Emergency department patient intake and triage (ESI)

<?xml version="1.0" encoding="UTF-8"?>
<bpmn:definitions xmlns:bpmn="http://www.omg.org/spec/BPMN/20100524/MODEL" xmlns:bpmndi="http://www.omg.org/spec/BPMN/20100524/DI" xmlns:dc="http://www.omg.org/spec/DD/20100524/DC" xmlns:di="http://www.omg.org/spec/DD/20100524/DI" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="Process_EdIntake_defs" targetNamespace="http://flowss.ai/bpmn">
  <bpmn:message id="Msg_Presentation" name="Presenting complaint"/>
  <bpmn:process id="Process_EdIntake" name="ED intake and triage" isExecutable="false">
    <bpmn:documentation>Five-level Emergency Severity Index (ESI) triage. ESI 1–2 patients bypass the waiting area and go straight to a clinician; ESI 3–5 patients complete registration and are monitored in the waiting area, where an interrupting timer triggers re-assessment of vital signs every 60 minutes. A patient who deteriorates is escalated immediately; otherwise monitoring resumes until a treatment space is free. The interval and routing are illustrative — follow your local triage policy.</bpmn:documentation>
    <bpmn:laneSet id="Process_EdIntake_lanes">
      <bpmn:lane id="Lane_Reception" name="Reception"><bpmn:flowNodeRef>Start_Arrival</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_QuickRegistration</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_FullRegistration</bpmn:flowNodeRef></bpmn:lane>
      <bpmn:lane id="Lane_Triage" name="Triage nurse"><bpmn:flowNodeRef>Task_TriageAssessment</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_AssignESI</bpmn:flowNodeRef><bpmn:flowNodeRef>Gw_ESI</bpmn:flowNodeRef><bpmn:flowNodeRef>Gw_WaitMerge</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_Monitor</bpmn:flowNodeRef><bpmn:flowNodeRef>Timer_Retriage</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_Reassess</bpmn:flowNodeRef><bpmn:flowNodeRef>Gw_Deteriorated</bpmn:flowNodeRef><bpmn:flowNodeRef>Gw_SpaceMerge</bpmn:flowNodeRef></bpmn:lane>
      <bpmn:lane id="Lane_Clinician" name="Emergency clinician"><bpmn:flowNodeRef>Gw_TreatMerge</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_Assess</bpmn:flowNodeRef><bpmn:flowNodeRef>Gw_Disposition</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_Discharge</bpmn:flowNodeRef><bpmn:flowNodeRef>End_Discharged</bpmn:flowNodeRef><bpmn:flowNodeRef>Task_Admit</bpmn:flowNodeRef><bpmn:flowNodeRef>End_Admitted</bpmn:flowNodeRef></bpmn:lane>
    </bpmn:laneSet>
    <bpmn:startEvent id="Start_Arrival" name="Patient presents"><bpmn:messageEventDefinition id="Start_Arrival_ed" messageRef="Msg_Presentation"/></bpmn:startEvent>
    <bpmn:userTask id="Task_QuickRegistration" name="Register arrival"/>
    <bpmn:userTask id="Task_TriageAssessment" name="Triage assessment and vitals"/>
    <bpmn:businessRuleTask id="Task_AssignESI" name="Assign ESI level"/>
    <bpmn:exclusiveGateway id="Gw_ESI" name="ESI level?" default="Flow_6"/>
    <bpmn:userTask id="Task_FullRegistration" name="Complete registration"/>
    <bpmn:exclusiveGateway id="Gw_WaitMerge"/>
    <bpmn:userTask id="Task_Monitor" name="Monitor in waiting area"/>
    <bpmn:boundaryEvent id="Timer_Retriage" name="60 min elapsed" attachedToRef="Task_Monitor"><bpmn:timerEventDefinition id="Timer_Retriage_ed"><bpmn:timeDuration xsi:type="bpmn:tFormalExpression">PT60M</bpmn:timeDuration></bpmn:timerEventDefinition></bpmn:boundaryEvent>
    <bpmn:userTask id="Task_Reassess" name="Re-assess vital signs"/>
    <bpmn:exclusiveGateway id="Gw_Deteriorated" name="Deteriorated?" default="Flow_12"/>
    <bpmn:exclusiveGateway id="Gw_SpaceMerge"/>
    <bpmn:exclusiveGateway id="Gw_TreatMerge"/>
    <bpmn:userTask id="Task_Assess" name="Assess and treat patient"/>
    <bpmn:exclusiveGateway id="Gw_Disposition" name="Disposition?" default="Flow_17"/>
    <bpmn:sendTask id="Task_Discharge" name="Discharge with care plan"/>
    <bpmn:endEvent id="End_Discharged" name="Patient discharged"/>
    <bpmn:userTask id="Task_Admit" name="Hand over to inpatient team"/>
    <bpmn:endEvent id="End_Admitted" name="Patient admitted"/>
    <bpmn:sequenceFlow id="Flow_1" sourceRef="Start_Arrival" targetRef="Task_QuickRegistration"/>
    <bpmn:sequenceFlow id="Flow_2" sourceRef="Task_QuickRegistration" targetRef="Task_TriageAssessment"/>
    <bpmn:sequenceFlow id="Flow_3" sourceRef="Task_TriageAssessment" targetRef="Task_AssignESI"/>
    <bpmn:sequenceFlow id="Flow_4" sourceRef="Task_AssignESI" targetRef="Gw_ESI"/>
    <bpmn:sequenceFlow id="Flow_5" name="ESI 1–2" sourceRef="Gw_ESI" targetRef="Gw_TreatMerge"><bpmn:conditionExpression xsi:type="bpmn:tFormalExpression">=esiLevel &lt;= 2</bpmn:conditionExpression></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="Flow_6" name="ESI 3–5" sourceRef="Gw_ESI" targetRef="Task_FullRegistration"/>
    <bpmn:sequenceFlow id="Flow_7" sourceRef="Task_FullRegistration" targetRef="Gw_WaitMerge"/>
    <bpmn:sequenceFlow id="Flow_8" sourceRef="Gw_WaitMerge" targetRef="Task_Monitor"/>
    <bpmn:sequenceFlow id="Flow_9" name="space free" sourceRef="Task_Monitor" targetRef="Gw_SpaceMerge"/>
    <bpmn:sequenceFlow id="Flow_10" sourceRef="Timer_Retriage" targetRef="Task_Reassess"/>
    <bpmn:sequenceFlow id="Flow_11" sourceRef="Task_Reassess" targetRef="Gw_Deteriorated"/>
    <bpmn:sequenceFlow id="Flow_12" name="no" sourceRef="Gw_Deteriorated" targetRef="Gw_WaitMerge"/>
    <bpmn:sequenceFlow id="Flow_13" name="yes" sourceRef="Gw_Deteriorated" targetRef="Gw_SpaceMerge"><bpmn:conditionExpression xsi:type="bpmn:tFormalExpression">=deteriorated</bpmn:conditionExpression></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="Flow_14" sourceRef="Gw_SpaceMerge" targetRef="Gw_TreatMerge"/>
    <bpmn:sequenceFlow id="Flow_15" sourceRef="Gw_TreatMerge" targetRef="Task_Assess"/>
    <bpmn:sequenceFlow id="Flow_16" sourceRef="Task_Assess" targetRef="Gw_Disposition"/>
    <bpmn:sequenceFlow id="Flow_17" name="discharge" sourceRef="Gw_Disposition" targetRef="Task_Discharge"/>
    <bpmn:sequenceFlow id="Flow_18" name="admit" sourceRef="Gw_Disposition" targetRef="Task_Admit"><bpmn:conditionExpression xsi:type="bpmn:tFormalExpression">=disposition = "admit"</bpmn:conditionExpression></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="Flow_19" sourceRef="Task_Discharge" targetRef="End_Discharged"/>
    <bpmn:sequenceFlow id="Flow_20" sourceRef="Task_Admit" targetRef="End_Admitted"/>
    <bpmn:textAnnotation id="Note_Triage"><bpmn:text>ESI routing and the 60-minute re-triage interval are illustrative; follow local triage policy.</bpmn:text></bpmn:textAnnotation>
    <bpmn:association id="Note_Triage_as" sourceRef="Task_Monitor" targetRef="Note_Triage"/>
  </bpmn:process>
  <bpmn:collaboration id="Process_EdIntake_collab">
    <bpmn:participant id="Process_EdIntake_pool" name="Emergency department" processRef="Process_EdIntake"/>
    <bpmn:participant id="Participant_Patient" name="Patient"/>
    <bpmn:messageFlow id="MsgFlow_Presents" name="Presenting complaint" sourceRef="Participant_Patient" targetRef="Start_Arrival"/>
    <bpmn:messageFlow id="MsgFlow_Discharge" name="Discharge instructions" sourceRef="Task_Discharge" targetRef="Participant_Patient"/>
  </bpmn:collaboration>
  <bpmndi:BPMNDiagram id="Process_EdIntake_di">
    <bpmndi:BPMNPlane id="Process_EdIntake_plane" bpmnElement="Process_EdIntake_collab">
      <bpmndi:BPMNShape id="Process_EdIntake_pool_di" bpmnElement="Process_EdIntake_pool" isHorizontal="true"><dc:Bounds x="160" y="200" width="2448" height="700"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Lane_Reception_di" bpmnElement="Lane_Reception" isHorizontal="true"><dc:Bounds x="190" y="200" width="2418" height="150"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Lane_Triage_di" bpmnElement="Lane_Triage" isHorizontal="true"><dc:Bounds x="190" y="350" width="2418" height="300"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Lane_Clinician_di" bpmnElement="Lane_Clinician" isHorizontal="true"><dc:Bounds x="190" y="650" width="2418" height="250"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Participant_Patient_di" bpmnElement="Participant_Patient" isHorizontal="true"><dc:Bounds x="160" y="60" width="2448" height="60"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Start_Arrival_di" bpmnElement="Start_Arrival"><dc:Bounds x="262" y="257" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="239" y="298" width="82" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_QuickRegistration_di" bpmnElement="Task_QuickRegistration"><dc:Bounds x="380" y="235" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_TriageAssessment_di" bpmnElement="Task_TriageAssessment"><dc:Bounds x="530" y="390" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_AssignESI_di" bpmnElement="Task_AssignESI"><dc:Bounds x="680" y="390" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Gw_ESI_di" bpmnElement="Gw_ESI" isMarkerVisible="true"><dc:Bounds x="855" y="405" width="50" height="50"/><bpmndi:BPMNLabel><dc:Bounds x="812" y="388" width="52" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_FullRegistration_di" bpmnElement="Task_FullRegistration"><dc:Bounds x="980" y="235" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Gw_WaitMerge_di" bpmnElement="Gw_WaitMerge" isMarkerVisible="true"><dc:Bounds x="1155" y="405" width="50" height="50"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_Monitor_di" bpmnElement="Task_Monitor"><dc:Bounds x="1280" y="390" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Timer_Retriage_di" bpmnElement="Timer_Retriage"><dc:Bounds x="1292" y="452" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="1324" y="486" width="77" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_Reassess_di" bpmnElement="Task_Reassess"><dc:Bounds x="1430" y="535" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Gw_Deteriorated_di" bpmnElement="Gw_Deteriorated" isMarkerVisible="true"><dc:Bounds x="1605" y="550" width="50" height="50"/><bpmndi:BPMNLabel><dc:Bounds x="1596" y="605" width="69" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Gw_SpaceMerge_di" bpmnElement="Gw_SpaceMerge" isMarkerVisible="true"><dc:Bounds x="1755" y="405" width="50" height="50"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Gw_TreatMerge_di" bpmnElement="Gw_TreatMerge" isMarkerVisible="true"><dc:Bounds x="1905" y="705" width="50" height="50"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_Assess_di" bpmnElement="Task_Assess"><dc:Bounds x="2030" y="690" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Gw_Disposition_di" bpmnElement="Gw_Disposition" isMarkerVisible="true"><dc:Bounds x="2205" y="705" width="50" height="50"/><bpmndi:BPMNLabel><dc:Bounds x="2199" y="686" width="62" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_Discharge_di" bpmnElement="Task_Discharge"><dc:Bounds x="2330" y="690" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="End_Discharged_di" bpmnElement="End_Discharged"><dc:Bounds x="2512" y="712" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="2502" y="753" width="56" height="28"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="Task_Admit_di" bpmnElement="Task_Admit"><dc:Bounds x="2330" y="795" width="100" height="80"/></bpmndi:BPMNShape>
      <bpmndi:BPMNShape id="End_Admitted_di" bpmnElement="End_Admitted"><dc:Bounds x="2512" y="817" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="2489" y="858" width="82" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
      <bpmndi:BPMNEdge id="Flow_1_di" bpmnElement="Flow_1"><di:waypoint x="298" y="275"/><di:waypoint x="380" y="275"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_2_di" bpmnElement="Flow_2"><di:waypoint x="480" y="275"/><di:waypoint x="505" y="275"/><di:waypoint x="505" y="430"/><di:waypoint x="530" y="430"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_3_di" bpmnElement="Flow_3"><di:waypoint x="630" y="430"/><di:waypoint x="680" y="430"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_4_di" bpmnElement="Flow_4"><di:waypoint x="780" y="430"/><di:waypoint x="855" y="430"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_5_di" bpmnElement="Flow_5"><di:waypoint x="880" y="455"/><di:waypoint x="880" y="730"/><di:waypoint x="1905" y="730"/><bpmndi:BPMNLabel><dc:Bounds x="886" y="458" width="42" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_6_di" bpmnElement="Flow_6"><di:waypoint x="880" y="405"/><di:waypoint x="880" y="275"/><di:waypoint x="980" y="275"/><bpmndi:BPMNLabel><dc:Bounds x="886" y="386" width="42" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_7_di" bpmnElement="Flow_7"><di:waypoint x="1080" y="275"/><di:waypoint x="1180" y="275"/><di:waypoint x="1180" y="405"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_8_di" bpmnElement="Flow_8"><di:waypoint x="1205" y="430"/><di:waypoint x="1280" y="430"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_9_di" bpmnElement="Flow_9"><di:waypoint x="1380" y="430"/><di:waypoint x="1755" y="430"/><bpmndi:BPMNLabel><dc:Bounds x="1386" y="411" width="54" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_10_di" bpmnElement="Flow_10"><di:waypoint x="1310" y="488"/><di:waypoint x="1310" y="575"/><di:waypoint x="1430" y="575"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_11_di" bpmnElement="Flow_11"><di:waypoint x="1530" y="575"/><di:waypoint x="1605" y="575"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_12_di" bpmnElement="Flow_12"><di:waypoint x="1630" y="550"/><di:waypoint x="1630" y="515"/><di:waypoint x="1180" y="515"/><di:waypoint x="1180" y="455"/><bpmndi:BPMNLabel><dc:Bounds x="1636" y="531" width="15" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_13_di" bpmnElement="Flow_13"><di:waypoint x="1655" y="575"/><di:waypoint x="1780" y="575"/><di:waypoint x="1780" y="455"/><bpmndi:BPMNLabel><dc:Bounds x="1661" y="556" width="20" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_14_di" bpmnElement="Flow_14"><di:waypoint x="1805" y="430"/><di:waypoint x="1930" y="430"/><di:waypoint x="1930" y="705"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_15_di" bpmnElement="Flow_15"><di:waypoint x="1955" y="730"/><di:waypoint x="2030" y="730"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_16_di" bpmnElement="Flow_16"><di:waypoint x="2130" y="730"/><di:waypoint x="2205" y="730"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_17_di" bpmnElement="Flow_17"><di:waypoint x="2255" y="730"/><di:waypoint x="2330" y="730"/><bpmndi:BPMNLabel><dc:Bounds x="2261" y="711" width="50" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_18_di" bpmnElement="Flow_18"><di:waypoint x="2230" y="755"/><di:waypoint x="2230" y="835"/><di:waypoint x="2330" y="835"/><bpmndi:BPMNLabel><dc:Bounds x="2236" y="758" width="29" height="15"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_19_di" bpmnElement="Flow_19"><di:waypoint x="2430" y="730"/><di:waypoint x="2512" y="730"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="Flow_20_di" bpmnElement="Flow_20"><di:waypoint x="2430" y="835"/><di:waypoint x="2512" y="835"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNShape id="Note_Triage_di" bpmnElement="Note_Triage"><dc:Bounds x="1270" y="240" width="260" height="50"/></bpmndi:BPMNShape>
      <bpmndi:BPMNEdge id="Note_Triage_as_di" bpmnElement="Note_Triage_as"><di:waypoint x="1330" y="390"/><di:waypoint x="1330" y="290"/></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="MsgFlow_Presents_di" bpmnElement="MsgFlow_Presents"><di:waypoint x="280" y="120"/><di:waypoint x="280" y="257"/><bpmndi:BPMNLabel><dc:Bounds x="286" y="146" width="55" height="28"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
      <bpmndi:BPMNEdge id="MsgFlow_Discharge_di" bpmnElement="MsgFlow_Discharge"><di:waypoint x="2380" y="690"/><di:waypoint x="2380" y="120"/><bpmndi:BPMNLabel><dc:Bounds x="2386" y="146" width="58" height="28"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
    </bpmndi:BPMNPlane>
  </bpmndi:BPMNDiagram>
</bpmn:definitions>