CareFlow Smart Emergency Department System

CareFlow is a modular Emergency Department Management System designed to streamline emergency healthcare workflows including triage, case management, doctor assignment, medical investigations, medication administration, billing, and notifications.

The system implements secure role-based access control and preserves complete patient-care timelines to ensure traceability, scalability, and efficient emergency response management.

Features:

Emergency Department Workflow

1. Staff Authentication Hospital staff members authenticate using secure JWT-based authentication. Role-Based Access Control (RBAC) determines accessible modules and actions. Supported roles include: ADMIN DOCTOR NURSE RECEPTIONIST LAB_STAFF RADIOLOGIST

2. Patient Registration Receptionist or nurse performs quick patient registration during emergency intake. A patient profile is created immediately to reduce waiting time in critical situations. Existing patient accounts can later be linked to the emergency profile.

3. Emergency Case Creation A new emergency case is created for the patient. Each case receives: unique case ID arrival timestamp initial status priority tracking

4. Triage Assessment Nurses perform triage evaluations to determine patient severity and urgency. The system supports: multiple triage assessments for the same case complete triage history tracking non-destructive updates Important Design Feature

New triage assessments DO NOT overwrite previous assessments.

Instead:

every triage entry is stored independently historical triage records remain preserved the latest assessment is marked as the active/current triage state

This design provides:

medical traceability auditability chronological patient condition tracking

5. Queue Prioritization Cases are dynamically ordered using: severity level triage urgency arrival time priority score The emergency queue updates automatically as new assessments are added.

6. Doctor Assignment Doctors are assigned to emergency cases. Assigned doctors can: review patient details access medical records prescribe medications request investigations

7. Medical Records Management Doctors create and update patient medical records. Medical records include: diagnosis clinical notes chronic diseases family history Records remain linked to the emergency case for continuity of care.

8. Medication Workflow Doctors prescribe medications for patients. Nurses administer medications and record administration events. Medication administration history is preserved for tracking and auditing.

9. Laboratory Workflow Doctors create laboratory investigation orders. LAB_STAFF can: upload PDF lab reports attach investigation findings publish results to the case timeline Doctors and nurses can retrieve lab results directly from the case.

10. Imaging Workflow Doctors create imaging requests. RADIOLOGIST users upload: imaging reports PDF findings Imaging reports become available within the patient case timeline.

11. Notifications System Users receive real-time notifications for: case assignments uploaded investigation results medication events workflow updates Notifications support: read/unread state mark single notification as read mark all notifications as read

12. Billing Workflow Completed emergency cases can generate billing records. Receptionists and admins can: create bills update billing status retrieve billing details track unpaid cases

13. Audit Logging Administrative and critical actions are logged. Audit logs support: accountability security monitoring operational traceability

14. Case Timeline

Each emergency case maintains a centralized timeline including:

triage events doctor assignments medications investigations notes status changes

This provides a complete chronological view of patient care.

Tech Stack: Backend NestJS TypeScript Node.js Database PostgreSQL Prisma ORM

Authentication: JWT Refresh Tokens bcrypt

Real-Time Communication: Socket.IO

Documentation: Swagger / OpenAPI

System Architecture:

The backend is organized into modular services:

src/ │ ├── auth/ ├── patients/ ├── cases/ ├── triage/ ├── queue/ ├── doctors/ ├── nurses/ ├── admin/ ├── notifications/ ├── billing/ ├── appointments/ ├── websocket/ ├── prisma/ └── common/

Main Modules: Module Description Authentication Login, JWT, password management Patient Management Patient profiles and medical records Emergency Cases Case lifecycle and workflow Triage Severity classification and vitals Queue Management Priority-based ER queue Doctor Module Clinical access and medications Nurse Module Vital signs and notes Admin Module User management and audit logs Notifications Real-time alerts Billing Payments and insurance Appointments Follow-up scheduling

Roles & Permissions: Role Permissions ADMIN Full system access DOCTOR Assigned cases only NURSE Active ER cases RECEPTIONIST Registration and billing LAB_STAFF uploading lab results ordered by dr RADIOLOGIST uplaoding image study report ordered by dr

Core Clinical Workflow: Patient Arrival ↓ Quick Registration ↓ Emergency Case Creation ↓ Triage Assessment ↓ Queue Prioritization ↓ Doctor Assignment ↓ Treatment & Monitoring ↓ Case Completion ↓ Discharge Summary ↓ Billing & Follow-up Appointment

Real-Time Events

The system uses Socket.IO for real-time communication.

Main Events Event Description queue.updated Queue changes notification.doctor_assigned Doctor assigned to case notification.critical_triage Critical patient alert notification.vitals_abnormal Abnormal vitals notification.new_prescription Medication prescribed notification.lab_ready Lab notification.image_ready imaging available

Security Features: JWT Authentication Refresh Token Rotation Password Hashing Role-Based Access Control Case-Level Authorization Immutable Audit Logs Soft Delete Support

Design Highlights: Realistic Emergency Room Workflow Modular Scalable Architecture Real-Time Clinical Communication Timeline-Based Case Tracking Role-Restricted Clinical Access Audit Logging for Traceability

Team Developed as a Software Engineering project for Emergency Department workflow management.