In our previous discussion about patient treatments, we noted some problems:

• Patients can have more than 1 Physician• Other personnel can be involved in a treatment, including:

• Other physicians• Nurses• Therapists

• A patient may be admitted for multiple illnesses

• Prescriptions can be tricky

There are also additional issues we didn’t properly address, including:

• Some patients are admitted to the hospital• Some patients are seen on an out-patient basis

• Treatments may involve additional procedures• Treatments may require the involvement of additional personnel

• We didn’t really address the costs involved

The following is an attempt at addressing these issues

It is by no means a final solution !!!

First, let’s slightly free-up our constraint that a patient can have only one Physician:• Let’s assume that they can have any number of physicians, but that only one physician at a time can be

involved in a treatment.

• This is actually a pretty simple fix:

Supervises Physician

Patient

TreatmentIllness Drugs

• Only Two Tables need to be changed:

Treatment

• ~ PatID

• ~ DrugCode

• ~ IllCode

• TDate

~ PhysID

Patient

• PatID

x Address

x Name

(No Physician Field)

Treatment

* Foreign Key

Illness

PatID LastName FirstName ○○○○○○○ ○○○○ ○○○ ○○○

123456789 Sotomayor Sonia ○○○○○○○ ○○○○ ○○○ ○○○

Patient

Treatments can involve a number of procedures and drugs

TPNo TreatNo * Procedure*7896673 102234 P788912

7896674 102234 P056785

7896675 102234 P128867

○○○○ ○○○○ ○○○○

Procedure Description CostP056785 General Anesthesia 300

○○○○ ○○○○ ○○○P128867 Reset Broken Bone 200

○○○○ ○○○○ ○○○P788912 Apply Cast 100

○○○○ ○○○○ ○○○

TreatProceduresProcedures

TDNo TreatNo * Drug * Units7654321 102234 D646221 57654322 102234 D046522 307654323 102234 D197703 10

7654324 102234 D332219 17654325 102234 D221078 2

○○○○ ○○○○ ○○○○ ○○○○

TreatDrugs

Drug Name Unit Cost○○○○ ○○○○ ○○○○ ○○○○

D046522 Aspirin Each 1.50

D197703 Demerol Each 10.00

D221078 Saline Solution CC 4.00

D332219 Laughing Gas Each 150.00

D646221 Placebo Each 12.75

○○○○ ○○○○ ○○○○ ○○○○

Another Possible Redefinition of Treatment: This one assumes multiple personnel per treatment

ILLCode Description○○○○ ○○○○

I9088722 Spiral Fract. R. Tibia

○○○○ ○○○○

TreatNo Patient* Illness* Date Dur102234 123456789 I9088722 10/04/2009 2102235 234567890 I7654320 10/05/2009 1102236 234567890 I3289760 10/05/2009 1

○○○○ ○○○○ ○○○○ ○○○○ ○○○○

What we know (so far):

• Sonia Sotomayor suffered a fracture of the R. Tibia on 10/04/2009• She received three different procedures (above)• She was given five different drugs (left)• So far, she owes:

• Procedures: 300 + 200 + 100 = 600.00• Drugs: (30 * 1.5) + (10 * 10) + (50 * 2) +

150 + (5 * 12.75) = 458.7545 + 100 +100 + 150 + 63.75 =

1,058.75

Drugs

Treatment* Foreign Key

TreatLoc ***

Possible Additional Treatment Relationships

TreatNo * Bldg * Rm *

○○○○ ○○○○ ○○○○

102234 12 403

○○○○ ○○○○ ○○○○

*** Assumes that treatment may occur in only one location

BldgCode Name ○○○○ ○○○○

12 Conrad Murray Bldg.

○○○○ ○○○○

Buildings

Rooms

TreatNo Patient* Illness* Date Dur102234 123456789 I9088722 10/04/2009 2102235 234567890 I7654320 10/05/2009 1102236 234567890 I3289760 10/05/2009 1

○○○○ ○○○○ ○○○○ ○○○○ ○○○○

BldgCode * Rm Name Cost○○○○ ○○○○ ○○○○ ○○○○

12 403 Pricey Operating Theater #3 300

○○○○ ○○○○ ○○○○ ○○○○

TreatProcedures

TreatDrugs

Patient

Illness

TreatNo * Drug * Number

○○○○ ○○○○ ○○○○

102234 D197703 20

102234 D200786 30

○○○○ ○○○○ ○○○○

TreatPrescrip

Drug Name Units Cost

○○○○ ○○○○ ○○○○ ○○○○

D197703 Demerol Each 10.00 D200786 Naproxen Each 5.50

○○○○ ○○○○ ○○○○ ○○○○

Drugs

We now also know:

• Sonia Sotomayor was treated in Pricey Operating Theater #3 in the Conrad Murray Building

• She was charged 2 * $300 = $600 for use of the room

• She now owes: $1,058.75 + $600 = $1,658.75

• She was given a prescription for 20 Demerol and 30 Naproxen (which may or may not be filled at the hospital)

What if Sonia Needs a Room?PatientRoom

PatRmID PatID * Date In Date Out Bldg Room Type* Tel

7661171 123456789 10/04/2009 10/06/2009 12 719 3 1719

PatientRmTypes

RmType Description Daily Cost

1 Ultra DeLux 2000

2 Private 1000

3 Double 700

4 Triple 350

5 8 Bunk Beds 100

6 Cot in Closet 25

PatRmID * Date Time Meal * 7661171 10/04/2009 18:00 1678

7661171 10/05/2009 6:00 550

7661171 10/05/2009 12:30 976

7661171 10/05/2009 6:15 1589

7661171 10/06/2009 7:00 630

PatientMeals

MealID Comp1 * Comp2 * Comp3 * Comp4 *

550 223 61 82 12

630 112 58 22 6

976 435 61 75 7

1589 223 61 83 13

1678 112 58 23 6

MealsMeal Comp.

Comp Description Cost

6 Orange Juice 5.00

7 Tepid Tea 2.50

12Sugared Water 3.00

13Cold Coffee 4.50

22 Imitation Grapes 2.00

23Pineapple bits 2.00

58Beggin' Bits 4.00

61Runny Peas 3.50

72Watery corn 4.00

75Rice Pudding 2.50

82Hard Biscuit 2.00

83Jello 2.00

112 Scrambled eggs 6.00

223 Rubber Chicken 8.00

435 Tiny meatloaf 7.00

We now also know:

• Sonia Sotomayor spent 2 nights in a double room ($1,400)• Her meals cost her $83.50

• She now owes $3,142.25

What if Sonia Needs a Room?PatientRoom

PatRmID PatID * Date In Date Out Bldg Room Type* Tel

7661171 123456789 10/04/2009 10/06/2009 12 719 3 1719

PatRmID * Date Time Drugs * Units7661171 10/04/2009 18:00 D197703 17661171 10/04/2009 18:00 D200786 27661171 10/04/2009 18:00 D046522 27661171 10/05/2009 7:00 D646221 27661171 10/05/2009 7:00 D197703 27661171 10/05/2009 12:00 D200786 27661171 10/05/2009 19:22 D197703 27661171 10/05/2009 19:22 D200786 27661171 10/05/2009 19:22 D646221 17661171 10/05/2009 7:22 D197703 27661171 10/06/2009 7:22 D200786 8

InRoomDrugs

Drug Name Units CostD046522 Aspirin Each 1.50

D197703 Demerol Each 10.00

D200786 Naproxen Each 5.50

D646221 Placebo Each 12.75

Drugs

We now also know:

• Sonia Sotomayor was given 4 different drugs in the hospital (above):

7 Aspirins at 1.50 each, 7 Demerols at 10.00 each, 8 Naproxen at 5.50 each, and 2 Placebos at $12.75 each

• The total cost of the drugs was: $150.00

• She now owes $3,392.25

Patients in rooms are also in need of/Charged for:• Telephone lines

• Sponge Baths

• IV hook-ups

• Wheelchair Transportation

You get the idea ….

* Foreign Key

TPNo TreatNo * Procedure*7896673 102234 P788912

7896674 102234 P056785

7896675 102234 P128867

○○○○ ○○○○ ○○○○

TreatProcedures

Procedures

How are we linking the hospital staff to the Treatment?

Treatment

Physician Treatments

TreatNo * PhysId * Procedure *102234 877456722 P056785

102234 789012345 P128867

102234 789012345 P788912

Procedure Description Cost

P056785 Local Anesthetic 50P128867 Reset Broken Bone 200P788912 Apply Cast 100

PhysId LastName FirstName Specialty ○○○○

789012345 Dolittle John Orthopedics ○○○○

877456722 Doless Joseph Anesthesiology ○○○○

Physician

We now also know:

• Dr. Dolittle reset Sonia Sotomayor ‘s broken bone and applied her cast

• Dr. Doless gave her the local anesthetic

(We have already addressed the fees)

* Foreign Key

TPNo TreatNo * Procedure*7896673 102234 P788912

7896674 102234 P056785

7896675 102234 P128867

○○○○ ○○○○ ○○○○

TreatProcedures

How are we linking the hospital staff to the Treatment?

Treatment

Nurse Treatments

NurseId LastName FirstName Specialty ○○○○ Hrly Charge

012568871 Drew Nancy Orthopedic ○○○○ 100

234876234 Ratchet Nurse Operating Room ○○○○ 100

345678901 Barton Clara Recording ○○○○ 50

TreatNo * NurseID *102234 012568871

102234 234876234

102234 345678901

Nurses

We now also know:

• Nurses Drew, Ratchet, and Barton assisted in Sonia’s procedures

• Sonia was charged a total of 2 * 100 + 2 * 100 + 2 * 50 or $500

• Sonia now owes $3,892.25

What about treatments given After the treatment?

It would require another entry into the treatment table and the Treatment Procedures table:

TreatNo Patient* Illness* Date Dur

○○○○ ○○○○ ○○○○ ○○○○ ○○○○

145365 234567890 I7654320 10/10/2009 2○○○○ ○○○○ ○○○○ ○○○○ ○○○○

TPNo TreatNo * Procedure*

○○○○ ○○○○ ○○○○8000034 145365 P165454

○○○○ ○○○○ ○○○○

TreatProcedures

Procedure Description Cost○○○○ ○○○○ ○○○

P165454 PT Leg Stretch 150○○○○ ○○○○ ○○○

Treatment Procedures

PT Treatments

TreatNo * PTID *

8000034 244476891

PTID LastName FirstName ○○○○

345678901 Masochist Sadie ○○○○

Physical Therapists

We now also know:

• Sonia Sotomayor ‘s had a Physical Therapy Leg Stretching treatment pm 10/10/2009• It lasted 2 hours and was administered by Sadie Masochist

• It cost her another $300

Our Basic ERD

Table with Foreign Key Table Referred to

Note:

Treatment

Patient

Illness

TreatDrugs

TreatProcedures

Procedures

Drugs

InRmDrugs

TreatPrescription

TreatLoc

Bldgs

Rms

PatientRoom PatientMeals

Meals MealComp

Room Type

PhysTreatNurseTreat

PTTreat

Physicians

Physicians

Nurses