHR) coming into fruition.
The Admission Stage
The initial admission stage is where the patient is admitted or visits the hospital or clinic.
During the admission stage, the administration of the hospital must identify who their client is

and other personal information that is related to the reason why they want to be admitted. For
example, from a nurses perspective, the admission process includes performing the initial
interview and obtaining a full history of the patient and family; the assessment of vital signs and
performance of a full physical assessment; identifying nursing diagnoses and formulating goals
and a care plan for the patient; and documenting all findings and the care plan in the
computerized nursing documentation system (Giangiulio et al. 2008, p.66-67). In an inpatient
hospital setting, the availability of the number of inpatient beds and rooms is very important to
keep track because of hospital overcrowding. By the time the patient is admitted to the hospital,
the nurses and doctors are expected to give a report of the patients situation in order to initialize
and provide the care the patient needs.
The Transfer Stage
This stage is an optional process where the patient can be transferred to another hospital.
During the transfer stage, the patient can choose to be relocated to another hospital from the
current hospital in which they are staying. When the patient arrives at the designated hospital, the
previous hospital must transfer the information of the patients medical records in order to update
and file it into the current hospital system. Once the patient and family are settled into their new
hospital and room, the ADT nurse provides an updated report related to the patient to the unit
nurse who assumes the care of the patient (Giangiulio et al. 2008, p.67).
The Discharge Stage
This discharge stage is the last stage where the patient has permission to leave the
hospital. The patient is not immediately discharged because the nurse or doctor must review the
patients medical record and follow a set of instructions, such as assign their prescription, and
medication instruction to the patient and their family members. The ADT Nurse also assesses

the legal guardians verbal understanding of the discharge instructions, confirms the plan for any
follow-up education or appointments for the patient/family, ensures that all discharge documents
are signed by legal guardians, and documents the patients and familys response to the discharge
teaching in the electronic nursing documentation system (Giangiulio et al. 2008, p.67-68). Once
these procedures and responsibilities are completed, the patient is free to leave.
DATABASE DESIGN Conceptual Diagram

What type of data does the Admission, Discharge, and Transfer System capture?
The admission, discharge, and transfer system (ADT) is a core and complex system that
plays a significant role in all major health centers and hospitals. It contains and captures all of the

important demographic and clinical information for each patient. Upon a patient entering a clinic
or hospital, the system will obtain data pertaining to that individual patient, such as name,
address, phone number, date of birth, sex, medical record number, and bill/account number
(Hanan & Durgin, 2015).
The ADT system captures data that informs connected systems of the patients status or
present location. For example, the ADT system will keep the pharmacy system informed as to
which ward a patient is located in. This information will be updated regularly since the patient
can be discharged or transferred elsewhere (Hanan & Durgin, 2015). The information captured
will be used by the pharmacy system to know which ward the patient reside in, where to send the
medication orders, where to send reports concerning patients, and to inform the system if the
patient was discharged, so that no other prescription orders are filled.
The ADT system also provides other systems with critically essential information, which
assists in managing and maintaining the streamline processes within the hospital. For example,
insurance information that is captured during the admission stage is used to facilitate the billing
process. In addition, the ADT system provides the means for the hospitals to gather additional
valuable information such as referral information, whether the patient has a will, if the patient
has a power of attorney, as well as the name of the patients physician (Hanan & Durgin, 2015).
In the case where a patient is transferred to another hospital or ward within the hospital,
the ADT system will ensure that all of the information that is captured during the time of the
patients previous stay would be sent over to their new transferred location. This further allows
for the patient to receive the most efficient and effective care, since the new doctors would now
be informed and better prepared for the patients past and present conditions.

What are the Database functions?

Main functions include:
Patient Search Engine with various filters including ID number, name, address, date of
birth, OHIP Number, admission date and discharge date
Patient identification creation and editing of each patient's related information,
including, for example: name, address, gender and age etc.
Prevents Duplication mechanisms such as Primary Key ID validation and the
duplications of two identical patient records, etc.
Ability to correlate patients between different facilities through a PIX (Patient Identifier
Cross-referencing) system
Insurance verification and validation
Patient admission documentation of data related to the episode that made the patient
seek the facility (Outpatient and Inpatient settings)
Real time Patient Information according to admission time, location, specialty and
room, among other
Follow-up of patients from the episode's creation until discharge including care time
and location, ordered and completed tasks
Management of waiting lists for Inpatient and Operating Rooms/Ward with prioritization
based on severity and symptoms (uses Patient Record)

How is the Data, Information and Knowledge presented to the user?

Information becomes accessible to users after data is entered into the database in different
fields or columns of a table. The combination of characters make up a patients information or

record. This information provides the end users, such as doctor and nurses, with overall
knowledge of the patients they are treating. For example, the Patient ID, name, date of birth,
admission date, discharge date, allergic reactions, and vital signs, among other fields, are
information that make up a patient record.
Creating a database offers a method for managing large amounts of information, which
makes it easier for users to access the information they need. In the ADT system, users are
usually members of the healthcare team in a specific facility. These members of the healthcare
team consist of doctors, nurses, admission clerks, pharmacists and laboratory personnel. The
users of ADT database are assigned a username and password in order to access patient
information that is within their security clearance. This aids with the privacy and confidentiality
of patient medical records.
Information is presented in the form of a graphical user interface (GUI) that is accessed
through web-based applications and software. The ADT systems information is outputted via
Electronic Medical Record (EMR) system interface. The interface allows for a natural, accurate
recording of patient-related information while simultaneously permitting seamless requests and
retrieval of reports from a variety of sources related to a patients broader EHR. Using EMR
interface will permit end users, such as physicians and nurses, to record and retrieve the details
of a patients condition, reasons for admission, treatment while hospitalized, reasons for
discharge, and where a patient may be transferred to. Using this interface will preserve the users
overview of a patients record so that any aspect of the patients health can be effortlessly
queried and inspected (Craig & Farrell 2010).
The ADT system may also utilize Laboratory Information Management System (LIMS)
and other Information Management systems. LIMS are information management systems that

process, store, and manage data from all stages of medical processes and tests. Part of the ADT
database captures patient treatment records that include laboratory studies.
DATABASE QUERIES:
Query 1
/* List All Patients who have a Cardiologist (Patient and Doctor) */
SELECT Patient_FName, Patient_LName, Doctor_FName, Doctor_LName,
Doctor_Specialization
FROM Patient, Doctor, Encounter
WHERE Doctor.Doctor_ID = Encounter.Doctor_ID
AND Encounter.Patient_ID = Patient.Patient_ID
AND Doctor.Doctor_Specialization = 'Cardiology';
OUTPUT:

Query 2
/* List all inpatients that are associated with Empire Life insurance company */
SELECT Patient_FName, Patient_LName, Provider_Name
FROM Inpatient, Patient, Insurance_Company, Admission_Desk, Insurance_Policy
WHERE Patient.Patient_ID = Admission_Desk.Patient_ID
AND Admission_Desk.Admission_ID = Inpatient.Admission_ID
AND Patient.Patient_ID = Insurance_Policy.Patient_ID
AND Insurance_Policy.Provider_ID = Insurance_Company.Provider_ID
AND Insurance_Company.Provider_Name = 'Empire Life';
OUTPUT:

The Usefulness of ADT System in Health Practices

Hundreds of people shift through doctors offices and thousands more enter hospitals on
a weekly basis. Many patients have an EMR that captures their personal information, as well as
medical history. In the age of technological evolution, many health practices have started to use
databases to facilitate these records. Databases in a clinic or a hospital have significant
usefulness for all users and, therefore, are a focal point in daily operation. ADT databases,
specifically, are useful because they integrate departments, provide accessibility of information
for staff, and store large volumes of data in a secured, organized manner.
Integration
Facilitating an ADT system must have all members of a health practice on the same page
to run efficiently. Healthcare workers, information technicians and other workers are directly
involved with healthcare services and the use of ADT systems at some point and must be able to
input information accurately. As a patient moves through admission and transfers to different
departments, said departments must collect data for every patient-care transaction from all
clinical support subsystems (Collen, 2012, p.47) . Providing this continuity of service and data
collection depends on everyone working cohesively so the patient can progress in the practice as
well as in health.
Accessibility
Accessing the ADT system anywhere and anytime is a major advantage in healthcare
practices. New technologies such as tablets, are being utilized for accessing EMR. Furthermore,
in large healthcare practices, such as a hospital and clinics, thousands of patients are seen weekly
and their EMRs must be viewed, manipulated and shared (with a patient or healthcare worker)
without a moments notice. The ADTs easy accessibility helps nurses input and query

10

information easier and can even provide alerts and alarms for possible adverse events such
when medication is administered untimely (Collen, 2012, p.109). The ADT systems fast access
to a patients EMR allows timely, efficient and accurate health care.
Organization and Storage
Paper records are starting to make the transition to digital copies because databases are
able to store huge volumes in a more organized fashion. Querying for information through hardcopy files can be meticulous, but electronically it is more time-saving as patients are encoded
with unique codes to distinguish their EMR from the other million EMRs in the database. The
structure of an ADT database is also facilitated with the use of security protocols to keep EMRs
confidential and private. Legally, all databases have to uphold security practices to protect their
patients. For example, the Health Insurance Privacy Act (HIPA) established and enforces
security standards for client information (Collen, 2012, p.112). ADT systems, therefore, help
organize the information and provide security to EMR databases.

CONCLUSION
The admission, discharge, and transfer system (ADT) is a core and complex system that
plays a significant role in all major health centers and hospitals. It contains and captures all the
important demographic and clinical information for each patient. The admission stage is where
hospital administration identifies the patient and the reason the patient is visiting the hospital.
These reasons may include emergency care, follow-up appointment, or laboratory tests among
other things. This stage also verifies the patient as either an inpatient or an outpatient. The ADT
system captures data that informs connected systems of the patients status or present location.
The transfer stage is an optional process where a patient may want to undergo as this process

11

exists to transfer the patient from one facility or room to another, either on or off-site. If a patient
were to be transferred to another hospital or ward within the hospital, the ADT system will
ensure that all the information captured during that patients stay would be transferred to the new
location. The discharge stage is the final stage where the patient has the permission of their
doctor to leave the hospital. They are given instructions on how to proceed with their care and
are, thereby, responsible for their own care. The primary functions of the ADT Database system
include; patient identification, insurance validation, and patient admission, among other features.
The ADT Database system also allows for the elimination of data redundancy and inaccurate
information as all patient information is available in real-time. Users of the ADT database will be
assigned a username and password in order to access data. This aids with privacy and
confidentiality. Also, it will allow access to those who have the security clearance to access some
or all of the information. Facilitating an ADT system must have all members of a health practice
working in cohesion. Providing this continuity of service and data collection depends on every
individual working cohesively so the patient can progress in the practice as well as in health.
ADT database systems organize EMR data in mass quantities, but do it safely and securely so
that minimal data is lost and security is not put at risk.

12

References
Collen, M. F. 1., & Springer E-books - York University. (2012). Computer medical databases:
The first six decades (1950-2010). London; New York: Springer-Verlag London
Craig, D., & Farrell, G. (2010) Designing A Physician-friendly Interface for an Electronic
Medical Record System. Retrieved April 9, 2015, from
https://www.med.mun.ca/getdoc/baaa5ba1-cee7-4df1-a96e-177e3a7d414e/craig-farrellHEALTHINF_2010_98_CR.aspxLtd.
Giangiulio, M., Aurilio, L., Baker, P., Brienza, B., Moss, E., & Twinem, N.
(2008). Initiation and Evaluation of an Admission, Discharge, Transfer
(ADT) Nursing Program in a Pediatric Setting. Issues in Comprehensive Pediatric
Nursing, Informa Healthcare USA, Inc. 31: 61-70.
Hebda, T., & Czar, P. (2013). Health Information Systems. In Handbook of
informatics for nurses and health care professionals (5th ed.). Upper Saddle River, N.J.:
Pearson Prentice Hall.
Zachary, Hanan., & Jane, Durgin. (2015). Pharmacy Practice for Technician (5th ed.) Clinton
Park, NY: Stephan Helba Publishing.

13