Sri Venkateshwara Multi-Speciality Hospital · Kukatpally, Hyderabad · 60 beds
VK
Emergency Department
Saturday 18 July 2026 · 10:47 AM · Dr. Vamsi Krishna on duty. 11 patients in the department, 1 ambulance 6 minutes out, no ICU bed in the building.
Arrivals today
23
12 dispositioned · 11 still here
Median door to doctor
9 min
across the 20 patients assessed
Past their target
1
▼ P. Ramesh Babu · 81 min, target 60
ICU beds free
0 of 8
at capacity · next step-down tomorrow
Registering:
Unknown patient — open a record now
Nothing on this form is mandatory. The record opens either way.
Resus bay 1 free
Not required to open this record
Patient nameMobile numberABHA numberPayer / TPAAddressNext of kinSigned consentAdvance payment
Time on this form
00:00
What happens the moment it opens
And what deliberately does not
A temporary identifier is minted. UNK-2026-0718-02 — date-stamped and sequential, so two unknown patients in the same hour can never be confused with each other.
A FHIR Encounter opens against a Patient resource whose only identifier is that temporary one. Vitals, orders, drugs and notes all attach to it from the first minute, which is the point: the clinical record must not wait for the clerical one (ADR #6 — FHIR R4 is the internal model, not an export format).
The patient appears on the Triage Board with no acuity level, at the top, flagged as awaiting a clinician. HOS does not assign one.
Consent is recorded as deferred — "emergency care, consent not obtainable", with the name of the clinician who deferred it and the time. Under the DPDP Act the purpose is recorded as emergency care; the consent record is opened, not skipped.
If the mode of arrival is police, an ambulance or a road traffic collision, an MLC entry is pre-opened in the MLC Register with the intimation clock started.
What does not happen: no payer is guessed, no ABHA is created, no name is inferred, and no bill is opened. A wrong identity in a permanent record is far more expensive than a blank one.
Identity reconciliation queue
Every unknown or incomplete record, and who is chasing it
3 records · 4 open tasks
1 reconciled today
| Status | Record | Arrived | Description at arrival | Outstanding | Owner |
|---|---|---|---|---|---|
| Merged | UNK-2026-0718-01 → B. Yellaiah, 46M |
04:12 | Male, about 45. Road traffic collision, brought by police. No identification on person. | Payer — Aarogyasri card number awaited | Swapna Reception |
| Partial | ED-2026-0718-14 V. Anjamma, 61F |
10:34 | Name and age given by her son. No ABHA number, no card carried. | ABHA link Payer | Swapna Reception |
| Partial | ED-2026-0718-09 D. Ramanjaneyulu, 58M |
10:41 | Walked in. Known to the hospital but no phone match — two records may be the same person. | Possible duplicate — needs a human to confirm | Swapna Reception |
UNK-2026-0718-01 became B. Yellaiah at 07:50. His brother arrived, identified him, and produced an Aadhaar card. The temporary record was merged into his existing one from a 2024 visit — by two named people, Swapna and Dr. Vamsi Krishna, because a merge is irreversible in practice even when it is reversible in software.
HOS can show candidate matches from recorded identifiers — name, age, phone fragment, previous visit. It never merges on its own, and the two-person rule is not configurable down to one. Identity matching is an administrative task, GREEN under ADR #7; the safety comes from the human confirmation, not from the confidence score.
Arrivals today
23 registrations · how each one came in
61% arrived with pre-notification
| Mode of arrival | Arrivals | Median door to doctor | Note |
|---|---|---|---|
| Own hospital ambulance | 6 | 5 min | All 6 had a pre-arrival radio call |
| 108 ambulance | 4 | 7 min | Pre-arrival call on 3 of 4 |
| Private vehicle | 8 | 16 min | No warning — the department finds out at the door |
| Walked in | 4 | 22 min | Mostly Level 4–5, routed to fast track |
| Police | 1 | 4 min | MLC-2026-0142 · 04:12 |
| All arrivals | 23 | 9 min | 20 assessed · 3 awaiting a doctor |
Triage board
4 patients · timer is time from door to a recorded medical assessment, not to the triage act
1 past target
1 awaiting acuity
| Door → doctor | Patient | Acuity — who set it | Recorded observations | Flags & orders | Where |
|---|---|---|---|---|---|
|
81 minutes
81 min
target 60 · +21
|
P. Ramesh Babu 34M · arrived 09:26 · private vehicle |
Level 4GREEN zone
Dr. Vamsi Krishna · 09:31
|
Temp 100.2 °F · BP 118/76 · pulse 92 · RR 18 · SpO₂ 98% · pain 3/10 All 6 inside your thresholds. |
Assessment overdue Fever, 2 days. No orders placed yet. |
Main area, chair 3 |
|
13 minutes
13 min
no target until a level is set
|
V. Anjamma 61F · arrived 10:34 · private vehicle, brought by her son |
Not setawaiting a clinician
HOS does not assign a level.
|
BP 182/104 · pulse 112, irregular · GCS 13 · SpO₂ 96% · RR 20 · temp 98.4 °F · glucose 138 mg/dL Recorded 10:35 by Staff Nurse Jyothi. |
3 values outside thresholds Onset recorded 10:22 (son's account). Dr. K. Ramesh paged 10:36, acknowledged 10:37. |
Resus bay 2 |
|
Assessed
7 min
target 10 · met
|
G. Nagaraju 52M · arrived 10:04 · own ambulance |
Level 2RED zone
Dr. Vamsi Krishna · 10:07
|
BP 168/98 · pulse 104 · RR 20 · SpO₂ 96% · pain 6/10 Chest pain, 40 minutes at arrival. |
ECG 10:12 Troponin sent 10:18 Under assessment, Dr. Vamsi Krishna. |
Resus bay 1 |
|
Assessed
27 min
target 30 · met
|
K. Swathi 29F · arrived 09:52 · private vehicle |
Level 3YELLOW zone
Dr. Vamsi Krishna · 09:56
|
BP 112/72 · pulse 84 · RR 16 · SpO₂ 99% · pain 5/10 Right wrist injury after a fall. All values inside thresholds. |
X-ray requested 10:22 Waiting for the plate. |
Main area, bay 4 |
Levels 1–5 map to the RED / YELLOW / GREEN zones printed on your triage cards: 1–2 → RED, 3 → YELLOW, 4–5 → GREEN. The ward summary in IPD shows the colours because that is what the ward asks for; this board shows the level because that is what the department records. One record, two audiences.
✦
Recorded observations against your published thresholds — V. Anjamma
Clinician assigns acuity
Reference display · AMBER tier
Your triage thresholds
Policy ED-TRG-04 · published 02 Jun 2026 · last edited by Dr. G. Prakash
3 breached by V. Anjamma
Systolic BP > 180 or < 90 mmHg
Pulse < 50, > 120, or irregular
Glasgow Coma Scale < 15
Respiratory rate > 24 per minute
SpO₂ < 92% on room air
Temperature > 39 °C (102.2 °F)
Capillary glucose < 70 or > 300 mg/dL
Pain score ≥ 7 of 10
HOS ships no thresholds of its own. These eight are yours: entered by your clinical lead, versioned, and editable in Quality & Safety → SOP Library. If HOS supplied them it would be making a clinical judgement about which numbers matter, at every one of its hospitals, from Hyderabad.
A breached threshold is a flag, not a level. Four of V. Anjamma's eight recorded values are inside these thresholds and three are outside; a Level 1 and a Level 4 patient can both breach three.
A breached threshold is a flag, not a level. Four of V. Anjamma's eight recorded values are inside these thresholds and three are outside; a Level 1 and a Level 4 patient can both breach three.
Critical-care capacity, if it is needed
A bed count. Not a recommendation about anyone.
8 of 8
There is no free ICU bed in this hospital right now. All 8 are occupied; 2 of those patients are recorded as critical. The ward side is 42 of 54.
Next recorded step-down: A. Bhaskar Rao, ICU-7, planned for tomorrow morning by Dr. K. Ramesh. That is a plan in the record, not a promise — it can change on the round.
Ventilator-capable bays outside the ICU: 0. The department has 2 resuscitation bays with monitoring but no ventilator.
Recorded referral agreements: 2 tertiary hospitals, both with a named on-call number and an agreed transfer protocol on file. Calling one is a clinician's decision and HOS has never made it; what it does is make sure nobody discovers the ICU is full at the moment they need it.
Door-to-doctor performance today
By the level a clinician assigned · targets are yours, from ED-TRG-04
2 breaches today
| Level | Zone | Your target | Patients today | Median | Breached |
|---|---|---|---|---|---|
| Level 1 — resuscitation | RED | Immediate | 0 | — | 0 |
| Level 2 — emergent | RED | 10 min | 2 | 7 min | 0 |
| Level 3 — urgent | YELLOW | 30 min | 5 | 21 min | 1 |
| Level 4 — less urgent | GREEN | 60 min | 9 | 14 min | 1 |
| Level 5 — non-urgent | GREEN | 120 min | 6 | 8 min | 0 |
| All levels 1 patient still awaiting a level | — | — | 22 | 9 min | 2 |
22 of today's 23 arrivals have a level assigned by a named clinician; V. Anjamma is the 23rd and is 13 minutes in. Level 5 patients are seen faster than Level 3 patients today because fast track works — see the Fast Track section for why that is a feature and not an accident.
In fast track now
3
2 chairs · 1 waiting
Routed to fast track today
11 of 23
▲ 48% of arrivals
Median door to discharge
34 min
▲ main area 96 min
Sent back to the main area
1
criteria are a filter, not a diagnosis
Fast track now
Level 4–5 · ambulatory · expected to be done inside 45 minutes
Both chairs busy · next free ≈ 10:55
| Waiting | Patient | Level | Reason for attendance | Status | Seen by |
|---|---|---|---|---|---|
In chair 21 min |
M. Vinod 24M · arrived 10:26 |
5 | Dressing change, healing laceration on the left shin | Dressing done · discharge summary printing | Dr. Vamsi Krishna 10:29 |
In chair 14 min |
Sk. Rehana 31F · arrived 10:33 |
5 | Sore throat and fever for one day. Temp 99.8 °F, all values inside thresholds. | Prescription being written | Dr. Vamsi Krishna 10:39 |
6 minutes 6 min target 120 · fine |
D. Ramanjaneyulu 58M · arrived 10:41 · walked in |
5 | Blood-pressure check and a repeat prescription. BP 138/86 at the desk. | Next in queue | Awaiting |
Why this section exists
And the fact that it failed once today
One queue means the sore throat waits for the chest pain. Today the median fast-track patient was done in 34 minutes and the median main-area patient in 96. Both numbers are from the same department on the same morning; the only difference is which queue they were in.
It failed once today, and here is where. Fast track was closed between 09:20 and 10:15 because both chairs were used for a suture repair that ran long. P. Ramesh Babu arrived at 09:26 into that window, went to the main area, and is now 81 minutes in with no assessment. A dashboard that only showed the 34-minute median would have hidden him.
The routing rule is a rule you wrote: fast track opens when two or more Level 4–5 patients are waiting and no Level 1 case is in a resuscitation bay. HOS applies it, shows you when it could not, and never re-levels a patient to make its own numbers look better.
Fast-track criteria
Set by Dr. G. Prakash · policy ED-FT-02 · 02 Jun 2026
Editable by you
✓
Acuity Level 4 or 5, assigned by a clinician
A level is never inferred to make a patient eligible
✓
Ambulatory — able to sit in a chair
✓
Single presenting complaint
✓
No imaging beyond a plain X-ray expected
✓
All recorded observations inside ED-TRG-04 thresholds
A single breached threshold sends the patient back to the main area — that happened once today
✓
Expected total stay under 45 minutes
One patient was returned to the main area today when a repeat pulse reading came back at 126. Criteria are a filter on recorded data. They are not a judgement about how sick anyone is, and a patient moving back is the system working.
In observation
4 of 6 bays
2 bays free
Decisions overdue
1
▼ Sk. Rafi · 1 h 07 m past
Median observation stay
5 h 12 m
1–17 Jul · 61 episodes
Converted to admission
38%
23 admitted · 36 discharged · 2 referred
OBS-1 · Sk. Rafi · 39M
Head injury with brief loss of consciousness · hourly neurological observations
Overdue
In observation
9 h 07 m
Decision was due
09:40
Overdue by
1 h 07 m
Entered 01:40 · consultant Dr. K. Ramesh · last neurological observation 10:15, GCS 15 at every one of the 9 checks · BP 124/78 · pulse 76 · no vomiting recorded · CT head not ordered.
Nine hours of charted observations and no recorded decision. HOS has no view on whether he should go home — it has a view that somebody must write down which.
Nine hours of charted observations and no recorded decision. HOS has no view on whether he should go home — it has a view that somebody must write down which.
OBS-2 · A. Deepika · 19F
Scorpion sting, left foot · observation per protocol
On clock
In observation
3 h 02 m
Decision due
15:45
Time left
4 h 58 m
Entered 07:45 · Dr. K. Ramesh · pain 3/10, down from 8/10 at arrival · BP 108/70 · pulse 88 · no systemic features charted · analgesia given 07:52 and 10:10.
OBS-3 · T. Padmavathi · 52F
Giddiness · intravenous fluids running
On clock
In observation
2 h 42 m
Decision due
16:05
Time left
5 h 18 m
Entered 08:05 · Dr. K. Ramesh · BP 96/60 at arrival, 108/68 at 10:30 · pulse 92 · capillary glucose 104 · 1 litre normal saline given · ECG done 08:20.
OBS-4 · N. Chittibabu · 66M
Breathlessness · nebulisation given
Watch
In observation
1 h 37 m
Decision due
17:10
Time left
6 h 23 m
Entered 09:10 · Dr. K. Ramesh · SpO₂ 93% at arrival, 96% at 10:35 on room air · RR 24 at arrival, 20 now · nebulisation 09:18 and 10:20 · chest X-ray done 09:40.
If a clinician decides this patient needs critical care, there is no ICU bed in this hospital. All 8 are occupied and the next recorded step-down is tomorrow morning. This is a bed count, shown now rather than at the moment it would be needed.
The decision clock
Policy OBS-04 · 8 hours · set by Dr. G. Prakash
Eight hours is your number, not ours. HOS ships no default. Change it to six and every clock on this screen recalculates; change it per presenting complaint and they recalculate per patient.
What the clock does at zero: flags the bay on this board, adds it to the bell, and after one hour escalates to the duty consultant. It does not discharge anybody, admit anybody, or decide anything.
Why it matters commercially: six observation bays turning over every 5 h 12 m is roughly 11 episodes a day. One forgotten patient at nine hours is one bay you did not have, and it is invisible on paper because nothing was written down — which is exactly why it is invisible on paper.
Where observation patients went
1–17 Jul · 61 episodes
| Outcome | Episodes | Share | Median stay |
|---|---|---|---|
| Discharged home | 36 | 59% | 4 h 40 m |
| Admitted | 23 | 38% | 6 h 05 m |
| Referred to another hospital | 2 | 3% | 3 h 20 m |
| Total | 61 | 100% | 5 h 12 m |
Both referrals out were for critical care when the ICU was full — which is the same constraint sitting on N. Chittibabu's card above, recorded twice this month already.
Inbound — one patient
AP-09-TG-4412 · own hospital ambulance · crew Sk. Nazeer (driver) and P. Kiran (attendant)
Arriving 10:53
Estimated arrival
6 min
10:53 · 3.2 km out on the Kukatpally main road
Lead time you have had
12 min
Radio call taken 10:41 · median today is 9 min
Pre-arrival note — recorded verbatim from the crew's radio call at 10:41 by Dr. Vamsi Krishna, read back and confirmed
“Male, about 35, road traffic collision on the Kukatpally main road. Conscious and talking to us. Bleeding from the right forearm, pressure dressing applied. Blood pressure on scene 128/84, pulse 96, breathing normal. He was not wearing a helmet. No other vehicle involved as far as bystanders say.”
Stored as an attributed account from the crew, not as a measurement taken here, and not summarised. When he arrives the department records its own observations alongside it — HOS never overwrites one account with another, and it adds no interpretation to either.
✓
Resuscitation bay 2 held
Sister on duty · 10:42 · V. Anjamma moves to bay 3 if both are needed
✓
Trauma trolley checked and open
Staff Nurse Jyothi · 10:43
✓
X-ray informed
Prasad · 10:43 · plates loaded, room clear from 10:50
✓
MLC entry pre-opened
Road traffic collision is a medico-legal case under your SOP · MLC-2026-0143 reserved, intimation clock starts at registration
✓
Orthopaedic on-call informed
Dr. P. Anil Kumar · 10:44 · he is operating in OT-1 until 11:07, which the OT schedule already knew
Blood bank informed
Not yet done. Nobody has asked for blood — this is the “in case” call, and it is the one that gets forgotten.
5 of 6 preparation steps done. The list is your SOP for a road traffic collision; each tick carries a name and a time.
Inbound right now
1
ETA 6 min · resus bay held
Arrived with pre-notification
14 of 23
▲ 61%
With warning
6 min
median door to doctor
Without warning
19 min
▼ 13 minutes slower
Ambulance log today
Own vehicle · 3 trips
1 vehicle
| Status | Called | Pickup | Patient | Pre-arrival note | At door |
|---|---|---|---|---|---|
| Inbound | 10:34 | Kukatpally main road | Male, about 35 — name not known | 10:41 · 12 min lead | 10:53 est. |
| Completed | 09:48 | Moosapet | G. Nagaraju 52M | 09:56 · 8 min lead | 10:04 |
| Completed | 03:55 | KPHB Phase 3 | B. Yellaiah registered as UNK-2026-0718-01 | 04:03 · 9 min lead | 04:12 |
What we do not pretend to do
Honesty about the limits is part of the product
There is no live map on this screen. Your ambulance has no telematics unit, so a moving dot would be a moving lie. The ETA above is what Sk. Nazeer said at 10:41 plus the distance he gave, and the screen says so.
Fit a tracker and the same field fills itself. The ETA is one value from one source; nothing else on the screen changes. Until then, a radio call and a person writing it down is the integration — and today it bought this department 12 minutes.
Arrivals with a pre-arrival note reached a doctor in a median of 6 minutes today. Arrivals without one took 19. That 13-minute difference costs nothing to obtain and no software is required to obtain it — which is why it is the first thing this section measures rather than the last.
Entries this month
14
4 shown below · full register searchable
Police intimations overdue
0
▲ all within 1 h of registration, per your SOP
Opening on arrival
1
MLC-2026-0143 · road traffic collision, 10:53
Certificates requested
1
Court request · due 25 Jul · 7 days
Register
Most recent first · nature of injury is recorded in the examining doctor's own words
4 of 14 entries
| MLC no. | Date & time | Patient | Nature of injury as recorded | Police intimation | Examining doctor | Chain of custody | Status |
|---|---|---|---|---|---|---|---|
| 2026-0142 | 18 Jul 04:12 |
B. Yellaiah 46M · registered as UNK-2026-0718-01, identified 07:50 |
Road traffic collision, two-wheeler. Abrasions over both knees and the right elbow; lacerated wound 6 cm over the right shin, sutured; no external head injury seen. | KPHB Police Station 04:26 · telephone and written memo · received by HC K. Srinivas, buckle no. 1187 |
Dr. Vamsi Krishna | Clothing (1 sealed bag), helmet, mobile phone — sealed 04:40, witnessed by Staff Nurse Jyothi | Referred out 09:20 At the family's request · transfer summary and MLC copy handed over and acknowledged |
| 2026-0141 | 17 Jul 22:35 |
Md. Shafi 27M |
Alleged assault. Lacerated wound 4 cm over the left parietal scalp, sutured. No other injury seen on examination. | Kukatpally Police Station 22:48 · written memo · received by SI M. Jaipal |
Dr. Vamsi Krishna | Nil | Closed Discharged 18 Jul 01:10 · injury certificate issued to police 08:00, receipt on file |
| 2026-0140 | 16 Jul 15:20 |
G. Sarojini 34F |
Alleged consumption of an unknown substance. Brought by family within the hour. Substance not identified at this hospital. | Kukatpally Police Station 15:31 · telephone and written memo · received by SI M. Jaipal |
Dr. Vamsi Krishna | One plastic container brought by the family — sealed, labelled and handed to police 16 Jul 18:40 against receipt | Transferred To the government tertiary centre 16 Jul 19:05 at police request · MLC copy and custody receipt handed over |
| 2026-0139 | 14 Jul 08:05 |
P. Anjaneyulu 51M |
Industrial injury. Crush injury to the right hand with fracture of the second and third metacarpals; wound debrided and fixed the same day. | KPHB Police Station 08:22 · written memo · received by HC K. Srinivas Employer intimation also issued 14 Jul 09:10 |
Dr. Vamsi Krishna | Nil | Closed Discharged 17 Jul · injury certificate and wage-loss certificate issued |
Outstanding statutory actions
Nothing here expires quietly
2 open
◷
Injury certificate requested by court — MLC-2026-0118
Incident 12 Jun 2026 · request received 11 Jul · due 25 Jul, 7 days left · assigned to Dr. Vamsi Krishna · the case sheet and photographs are attached and ready to review
○
MLC-2026-0143 opens at 10:53
Road traffic collision, inbound by ambulance. Number reserved; the 1-hour intimation clock in your SOP starts at registration, not at the call.
A missed police intimation is not a workflow inefficiency, it is an offence by the hospital. So the clock is on the bell, it escalates, and it cannot be dismissed — only completed by a named doctor.
Death declaration & statutory notification
Documentation only
The determination of death is made by a registered medical practitioner at the bedside. HOS records that it was made, by whom, and at what time. It has no part in the determination, it offers no opinion, and no AI feature in this product touches this workflow — not to draft it, not to summarise it, not to prompt it.
1
Time of death recorded, with the name and registration number of the declaring doctor
2
Family informed in person, by the declaring doctor
Recorded as done, with who was present. Never by message.
3
Medical Certificate of Cause of Death — Form 4 or 4A
Completed by the treating doctor. The cause is the doctor's, in the doctor's words.
4
Body handed over with identification confirmed by a named relative
Two staff signatures, with time and the relationship of the person receiving.
5
Registered with the municipal registrar within 21 days
Registration of Births and Deaths Act, 1969. The clock is tracked and escalates well before day 21.
6
If medico-legal: police intimated, post-mortem referral raised, body not released without police clearance
The MLC entry and the death record are linked in both directions.
7
Organ-donation counselling offered, and the offer recorded either way
Per your hospital policy. The record notes that it was offered, not what was decided under pressure.
Last recorded in this department: 11 Jul 2026, 03:40 — declared by Dr. K. Ramesh. Form 4 issued 11 Jul 09:20, registered with the municipal registrar 12 Jul. Mortality review completed by the committee under Sister Vasavi on 15 Jul and filed in Quality & Safety → Mortality Review.