Hospital Feedback

Overview#

An ambulance crew hands over a cardiac arrest patient at the emergency department and clears for the next call. Without a feedback pathway, the clinical record ends at the ED door: the crew, the service's governance team, and the ePCR itself have no way of knowing whether the patient was admitted, what the final diagnosis was, or whether the pre-hospital intervention contributed to a good outcome. The Hospital Feedback module solves this by receiving structured clinical messages from the hospital after handover and writing the results back to the canonical incident and encounter records.

The module accepts inbound HL7 FHIR R4 responses, HL7 v2.4 ORU^R01 result messages, and ADT admission, discharge, and transfer notifications from receiving hospitals. It parses discharge disposition codes, downstream diagnoses, and key outcome markers, then attaches them to the originating incident timeline so clinical governance, audit officers, and service improvement leads can review outcome data in the same environment where the pre-hospital record lives.

Key Features#

• HL7 v2.4 ORU^R01 Parsing: Incoming result messages from hospital laboratory and clinical systems are parsed to extract the MSH, PID, PV1, and OBX segments, surfacing coded results and diagnostic context against the original encounter.
• ADT Discharge Disposition: Admission, discharge, and transfer messages from hospital patient administration systems are processed to capture PV1-36 discharge disposition codes, giving the ambulance service visibility of whether the patient was admitted, discharged, transferred, or died.
• FHIR R4 Outcome Reception: Hospitals with modern electronic health record platforms can return structured outcome data as FHIR R4 Encounter and Observation resources, which are correlated to the originating incident by pre-alert reference.
• Incident Timeline Closure: Every disposition or outcome record received is linked back to the canonical incident from which the pre-alert was sent, so the full patient journey, from first call through hospital discharge, is visible on a single timeline.
• Idempotent Outcome Updates: Outcome records can be refreshed as the hospital's picture evolves, for example when a working diagnosis is confirmed or a patient is readmitted, without creating duplicate records.
• Acknowledgement Generation: The module returns standards-compliant acknowledgement messages to the sending hospital system (HL7 v2.4 ACK or HTTP 200 with FHIR OperationOutcome) so hospital messaging infrastructure receives a definitive delivery confirmation.
• LOINC and ICD-10 Preservation: Coded clinical values arriving in feedback messages are preserved in their original form so coded diagnoses and observation results remain interpretable by downstream audit and research workflows without re-coding.
• Clinical Audit Record Emission: Each processed feedback event produces an outcome record in the clinical audit domain, enabling governance leads to review outcome patterns across linked incidents without manual data extraction.
• Best-Effort Resilience: Outcome feedback is treated as a quality-improvement enhancement rather than a critical operational path, so transient hospital system unavailability does not affect frontline documentation or dispatch workflows.

Use Cases#

• STEMI Outcome Loop: A governance lead reviews whether ambulance STEMI encounters, identified by pre-hospital ECG, resulted in confirmed catheterisation lab activations and reperfusion within target times, using feedback messages received from the receiving cardiac centre.
• Cardiac Arrest Outcome Tracking: A service monitors 30-day survival and neurological outcome signals returned by hospitals after cardiac arrest cases, using the data in debrief and training programme review.
• Non-Conveyance Safety Review: Following a non-conveyance episode, a clinical supervisor checks whether a later ADT message from a hospital indicates the patient re-presented within a clinically significant window, supporting safeguarding review.
• Stroke Pathway Confirmation: A stroke quality improvement programme correlates pre-hospital Face-Arm-Speech-Time assessments with confirmed stroke diagnosis codes returned in hospital feedback messages to refine field recognition protocols.
• Regional Clinical Audit: An ambulance service collates feedback messages from multiple hospitals across a region to support an approved audit of sepsis recognition and antibiotic timing, comparing pre-hospital assessments against admission diagnoses.
• Handover Dispute Resolution: When a question arises about the clinical state of a patient at the time of handover, the combination of the signed handover record and the subsequent hospital feedback message provides a contemporaneous baseline for review.

Integration#

The Hospital Feedback module is the inbound counterpart to the Hospital Pre-Alert module. When a pre-alert is sent to a receiving hospital, the originating incident reference travels with it, and all subsequent feedback messages from that hospital are matched back to the same incident using that reference. Hospital connections, including endpoint addresses, preferred message format (HL7 v2.4 or FHIR R4), and authentication credentials, are managed through the administration console per hospital record scoped to the tenant. Processed outcome records appear on the ePCR clinical workspace as an extension of the encounter, and outcome signals feed the clinical governance dashboards and KPI reporting workflows without requiring a separate import step.

Open Standards#

• HL7 v2.4: Inbound ADT and ORU^R01 messages are parsed according to the HL7 Version 2.4 messaging standard, including the MSH header, PID patient identification, PV1 patient visit (including the PV1-36 discharge disposition field), and OBX observation result segments.
• HL7 FHIR R4: Hospital systems that support modern interoperability standards can return outcome data as FHIR R4 Encounter, Observation, and Condition resources, which are processed using the same open healthcare exchange model as the pre-alert pathway.
• LOINC (Logical Observation Identifiers Names and Codes): Observation results returned in ORU^R01 and FHIR Observation resources are preserved with their LOINC codes so coded measurements remain interoperable across clinical audit and research workflows.
• SNOMED CT: Discharge diagnoses and clinical outcome context returned in feedback messages may be expressed using SNOMED CT codes, which are preserved to support coded aggregation in clinical audit and service improvement review.
• ICD-10: Diagnostic codes carried in hospital feedback payloads are accepted in ICD-10 format and preserved in the outcome record alongside SNOMED CT codes for services where hospital systems use ICD-10 as the primary diagnostic vocabulary.
• HL7 FHIR R4 OperationOutcome: Acknowledgement responses to hospitals that deliver feedback over FHIR REST endpoints are returned as FHIR OperationOutcome resources, providing a standards-compliant delivery confirmation.
• OAuth 2.0 (RFC 6749): Hospital systems that connect over FHIR REST use standards-based delegated authorisation for authentication, with per-hospital credentials managed independently in the administration console.
• ISO 8601: All admission, discharge, outcome, and message receipt timestamps are stored in ISO 8601 format to ensure portability and unambiguous machine-readable ordering across partner systems and audit exports.

Availability#

• Enterprise Plan: Included
• Professional Plan: Available; hospital connection configuration and HL7 v2.4 message parsing are included; FHIR R4 outcome reception requires confirmation of hospital endpoint capability during onboarding.

Last Reviewed: 2026-05-26