admission-synthesise

Admission Synthesise

Action level: L0 (read and analyse only). This skill writes to the contract; it files, sends and signs nothing.

Purpose

Establish the clinical narrative every later artefact is derived from.

When to use

Start of every discharge packet run - once discharge is ordered or anticipated. Typical triggers: "prep the discharge packet", "start the discharge packet", "pull together the hospital course", "summarise the stay".

When NOT to use

When NOT to use: do not use it to reconcile medications (med-reconcile owns the diff), to write the summary prose (summary-draft), to write patient-facing text (patient-instructions), or to build the follow-up list (followup-plan). Do not use it outside an inpatient encounter - there is no admission narrative to extract - and do not run it to "fill gaps" when the record is incomplete; escalate instead.

Inputs

Inpatient notes, procedure/operative reports, medication administration record, labs, imaging, problem list. Contract: base/contracts/hls.discharge-care-transition.v1.json.

Steps

1. Read the admission diagnosis, hospital course and problem list into structured encounter facts; carry the encounter's own source_note / documented_date when the record gives them.
2. Extract procedures and key results with their dates.
3. Record each medication and inpatient change with its source_note and documented_date (discharge-rules.md #9).
4. Write encounter{}, admission_meds[] and inpatient_changes[] to the contract as the entry hop.
5. Write a short readable recap for the clinician - one bullet per fact, each ending with its citation - drawn only from what step 4 wrote.
6. Hand off to med-reconcile; report anything the record does not support as an escalation, never as a fact.

Output

Contract JSON conforming to hls.discharge-care-transition.v1: encounter{patient_id, admission_dx, discharge_date, source_note, documented_date}, admission_meds[{drug, dose, status, source_note, documented_date}] and inpatient_changes[{drug, action, dose, reason, source_note, documented_date}], plus escalations[] for every absent field and a bulleted recap for the clinician.