Emergency Unit Management: a guide to better practice

1. Emergency Unit Management: a guide to better practice Basil Bonner Head: Emergency Unit Milnerton Medi-Clinic

2. Benefits and opportunities of providing effective emergency care Enhance hospital’s image Emergency department viewed as a source of problems in hospital operation Careful balance

3. Scope of EU management • Complex interplay of factors pertaining to the productive functioning of the Emergency Unit • Operational • Financial -assets , stocks, expenses • Staffing and interpersonal issues • Clinical and client focus

5. Operational issues • Chain of command – relationship between hospital administration and medical staff • System of Unit Management: • nursing Unit manager and Clinical Head / director • Clinical environment – consultative, diagnostic/therapeutic and procedural

6. Operational issues cont.. • Administrative functions related to patient registration and interaction • Access to other related clinical and non clinical services • Disaster plan ready • Relationship with EMS and disaster planning • General management function - POLC

7. Financial management • Volumes vs. staffing • Billing and re imbursement • Debt management and financial reports • Monthly assessments of all aspects of business • Budgets - heads / capital / smalls

8. Asset management • Stock • Capital items and equipment • Smalls < R300 • Furniture

9. Staffing issues • Choosing right mix and balance • Getting the numbers right • Nursing /medical /admin /support services • Back up and on call / standby • Communication network

10. Human resources • Staffing expectations • Professional / Career • personal • Participative management • Contracts • Hours / leave / other

11. Personal development & Training • Personal development plans • Liaison with training dept. • Performance appraisal • Training budget • Maintain professional standards , encourage growth • Library and IT access / look up

12. Clinical management • Clinical governance • Medico-legal considerations • Risk management • Ethical • Quality improvement

13. Clinical Governance :defined • “framework through which organisations are accountably improving the quality of their services, and creating an environment in which excellence in clinical care can occur” Scally, G. BMJ 4 july 1998

14. Clinical governance: Key Issues • Clinical audits and critical outcome reviews • Risk assessment review and strategy • Communication strategy • Client service and experience • Personnel development • Data acquisition • Research and education

15. Medico-legal issues • EU lends itself to possibilities for liability risk • Risk management strategy required to minimise risk • Knowledge of patients and staff rights very important

16. Risk management • Documentation standards • Regular review of patterns in EU • Drug register audits • Identification and Review of all potential risks • Financial • Ethical / moral • Attitudes • Clinical standards

17. Risks • IH transfers – stability of patients…. • Substance abuse • Long/excessive duty shifts • Telephonic advice • Written admission orders • Shift change over times • Multi-trauma / complex medical problems • Refuse Hospital Treatment / Against Medical Advice • Poor record keeping • Patient who presents twice in 24 hours

18. Strategies for risk management • Document all incidents • Maintain good communication • Use specialists appropriately and judiciously • Provide adequate staff cover – docs and nurses • Prescribe carefully • Allow time for patient’s questions • Code accurately • Mortality reviews • Discrepancy reviews of X rays / ECG’ s……..

19. Quality cycle

20. Research and Development • Essential component of clinical governance • Reviews and audits • Original research (ethics approval) • Participative studies and trials

21. Clinical standards • Must set norms and standards for • Practice • Policy and procedures • Clinical guidelines • Communication • Appropriate and professional Referrals • Updates/training

22. Policy and Procedures • Operational plan to meet local needs • Staffing and organising emergency system responses • Integration with other depts. In hospital • Ongoing education for all personnel • Admissions register • Quality assurance control.

23. Client service • Create forum for client service feedback • Everyone’s responsibility! • Review of patient opinion surveys • Answering calls and complaints • Complaints register • Link to medico–legal assistance / advice

24. Ethics and emergency medicine • Each decision must be made for the individual, with compassion, based on ethical principles and available scientific information • Principles must prevail of • autonomy • beneficence • non malevolence • justice • Patients bill of rights

25. summary • EU management must • Provide a place where patients can feel wanted and cared for • Provide high quality emergency patient care • Attract and maintain personnel with necessary skills and attitudes • Support a vision that sets sights at ever increasing standards of service delivery .