Emergency department planning and design
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The document summarizes the key planning and design considerations for an emergency department. It outlines the major functional areas that should be included like triage, treatment areas, and diagnostic spaces. It describes optimal patient flows through signage and separate entrances. Key locational factors are discussed like being ground level with direct access to important inpatient units. Detailed requirements are provided for treatment spaces, equipment, and environmental factors.
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Emergency department planning and design
- 1. 33 Emergency Department Planning and Design
- 2. 34 Emergency Department Planning and Design The emergency department is a core clinical unit of a hospital and the experience of patients attending the emergency department significantly influences patient satisfaction and the public image of the hospital. Its function is to receive, triage, stabilize and provide emergency management to patients who present with a wide variety of critical, urgent and semi urgent conditions whether self or otherwise referred. The emergency department also provides for the reception and management of disaster patients as part of its role within the disaster plan of each region. Description of patient flows: -Triage: Patients may present self-referred or via emergency services (ambulance, police, etc.). All patients should be triaged through a single point. The aim of triage is to "sort" patients in order to provide optimum care consistent with their medical need and to ensure the efficient utilization of the available resources. The department should be accessed by two separate entrances; one for ambulance patients and the other for ambulant patients. -Reception: There is a close operational relationship between Triage and reception. After triage, patient details are recorded by the clerical staff and a medical record either raised or a previous medical record retrieved. -Treatment: Patients may be directed to: Resuscitation area, Acute Treatment area, Consultation area, and Medical Imaging. After assessment and treatment, patients are admitted, transferred or discharged. -Patient and Visitor Exit Routes: Patient and visitor exit routes out of the emergency department should be clearly sign posted from within the emergency department. Planning and organization of Emergency department: 1.Space and functional areas: The major functional areas of the department may be divided broadly into: • Ambulance and ambulatory entrances • Reception/Triage/Waiting area • Resuscitation area • Acute Treatment area (of non-ambulant patients) • Consultation area (for ambulant patients)
- 3. 35 • Staff workstations • Procedure room(s) • Plaster room • Pharmacy/drug preparation • Isolation room(s) • Storage • Clean and dirty utility • Shower/bathroom/toilets • Staff rooms • Mobile equipment bay • Mobile X-Ray equipment bay • Offices and administration area • Diagnostic areas eg. Medical imaging unit/ laboratory area (optional) • Emergency department short stay/observation ward (optional) 2.Location and Functional relationships with other department: The emergency department should be located on the ground floor for ease of access, should be close to public transport, and adequately signed to ensure ease of way finding. It should have a general X-Ray table, and X-Ray facilities in the trauma/resuscitation area. Immediate access to CT scanning, MRI, and Ultrasound will enhance the emergency department's effectiveness. Rapid access to intensive care unit is highly desirable to minimize transfer times of critically ill patients. Also, rapid access to operating room is highly desirable in certain surgical emergencies, e.g. Ruptured aortic aneurysm, major trauma etc. Rapid access is highly desirable to minimize turnaround times for laboratory investigations. Point of care access for electrolyte/blood gas analysis, pregnancy testing and urine testing are highly desirable. 3.Access and Car Parking Car parking should be close to the entrance, well lit and available exclusively for patients, their relatives and staff. Parking should be available for: Appropriate number of ambulances.
- 4. 36 On call duty emergency physician Taxis and private vehicles which drop off/pick up patients. Police vehicles Fire Brigade 4. Short Stay Unit A Short Stay Unit is used to describe a unit managed within and by the Emergency orientation is to manage acute problems for patients with an expected length of stay of less than 24 hours. Where provided, a short stay unit should be facilitated similar to a hospital ward. 8 beds are considered to be the minimum functional size. All beds should be capable of physiological monitoring at least similar to an acute cubicle. There should be a separate staff station of an appropriate size and an office for the nurse unit manager. Department whose prime 5.Bed Spacing In the Acute Treatment area there should be at least 2.4 meters of clear floor space between beds. 6.Physiological Monitors Each Acute Treatment area bed should have access to a physiological monitor. Central monitoring is recommended. Monitors should have printing and monitoring functions which include a minimum of: ECG, Temperature, and SpO2. 7.Patient Call Facilities All patient care areas including toilets and bathrooms require individual patient call facilities. Emergency department bed spaces should have call buttons that can be easily reached by a patient on the emergency department trolley. 8.Hand Washing Facilities Hand washing facilities should comply with Standards. Alcohol hand rubs should be available at each bedside. Basins for hand washing should be available within each treatment area and should be accessible without traversing any other clinical area. There should be basins at a ratio of 1 for every 4 beds. 9.Patient Bathroom Shower and toilet facilities should be available for patients and relatives.
- 5. 37 10.Staff Station The Staff Station in the Acute Treatment area will be the major staff area within the department. The station should provide an uninterrupted view of patients and the floor may be raised to achieve this aim. It should be centrally located and constructed in such a fashion to ensure that confidential information can be conveyed without breach of privacy. The following equipment and fittings should be accessible: • Telephones • Direct line for GP admitting calls only • Direct line telephone for incoming Ambulance/Police use only • Computer terminals • Printer • Photocopier • X-Ray viewing boxes/digital imaging systems • Dangerous drugs/medication cupboards • Emergency and patient call display • Writing and work benches 11.Staff Room At least one room should be provided within the department to enable staff to distress during rest periods. Food and drink should be able to be prepared and appropriate table and seating arrangements should be provided. It should be located away from patient care areas and have access to natural lighting and appropriate floor and wall coverings. The staff room should be based upon the number of staff working at any one time. 12.Staff Change/Lockers/Toilets/Shower Facility Access to male and female staff change, locker rooms and shower facilities should be available. Appropriate security and restricted access to this area should be available. 13.Equipment/Store Room This is used for the storage of equipment and disposable medical supplies for the department. As a general principle, emergency departments should have sufficient storage space to carry one week’s supply of disposable medical supplies and intravenous fluids.
- 6. 38 14.Clean Utility This should be of sufficient size for the storage of clean and sterile supplies and should possess adequate bench top area for the preparation of procedure trays and equipment. 15.Dirty Utility/Disposal Room Access should be available from all clinical areas. There should be sufficient space to house the following: • Stainless steel bench top with sink and drainer • Pan and bottle rack • Bowl and basin rack • Utensil washer • Pan/bowl washer sanitizer 16.Security Room The location of an office for security personnel near the entrances should be considered. This room should be so positioned as to enable direct visualization of the waiting room, triage and reception areas with immediate access to these areas being essential. 17.Doors All doors through which patients may pass must be of sufficient size to accommodate a full hospital bed with attached intravenous flasks and traction apparatus with ease and must be designed in accordance with standards. Corridors In general, the total corridor area within the department should be minimized to optimize the use of space. Where corridors are necessary, they should be of adequate width to allow the cross passage of two hospital beds or a hospital bed and linen trolley without difficulty. There should be adequate space for trolleys to enter or exit any of the consulting rooms, and to be turned around. Standard corridors should not be used for storage of equipment, linen, waste or patients. 18.Wall Finish Hospital beds, ambulance trolleys, and wheelchairs may cause damage to walls. All walls surfaces in areas which may come into contact with mobile equipment
- 7. 39 should be reinforced and protected with buffer rails or similar. Bed stops should be fitted to the floor to stop the bed head from coming into contact with and damaging fittings, monitors, etc. 19.Floor Covering The floor covering in all patient care areas and corridors should have the following characteristics • Non slip surface • Impermeable to water, body fluids • Durable • Easy to clean • Acoustic properties that reduce sound transmission • Shock absorption to optimize staff comfort but facilitate movement of beds 20.Air Conditioning The emergency department should have a separate air system capable of rapid change from recirculation to fresh air flow. Special purpose rooms (e.g. Infectious Disease Isolation Room) or areas (ie. paediatric waiting area) may have special flow and filtering requirements. 21.Lighting and Emergency Power It is essential that a high standard focused examination light is available in all treatment areas. Clinical care areas should have exposure to daylight wherever possible to minimize patient and staff disorientation. The emergency department must be connected to a stand by generator. It should be capable of automatically switching on within seconds on failure of the main electric supply.