MODERN ACCIDENT & EMERGENCY DEPT

1. MODERN ACCIDENT & EMERGENCY DEPT BY Dr. Obianyor O.D MBBS, FWACS Head, Dept of Orthopaedics / Trauma Surgery (DOTS)

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

3. 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

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6. MAJOR SPACE DETERMINANTS • Revolves around the major function areas of the department :- • Ambulance & ambulatory areas • Reception / triage / waiting area • Administration area • Resuscitation area • Acute treatment area (of non ambulant patients) • Consultation area / fast track area ( for ambulant) • Staff work station

7. SPECIALTY AREAS • Paediatricarea • 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

8. 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

9. RECEPTION / CLERICAL OFFICER. Admin staff at the reception counter - may receive patients arriving for treatment and direct them to the triage area for: • Registration interviews • Collate the medical records • Print identification labels The counter should provide seating and be partitioned for privacy at the interview should have direct communication with other areas Other functions • General enquiries from the public • Processing loans of surgical aids • The receipt of monies

10. 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

11. 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

12. 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. Waiting room outside Nigeria NOHL Waiting Room

13. CONSULTATION AREA Provided 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 conditions Each 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 set ENT Microscope Head light / mirror Turning fork Motorized vision screen Slit Lamp IV pole Room with blackout capability

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15. Procedure Room(s) Required for the performance of procedures such as lumber puncture, tube thoracostomythracocentesis, abdominal paracentesis, bladder catheterization, suturing. It requires noise insulation & at least 20m² in size Minimum equipment & fittings • Service panel • Operating theatre light suspended from the ceiling with a min 80,000 • Xray viewing box / digital imaging system • Monitoring equipment Bp₁, spo₂, ECG

16. 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, xrayviewing 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

17. Also • A full range of always mgt equipment • Xrayvewing 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 accessible Immediately accessible • IV access trolleys • Thoracotomytray • Intercostals catheter • Urinary catheter • Invasive vascular access tray

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19. 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

20. (a) Resuscitation room (for each patient space) • 02 outlets • Medical air outlets • Suction outlets • N O outlets • Scavenging unit (ii) Physiological monitors Centre 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

21. 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 area • Resuscitation / procedure / plaster room • Electricity supply • 24/7 • Surge protector

22. 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

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24. (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

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26. ( C ) TELEMEDICINE AREA Telemedicine 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 CCTV ADMIN 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 sink Bowl/basin rack Resting equipment

27. FUNCTIONAL RELATIONSHIP Medical Imaging General Xray table Upright Xray facilities + over head gantry CT Scanned MRI USS and nuclear medicine modalities

28. PATIENTS FLOW

30. THANK YOU