GUIDELINES ON EMERGENCY DEPARTMENT DESIGN free pdf ebook was written by DeeR on July 16, 2008 consist of 25 page(s). The pdf file is provided by and available on pdfpedia since April 16, 2012.

guidelines on emergency department design __________________________________________________________________________________ preamble these guidelines are the first revision of the..of design and equipment surveys from more than 60 emergency departments..designing emergency department facilities. consumer involvement at key review points is...

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GUIDELINES ON EMERGENCY DEPARTMENT DESIGN __________________________________________________________________________________ PREAMBLE These guidelines are the first revision of the original publication of 1998. They are designed to assist clinicians, planners and architects in producing a design for an emergency department which is of adequate size and contains adequate facilities to fulfill its role. As emergency departments have high patient turnover, varied casemix and a large workforce, their design is crucial to their function. Emergency departments must be planned with due consideration for the potential for growth and expected changes in health care delivery. Current and potential models of care must be considered. Key considerations include safety and security, amenity, access, image and consumer expectations, and evolving work practices. This paper was produced with the input of many people who have direct experience with ED design or redevelopment. The guidelines are based on extensive consultation and research, including results of design and equipment surveys from more than 60 emergency departments over 15 years and detailed evaluation of plans of existing departments. Recommended sizes for various spaces are expressed in relation to departmental activity. In general, a combination of activity (number of attendances), acuity (types of attendances) and the desired performance level (waiting times and access block) determine the amount and type of space required. In addition, workforce is broadly proportional to activity. Therefore staff area sizes are also related to departmental activity. These guidelines are based on current Australasian conventional emergency department practice but do include reference to variations in service models that have been incorporated into recent designs. The best outcomes will be achieved if there is close consultation and collaboration between managers, emergency department clinicians and architects in designing emergency department facilities. Consumer involvement at key review points is highly desirable. An image gallery of contemporary facilities is provided for illustrative purposes only. This is a living document which will evolve as emergency medicine develops. 1. INTRODUCTION 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, stabilise 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. In addition to standard treatment areas, some departments may require additional specifically designed areas to fulfill special roles, such as: The management of paediatric patients The management of major trauma patients The management of psychiatric patients West Melbourne Victoria 3003 Australia Telephone: (03) 9320 0444 Fax: (03) 9320 0400 34 Jeffcott Street
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G15 – Emergency Department Design - March 2007 Page 2 ____________________________________________________________________________________________________ The management of patients following sexual assault The management of infectious patients The extended observation and management of patients The management of prisoners in custody The management of patients affected by chemical, biological or radiological incidents Undergraduate, postgraduate teaching Transport and retrieval services Telemedicine In addition to clinical areas, emergency departments require facilities for the following essential functions: Teaching Research Administration Staff amenities Information which would assist in the planning of an emergency department include Annual census and trends Average daily census with peak patient volumes Triage categories of patient presentations Admission/transfer rate, including the number of cases requiring monitoring Average length of stay Turnaround times for radiology and pathology Patient mix, identifying those who are >65 years of age, and paediatric cases Additional information which pertain to the role delineation of the department ie. trauma service, regional referral service In general planning, the physical design goals should not be confused with operational goals. Designing a functional emergency department will not resolve access block. In order to maximise functional consideration, it is recommended that The clinical areas be designed to accommodate higher acuity patients. All treatment spaces should be wired for monitoring with access to the patient available from all sides Paediatric clinical spaces require as a minimum the same space requirements if not more than adult patient care spaces to accommodate family members and /or carers, storage area for toys, books etc The department design has the ability to respond to clinical demands. The central station or ‘arena’ department design concept is appropriate to a certain department size. When this is exceeded modular design principles should be adopted to maximise operational practices ie. subgrouping patient care areas each with ready access to its own clinical support areas and its own central station to avoid staff fragmentation Overuse of specialty rooms be avoided. Maintain flexibility to cope with emerging advances in clinical care ie. staff access to computer wireless technology in clinical recording Spatial consideration be made to accommodate family members and/or carers who will be accompanying the patient Privacy and confidentiality be maximised The clinical areas have the capacity to be isolated to prevent cross infection or cross contamination in the event that an area becomes contaminated Once designed, the plan should be tested by using a number of clinical scenarios ie. multiple trauma, chest pain, paediatric resuscitation, mental health presentation with a behavioral problem, gynaecological presentation, potentially infectious or poisoned patients ie. MRSA, TB, SARS, "white powder", fracture, malaria, to ensure optimal patient flow.
G15 – Emergency Department Design - March 2007 Page 3 ____________________________________________________________________________________________________ 2. MAJOR SPACE DETERMINANTS 2.1 General Space determinants revolve around the major functional areas of the department. These may be divided broadly into: Ambulance and ambulatory entrances Reception/Triage/Waiting area Administrative area Resuscitation area Acute Treatment area (of non-ambulant patients) Consultation area/fast track area (for ambulant patients) Staff workstations Specialty areas, eg. Paediatric areas Distressed relatives/interview room Procedure room(s) Plaster room Pharmacy/drug preparation Ophthalmology/ENT Mental Health Assessment Isolation room(s) Decontamination areas Teaching areas Tutorial room Support services Storage Clean and dirty utility Shower/bathroom/toilets Staff rooms Linen trolley bay Mobile equipment bay Mobile X-Ray equipment bay Cleaner's room Lounge/beverage preparation area Emergency services officer/lounge Offices and administration area Diagnostic areas eg. medical imaging unit/ laboratory area (optional) Emergency department short stay/observation ward (optional) Circulation space 2.2 Total Size The total internal area of the emergency department, excluding observation ward and internal medical imaging area if present, should be at least 50m 2 /1000 yearly attendances or 145m 2 /1000 yearly admissions, whichever size is greater. The minimum size of a functional emergency department that can incorporate all of the major areas is 700m 2 . These figures are based upon access block being minimal. Emergency Departments may take extended amounts of time from conception to completion, therefore allowances for future growth and development must be made in the design process.
G15 – Emergency Department Design - March 2007 Page 4 ____________________________________________________________________________________________________ The total size and number of treatment areas will also be influenced by factors such as: patient numbers, casemix and activity; projected population growth and changing population demographics; anticipated changes in technology; laboratory and medical imaging turnaround time; inpatient bed accessibility; and staffing number and structure. 2.3 Total Number of Treatment Areas The total number of patient treatment areas should be at least 1/1100 yearly attendances or 1/400 yearly admissions, whichever is greater in number. Areas such as procedure, plaster and interview rooms are not considered as treatment areas nor are holding bays or observation unit beds for admitted patients. The number of resuscitation areas should be no less than 1/15,000 yearly attendances or 1/5,000 yearly admissions and at least 1/2 of the total number of treatment areas should have physiological monitoring. 3. FUNCTIONAL RELATIONSHIPS The functional relationships may be summarised by the following diagram: EMERGENCY DEPARTMENT Direct Access Ready Access Ambulance Medical Imaging Short Stay Unit Car Parking Helipad (if applicable) Coronary Care Unit Intensive Care Unit Operating Rooms Pathology/Transfusion Service Medical Records Access Inpatient wards Pharmacy Outpatients Mortuary 3.1 Medical Imaging The Unit is dedicated to the imaging of emergency department patients. It should have a general X-Ray table, upright X-Ray facilities and an additional overhead gantry in the trauma bay/resuscitation area is recommended. The presence/absence of a film processor is dependent upon proximity to the main Medical Imaging Department or the use of digital radiography. Immediate access to CT scanning, Magnetic Resource Imaging (MRI), Ultrasound and Nuclear Medicine modalities will enhance the emergency department's effectiveness. A system of electronic display of images and reports (ie. Picture Archiving Communications System or PACS) is highly desirable. 3.2 Medical Records Access is required so that patients’ previous medical histories are obtainable without delay. A system of mechanical or electronic medical record transfer is desirable to minimise delays and labour costs. Access to medical records must be available 24 hours/day. 3.3 Intensive Care Unit and Coronary Care Unit Rapid access is highly desirable to minimise transfer times of critically ill patients. 3.4 Operating Rooms Rapid access is highly desirable in certain surgical emergencies, eg. ruptured aortic aneurysm, ectopic pregnancy, major trauma etc
G15 – Emergency Department Design - March 2007 Page 5 ____________________________________________________________________________________________________ 3.5 Pathology Rapid access is highly desirable to minimise turnaround times for laboratory investigations. Mechanical or pneumatic tube transport systems for specimens and electronic reporting of results are recommended. Point of care access for electrolyte/blood gas analysis, pregnancy testing and urine testing are highly desirable. 3.6 Pharmacy Proximity is desirable to enable prescriptions to be filled by patients with limited mobility. 4. DESIGN CONSIDERATIONS 4.1 General This should allow rapid access to every space with a minimum of cross traffic. There should be close proximity between the Resuscitation/Acute Treatment areas for non-ambulant patients and other treatment areas for ambulant patients, as staff may require relocation at times of high workload. Visitor and patient access to all areas should not traverse clinical areas. Protection of visual, auditory and olfactory privacy is important whilst recognising the need for observation of patients by staff. 4.2 Site Selection Decisions regarding site location have a major influence on the eventual cost and operational efficiency of the department and should be made in conjunction with emergency department staff. The site of the emergency department should, as much as possible, maximize the choices of layout. In particular, sites of access points must be carefully considered. 4.3 Staging If redevelopment is planned, the disruption to the function of the emergency department should be minimised. 4.4 Access and Car Parking 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 (ACEM Guidelines on ED Signage). Car parking should be close to the entrance, well lit and available exclusively for patients, their relatives and staff. Protected proximate parking areas should be available for urgent call in staff. Appropriate physical barriers should protect “drop off” zones. Undercover parking should be available for: Appropriate number of ambulances. This will be determined by case load and availability of ambulance access to other parts of the hospital for non-emergency patients. On call duty emergency physician Taxis and private vehicles which drop off/pick up patients (including those with limited mobility) adjacent to the ambulance patient entrance. Police vehicles Fire Brigade The emergency department should be clearly identified from all approaches. Illuminated signage is required for some signs to ensure visibility at night. The use of graphic and character display (eg. a white cross on a red background with the word "emergency") is encouraged. Multilingual signage may be required in departments with a significant caseload of culturally and linguistically diverse patients.
G15 – Emergency Department Design - March 2007 Page 6 ____________________________________________________________________________________________________ 4.5 Fire Safety Emergency Departments should be constructed to comply with fire regulations. 4.6 Grouping of Rooms - Functional relationships An emergency department is comprised of the following functional areas: Entrance/Reception/Triage area Resuscitation area Acute Treatment area Consultation area Staff/amenities Administration area and associated workstations The main aggregation of clinical staff over 24 hours will be at the staff station in the Acute Treatment/Resuscitation area. This should be the focus around which the other clinical areas are grouped. The Entrance/Reception/Triage area is the focus of initial presentation and hospital administrative functions. The Administration area should be accessible to the clinical areas but should not impair the clinical function of the department. These support areas are best arranged around the periphery of the department. 4.7 Bed Spacing In the Acute Treatment area there should be at least 2.4 metres of clear floor space between beds. The minimum length should be 3 metres. 4.8 Lighting It is essential that a high standard focused examination light is available in all treatment areas. Each examination light should have a power output of 30,000 lux, illuminate a field size of at least 150mm and be of robust construction. Clinical care areas should have exposure to daylight wherever possible to minimise patient and staff disorientation. Lighting should conform to Australian/New Zealand Standards. 4.9 Sound Control Clinical care areas should be designed so as to minimise the transmission of sound between adjacent treatment areas and sound levels should conform to Australian and New Zealand Standards and World health organization guidelines. Distressed relatives/Interview rooms and selected offices should have a high level of sound control to ensure privacy. 4.10 Service Panels Service panels should be minimally equipped as follows: a. Resuscitation room (for each patient space) 3 x oxygen outlets 2 x medical air outlets 3 x suction outlets 16 x GPOs in at least two separate panels 1 x nitrous oxide outlet (optional) 1 x scavenging unit
G15 – Emergency Department Design - March 2007 Page 7 ____________________________________________________________________________________________________ b. Acute Treatment bed - adult and paediatric 2 x oxygen outlets 1 x medical air outlet 2 x suction outlets 8 x GPOs in two separate panels 1 x nitrous oxide outlet (optional) 1 x scavenging unit c. Procedure room/suture room/plaster room 2 x oxygen outlets 1 x medical air outlet 1 x suction outlets 8 x GPOs in two separate panels 1 x nitrous oxide outlet 1 x scavenging unit d. Consultation room 1 x oxygen outlet 1 x suction outlet 4 x GPOs e. External service panels 3 x oxygen outlets 2 x medical air outlets 2 x suction outlets 12 x GPOs in at least two separate panels 1 x nitrous oxide outlet (optional) 1 x scavenging unit 4.11 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 NIBP Temperature SpO 2 4.12 Storage Around Bed Adequate storage space for disposable and non-disposable medical equipment should be available near each bed space. Storage space may consist of modular plastic type bins or other materials involving a similar design concept. There should be adequate consideration for the temporary holding of patient belongings. 4.13 Cabling Adequate cabling should be provided to ensure availability of GPOs to all clinical and non- clinical areas. Provision should also be made for cabling of telephone, patient call, emergency call, and computers to areas where these are necessary. Wide bandwidth cabling should be installed for electronic imaging systems telemedicine and internet applications. It is anticipated the availability of wireless applications will increase, and this will complement the above applications.
G15 – Emergency Department Design - March 2007 Page 8 ____________________________________________________________________________________________________ 4.14 Medical Gases Medical gases should be internally piped, to all patient care areas. 4.15 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 Australian and New Zealand Standards. There should be at least one pathway through the emergency department to key areas (imaging, OR, ICU) that will accommodate a bariatric bed. 4.16 Corridors In general, the total corridor area within the department should be minimised to optimise 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. 4.17 Air Conditioning The emergency department should have a separate air system capable of rapid change from recirculation to fresh air flow. Special purpose rooms (eg. Infectious Disease Isolation Room) or areas (ie. paediatric waiting area) may have special flow and filtering requirements. 4.18 Information/Communications Support Emergency departments are high volume users of telecommunications and information technology. Telephones should be available in all offices, at all staff stations, in the clerical area and in all consultation and other clinical rooms. A central communications area for the disposition of all incoming calls is recommended. The use of multifunction, wireless communication devices should be considered. Additional phone jacks should be available for the use of facsimile machines and computer modems where required. A dedicated telephone to receive admitting requests from outside medical practitioners is desirable. Cordless phones or phone jacks should be available for access to patients' beds. An intercom or public address system that can reach all areas of the emergency department should be available. Public telephones with acoustic hoods should be available in the waiting area. A direct line to a taxi company is desirable. Direct telephone lines bypassing the hospital switchboard should be available. They would be used in internal and external emergencies or when the hospital PABX is out of service. The staff station should have a dedicated inward line for the ambulance and emergency services. There should be facsimile lines in clinical as well as administrative areas. Direct radio communication should be available between the ambulance service and the emergency department. including incoming aeromedical transport. An electronic emergency department information system should be installed to support clinical management, patient tracking and departmental administration. Sufficient terminals should be available to ensure that queuing does not occur, even at peak times. Computer terminals and telephones need to be co-located to optimize staff efficiency. Workspace design should include sufficient bench-widths or suitable suspension devices for screens, keyboards, drives and printers. Additional computer terminals, software and peripheral devices should be installed to enable other departmental functions. The increasing use of electronic medical records should be anticipated and access to electronic knowledge bases should be routine.
G15 – Emergency Department Design - March 2007 Page 9 ____________________________________________________________________________________________________ 4.19 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. 4.20 Emergency Call Facilities All bed spaces and clinical areas, including toilets and bathrooms, should have access to an emergency call facility so staff can summon urgent assistance. The emergency call facility should alert to a central module situated adjacent to the staff station as well as to the Staff and Tutorial rooms. 4.21 Duress Alarm A duress alarm system should be available to staff working in any area with potentially aggressive patients, particularly those in isolated areas, to ensure safety. 4.22 Hand Washing Facilities Hand washing facilities should comply with Australian and New Zealand 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 and at the ratio of 1 to 1 for every Procedure/Resuscitation/Consulting room/Triage/Isolation area. Taps in clinical areas should be fitted with anti-splashback devices and operated hands free. Dispensers for non-sterile latex gloves, face masks and gowns should be available in the vicinity of each hand basin and each treatment area to assist staff compliance with standard precautions. 4.23 Emergency Power Emergency power must be available to all lights and GPOs in the Resuscitation and Acute Treatment/Observation areas of the department. Emergency lighting should be available in all other areas. All computer terminals should have access to emergency power. In the event of a total power failure, sufficient space and power points should be available to enable a backup system of lighting to be stored and maintained. 4.24 Wall Finish Hospital beds, ambulance trolleys, and wheelchairs may cause damage to walls. All wall surfaces in areas which may come into contact with mobile equipment 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. 4.25 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 optimise staff comfort but facilitate movement of beds. Office(s), Tutorial, Staff rooms, Clerical areas and the Distressed Relatives' room should be carpeted.
G15 – Emergency Department Design - March 2007 Page 10 ____________________________________________________________________________________________________ 4.26 Wall Clocks A wall clock should be visible in all clinical areas and waiting areas. Time-elapse clocks are desirable in the resuscitation, procedure and plaster rooms. Times displayed in all areas and on computers must be synchronised. 4.27 Electricity Supply The electricity supply to the emergency department should be surge protected to protect electronic and computer equipment. The Resuscitation area should be cardiac protected and the Acute Treatment area body protected and the electricity supply to other patient care areas should be in accordance with Australian and New Zealand Standards. 5. DESCRIPTION OF PATIENT FLOWS The following diagram outlines the various pathways that a patient may follow when (s)he enters the emergency department: Ambulant Ambulance Triage Ambulatory Care/ Fast Track nmm Acute & subacute assessment Supports Specialties/ Womens & Childrens Health n Supports Resuscitation & Trauma Mental Health Short Stay Unit MAPU Inpatient Wards HOME (Community)
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