MODERN ACCIDENT & EMERGENCY DEPT

BY Dr. Obianyor O.D

MBBS, FWACSHead, Dept of Orthopaedics / Trauma Surgery

(DOTS)

KEY CONSIDERATIONS SAFETY & SECURITY AMENITY ACCESS IMAGE & COSUMER EXPECTATIONS EVOLVING WORK PRACTICES

INTRODUCTION The ED in a core clinical unit of a hospital and the experience of

patients attending the ED significantly influences patients satisfaction and the public image of the hospital.

Its function is to: Receive Triage Stabilize Provide emergency management to the patient who present

with a wide variety of critical, urgent and semi-urgent conditions whether self or otherwise referred.

Some ED may be designed to fulfill special role as in management or pediatric lots, major trauma pts, psychiatric patients etc.

In addition to clinical areas: Teaching Research Administration Staff amenities

NOHL Casualty Building

Casualty Building outside Nigeria

MAJOR SPACE DETERMINANTS Revolves around the major function areas of the

department :-Ambulance & ambulatory areasReception / triage / waiting areaAdministration areaResuscitation area Acute treatment area (of non ambulant patients)Consultation area / fast track area ( for

ambulant)Staff work station

SPECIALTY AREAS Paediatric area Distressed relatives/ interview room Procedure room Plaster room Pharmacy / drug prep Isolation rooms Decontamination area Mobile xray equip bay Support services Lounge / beverage preparation area EMS offices / lounge Shower / bathroom / toilets

TOTAL SIZE 50m²/1000 yearly attendances Min ≥ 700m² Location :- Ground Floor – ease of access

Close to public transport Adequately signed to ensure ease of location Car parking – close to entrance —> pts / relatives/ staff

Undercover parking

• The ED should be clearly identified from all approaches: Illuminated signage to ensure visibility at night Graphic & character display Multilingual signage – yoruba / igbo / Hausa

Appropriate. ambulance

On call duty Emergency div Police

Fire Brigade (comply that need regulation

RECEPTION / CLERICAL OFFICER.Admin staff at the reception counter - may receive patients arriving for treatment and direct them to the triage area for:Registration interviewsCollate the medical recordsPrint identification labelsThe counter should provide seating and be partitioned for privacy at the interview should have direct communication with other areasOther functionsGeneral enquiries from the publicProcessing loans of surgical aidsThe receipt of monies

RECEPTION / TRIAGE AREA The department should be accessed by 2 separate entrance: one for ambulance

patients and the other for ambulance patients Each entrance area contain a separate foyer that can be sealed by the remote

activation of security doors. The ambulance entrance should be screened as much as possible for signal and

sound from the ambulant patient entrance Both entrances should direct the patient flow towards the reception / triage area. Assessment, observation and first aid are provide in the reception /triage area

which should have visual and auditory privacy. The triage area should have access to the following equipment and fittings NIBP monitor Spo₂ Computer terminal with printer, security mounted Hand basin for hand washing Towel rail Examination light Mobile exam trolley Telephone Chairs and desk Scales Storage space for bandages, basic medical equipment, stationery White board

WAITING ROOM: (min size. 5m² / 1000 yearly attendance) should provide sufficient space for waiting patients as well as relatives / escorts. The area should be open and easily observed from the triage and reception areas. Seating should be comfortable and adequate space should

be allowed for wheelchairs, prams, walking aids and patients begin & assisted

Zoning considered – quite areas, TV lounge and family or small group access

Natural lighting should be maximized Areas where children may play with suitable furnishing, toys

etc TV – should not be noisy

- ability to broadcast dept status information or public health messages. Use of art photographs and murals especially of nature

scenes

There must be access to: Triage &reception areas Baby change room Light refreshment facilities – beverage dispensing

machine Telephone, taxi-phone & change machines Health literature

A separate wanting area for children – desirable visible to the triage nurse.

The area should be continuously monitored by electronic surveillance to safeguard security & patient well being.

NOHL Waiting RoomWaiting room outside Nigeria

CONSULTATION AREAProvided for the examination & treatment of ambulant patients who are not experiencing a major or serious unless require resuscitation or monitoring.It many ne configured as a fast track area for the treatment or patients who suffer from non- coupler & single system conditionsEach area should be of sufficient size Service panel Examination couch / trolley Minimum 12m² in area Desk and 3 chairs Computer outlet and terminal may be adapted to serve specific function

ENT

Ophthalmology

Dressing: Dressing trolley Wall storage for dressing materials

Full ENT setENT Microscope

Head light / mirrorTurning fork

Motorized vision screen

Slit Lamp

IV poleRoom with blackout capability

NOHL Consultation Room Consultation room outside Nigeria

PROCEDURE ROOM(S)Required for the performance of procedures such as lumber puncture, tube thoracostomy thracocentesis, abdominal paracentesis, bladder catheterization, suturing.It requires noise insulation & at least 20m² in sizeMinimum equipment & fittingsService panelOperating theatre light suspended from the

ceiling with a min 80,000Xray viewing box / digital imaging systemMonitoring equipment Bp₁, spo₂, ECG

RESUSCITATION ROOM/BAY- Treatment of critically ill or injured pts. It has the following: Minimum size for the single bed resume in 35m. Area to fit a specialized uninterrupted rescue bed . Space to ensure 360 access to all pasts or the patients for procedures. Circulation space to allow most of staff & equip Space for equip monitors storage wash up & disposal facilities Approximate lighting, equip to hang IV fluids etc Max possible visual & auditory privacy for the occupants of the room &

other pts & relation RA - easily accessible from the ambulance entrance & separate from pts

circulation areas : Must be easily accessible from the staff station in the acute tx/observation area. Should have a full range of physiological monitoring & rescue equip. Rooms equipped with work benches, storage cupboards, hand basin, xray viewing

boxes & computer access Solid partitioning

Each resuscitation fit bed space- equipment into: Service panel Physiological monitor with facility for ECG, printing, NIBP,SPO2, temp, invasive

pressures, co2 An operating room high with a min. illumination 80,000lux Radiolucent rescue trolley with cassette trays Wall mounted diagnostic set Overhead IV track

Also A full range of always mgt equipment Xray vewing box Wall clock with real time & stop clock function Pediatrics open care unit- for neonates management Computer outlet and terminals Min of 2 standard telephone Hands free telephone Cardiac arrest / resuscitation drug and equip trolley Portable monitor/ defibrillator Transcutaneous pacemaker etc immediately accessibleImmediately accessible IV access trolleys Thoracotomy tray Intercostals catheter Urinary catheter Invasive vascular access tray

NOHL Resuscitation Room Resuscitation room outside Nigeria

Bed spacing 2.4m of clear space b/w bed screens

Lighting: A high standard focused examination light in all

treatment areas Clinical area- exposure to day lights/

Sound control – to minimize sound transmission Distressed relatives/interview rooms

Service panels

(a) Resuscitation room (for each patient space) 02 outlets Medical air outlets Suction outlets N O outlets Scavenging unit 

(ii) Physiological monitorsCentre monitoring preferred Monitors should printing/ monitoring function ECG NIBP TEMP SP02

(iii) medical gases - internally p.ped to all pts care areas(iv) Doors- sufficient size to take full hospital bed with attached iv

flasks/ traction appliances.(v) Corridors-large enough to allow cross passage of 2 hospital

beds.(vi) Air Conditioning : ED should have a separate air system

capable of rapid change from re-circulation to fresh air flow- special flow and filtering requirement

Vii Information / communication support Telephones – available in all offices/ staff stations/ clinical areas/all consulting

room Central communication area for the disposition of all incoming calls. Cordless phones or jacks – for access to patients beds.

(b) An intercom or public address system – that can reach all areas of the emergency department Public telephone- available in the waiting areas Direct radio communication – available between the ambulance service and ED

(+aero medical transport) Electronic ED information system – to support clinical management, patient

tracking and departmental admin Electronic medical records Computers/terminals Wall clocks

visible in clinical areas and waiting areaResuscitation / procedure / plaster room

Electricity supply 24/7 Surge protector

STAFF STATION: Major staff area with the Dept It should provide uninterrupted view of patients and the floor may be

raise Centrally located, constricted to ensure breach of privacy Must guarantee security of staff information and privacy Size – 10m²

Equipment and fittings – accessible Telephones DL for GP admitting calls only DL for incoming ambulance / police use only Computer terminals Printer /fax/photocopier X-ray viewing boxes DDA cupboards Emergency and patient call display Under desk duress alarm Storage for stationery /writing and work benches Police blood alcohol sample safe

NOHL Staff Station Staff Station outside Nigeria

(A) TUTORIAL ROOM: Size 0.8²/1000 yearly attendances Provides facilities for formal undergraduate and post graduate education and

meetings. It should be in a quiet non-clinical area, near the staff room and offices. It should have:- VCR / DVD Television Slide projector/ overhead projector Projection screen White board Computers terminals and outlet Digital projector Xray viewing facilities / digital imaging systems Telephone Examination couch Storage cupboard for stimulation mannequins and training materials

(B) LIBRARY Quiet area containing appropriate written audiovisual and electronic

reference materials All computer terminals should be able to access knowledge database

Library

Telemedicine Room

( C ) TELEMEDICINE AREATelemedicine facilities:- a dedicated, fully enclosed room with appropriate power and communication cabling provided.Others Security Room: near the entrance to ED should have direct visualization of the

waiting room, triangle and reception areas with immediate access to these areas.

Remote monitoring of other areas in the department by CCTVADMIN AREA:Offices provide space for the administrative managerial, safety and quality, teaching and research roles of the ED.CLINICAL SUPPORT AREAS Clean utility : - storage of clean and sterile supplies

Dirty utility /Disposal Room Equip / store room Pharmacy / medication room Linen trolley bay Mobile radiology bay Cleaners room Trolley / wheelchair/hoist/bay Disposal room Disaster equipment store

Bench top with sinkBowl/basin rack

Resting equipment

FUNCTIONAL RELATIONSHIP

Medical Imaging

EMERGENCY DEPTDIRECT ACCESS

READY ACCESS

ACCESS

Ambulance Car Parking In patients wards

Medical Imaging

Helipad Pharmacy

Short stay Unit Coronary case unit

Out patients

ICU MortuaryOperating RoomPathologyMedical Records

General Xray tableUpright Xray facilities+ over head gantry

CT ScannedMRI

USS and nuclear medicine modalities

PATIENTS FLOW

THANK YOU