Hospital Management course session IV - Emergency room, OPD and Wards design and specs

1. Hospital Management
OPD, ER, Wards
Session IV
Wednesday, February 15, 2012
Dr. Ashfaq Ahmed Bhutto
MBBS, MBA, MAS, DCPS, MRCGP, (PhD)

2. Module 1
OUTPATIENT CLINICS
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3. Acknowledgement
 This document is intended to be used as a
guide.
 Adopted from Department of Veterans Affairs
Ambulatory Care Service, the Department of
Veterans Affairs Veterans Health Administration
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4. Patient flow
in OPD
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5. ACCESSIBILITY
 Outside Accessibility
 Walks
 Free of steps or abrupt changes of level.
 Minimum width of 5’ -0”.
 Maximum gradient of 1:33 (otherwise considered a ramp).
 Cross slopes no greater than 1:50.
 Walks with gradients of 1:50 to 1:33 have rest areas every 200’.
 Changes in level are blended to common levels by grading,
curb cuts or ramps.
 Firm, nonslip surfaces
 Free of gratings, manholes, etc.
 Level platforms (minimum of 6’-0” x 6’-0”) at doors. 2.
 Hazards
 Accessible paths of travel are free of hazardous side
protrusions.
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6. ACCESSIBILITY
 Curb Ramps
 Provide wherever a walk
crosses a curb.
 Located or protected to
prevent obstruction by parked
vehicles or street
 Furnishings.
 Maximum slope, 1:20
 Minimum width, 4’-0”.
 Smooth transition from curb
ramp to street or grade level.
 Firm, slip resistant surface.
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7. ACCESSIBILITY
 Ramps
 Maximum slope, 1:20
 Slope of 1:33 to 1:24: ramp no greater than 40’ in length.
 Slope of 1:25 to 1:20: ramp no greater than 35’ in length.
 Cross slope no greater than 1:50.
 Minimum clear width, 4’-0”.
 Top and bottom landings are at least 5’0” long.
 Intermediate landings at least 35’ or 40’ intervals are at least 5’0” long.
 Where doors swing onto a ramp landing, the landing is level an at least 6’-0” x 6’-0”.
 Where required, handrails are installed on both sides.
 Handrails are mounted at a height of 2’-9” and extend 1’-0” beyond beginning and
end of ramp.
 Firm, slip-resistant surface.
 Ramp curbs are at least 4” high by 4” wide.
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8. ACCESSIBILITY
 Passenger Loading Area
 In a safe area and clearly
designated for passenger
arrival and departure.
 Close as possible to
accessible entrance.
 Zoned to prohibit parking.
 Ramped to sidewalk level.
 Access aisles, measuring at
least 5’-0” wide by 20’-0” long
and parallel and level with the
vehicle pull-up space.
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9. ACCESSIBILITY
 Parking
 10% of total number of parking spaces accessible.
 Located conveniently to accessible entrances.
 Identified by accessibility symbols and routing signage.
 Spaces are at least 8’-0” wide with access aisles on each side.
 Spaces 11’-0” wide with 5’-0” access aisles for specially adapted
vans.
 Access aisles are at least 5’-0” wide with surface slope not
exceeding 1:50.
 Smooth transition from access aisle to adjacent walkway.
 Minimum clear width of adjacent walkways not reduced by
vehicle overhang.
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11. Inside Accessibility
 Entrances
 All highly used entrances are accessible.
 They are connected by an accessible walk to accessible parking and public
streets.
 They are connected to all accessible elements (e.g. elevators and ramps) and
spaces throughout a building by paths of travel at 3’-8”.
 Signage at accessible entrances.
 Maximum opening force for interior hinged doors is 5lbs.
 Thresholds are flush with finished floor or beveled with a slope no greater than
1:2.
 Operating devices on doors are easy to operate with one hand.
 Knurled surfaces on operating hardware of doors leading to hazardous areas.
 Bottom rail (kickplate) is at least 1’-0” high.
 Automatic doors are used in high-use areas.
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12. OPD Entrance
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13. Inside Accessibility
 Floors
 Firm and slip-resistant surface.
 Changes in level between 1/4” and 1/2” are beveled with a slope no greater than 1/2”.
(Changes in level up to 1/4” require no edge treatment).
 Changes in level greater than 1/2” comply with “Ramps”.
 Carpet
 Carpet is securely attached and has a low-cut pile and tight weave.
 Corridor Handrails
 1 1/2” diameter.
 1 1/2” space between handrail and mounting surface.
 Height of handrails, 2’-10”.
 Handrail sections are free of sharp edges.
 Wall surfaces behind handrails are smooth.
 Ends of hand rails are rounded.
 High and low bumper guards in equipment and W/C & Litter storage.
 Low bumper guards (just above base) at reception, interview counter & service windows
(agent cashier & pharmacy) to protect against W/C footrest.
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14. INTERIOR FINISHES
 Interiors
 Design solution is consistent with the interior concept including
the users needs.
 Design solution reflects state-of-the-art health care design
including, but not limited to, color, textures, and patterns.
 Materials and finishes meet fire, safety, and accessible codes.
 Design projects a high quality of care and caring.
 Way finding system is developed to satisfy the orientation needs
of the first time user.
 Signage is a coordinated system and is appropriate, readable,
and directive.
 Space planning is appropriate to functions.
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22. Module 2
EMERGENCY DEPARTMENT
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23. Emergency department
 Emergency department (ED), OR
 Emergency room (ER), OR
 Emergency ward (EW), OR
 Accident & emergency (A&E) department OR
 Casualty department
ER in a hospital or primary care is a department that
provides initial treatment to patients with a broad
spectrum of illnesses and injuries, some of which may be
life-threatening and requiring immediate attention.
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24. Signage
A hospital with an
emergency department
usually has prominent
signage reading
Emergency or Accident
and Emergency (often in
white text on a red
background) and an
arrow to indicate where
patients should proceed.
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25. History-Emergency Medicine
During the French Revolution, after seeing the speed with which the
carriages of the French flying artillery maneuvered across the
battlefields, French military surgeon Dominique Jean Larrey applied
the idea of ambulances, or "flying carriages", for rapid transport of
wounded soldiers to a central place where medical care was more
accessible and effective. Larrey manned ambulances with trained
crews of drivers, corpsmen and litter-bearers and had them bring the
wounded to centralized field hospitals, effectively creating a
forerunner of the modern MASH units. Dominique Jean Larrey is
sometimes called the father of emergency medicine for his
strategies during the French wars.
Reference wikipedia
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26. History-ER
The first specialized trauma care center in the world was opened at
the University of Louisville Hospital in 1911 and developed by
surgeon Arnold Grishwold during the 1930s and '40s. University of
Louisville was also the first hospital to have equipped police vehicles
with medical supplies and trained officers to give emergency care
while en route to the hospital. Arnold Grishwold also developed
auto-transfusion.-Reference wikipedia
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27. 1st step in ER
 Millions of People visit an emergency room each year.
 This is a 24-hour-a-day, non-stop world of emergency medicine.
 A visit to the emergency room can be a stressful, scary event.
 Why is it so scary?
 First of all, there is the fear of not knowing what is wrong with you.
 There is the fear of having to visit an unfamiliar place filled with people you
have never met.
 Also, you may have to undergo tests that you do not understand at a pace
that discourages questions and comprehension.
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28. Emergency Room Patients
 Car accidents  Unconsciousness
 Sports injuries  Confusion, altered level of
consciousness, fainting
 Broken bones and cuts from
 Suicidal or homicidal thoughts
accidents and falls
 Overdoses Severe abdominal pain,
 Burns persistent vomiting
 Uncontrolled bleeding  Food poisoning
 Heart attacks, chest pain  Blood when vomiting, coughing,
 Difficulty breathing, asthma urinating, or in bowel movements
attacks, pneumonia  Severe allergic reactions from insect
bites, foods or medications
 Strokes, loss of function and/or
 Complications from diseases, high
numbness in arms or legs
fevers
 Loss of vision, hearing
Unconsciousness
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35. 35

36. Understanding ER
 Triage
 Registration
 Examination Room
 Diagnostic Tests
 Diagnosis and Treatment
 Emergency Physician
 Emergency Nurse
 Physician Assistant
 Emergency Department Technician
 Unit Secretary
 Doctors in training
 Disposed off
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37. Basic requirements for emergency care
 Beds in the right place
 Fully staffed emergency operating theatres
 Availability of properly trained staff and surgeons
 Availability of ICU beds
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38. Staffing requirement
 There is a requirement for one consultant general
surgeon for 30 000 population as per UK specifications.
 A proud country should be capable of providing the
surgical needs for a population of 450–500 000 as
follows:
 General surgical units of 11 general surgeons
 4 vascular surgeons
 Trauma and orthopaedic units comprising 15 consultants
 Department of 30 anaesthetic consultants.
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40. Functional flow in ER
 A brief triage, or sorting, interview to help determine the
nature and severity of their illness.
 Individuals with serious illnesses are then seen by a
physician more rapidly than those with less severe
symptoms or injuries.
 After initial assessment and treatment,
ONE OF BELOW IS DONE
 Admitted to the hospital
 Stabilized and transferred to another hospital for various
reasons
 Discharged
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41. Emergency Department Patient Flow Concept Map
ED to Wards
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42. ED Performance Reports
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43. Basic requirements for an emergency
surgical service
 Core specialties on site
 24-hour clinical radiology and staffed emergency operating theatre
 ICU, coronary care, haemodialysis unit
 Consultant availability for the full 24-hours in the two main admitting
specialties of general surgery and trauma and orthopaedics in
addition to acute general medicine and anaesthetics
 Appropriate training arrangements.
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44. Critical conditions handled at ER
 Cardiac arrest
 Advanced Life Support
 Advanced Cardiac Life Support
 Heart attack
 Trauma
 Advanced Trauma Life Support (ATLS)
 There is critical time frame: commonly known
as the "golden hour."
 Asthma and COPD
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45. Core specialties required
 Full anaesthetic service with ICU
 General medicine
 General surgery
 Gynaecology
 Paediatrics
 Radiology
 Trauma and orthopaedics
 Pathology and blood transfusion.
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46. Justification of dedicated team
 Emergency surgical care, in all but the smallest hospitals, requires
that the surgical team of consultant, specialist registrar and/or senior
house officer, junior house officer and/or nurses should be free of all
other programmed commitments for the duration of their emergency
duties.
 Ideally, there should be sufficient workload to:
 Justify the dedication of the team to emergencies
 Make good use of emergency daytime operating theatres both for
trauma and general surgery
 Enable a separate vascular surgical rota from the general surgical rota.
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47. Essential of ER design
 High visibility
 Flexibility
 Greater efficiencies
 Disaster planning
 Security
 Patient care
 Collaboration
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48. Department layout
A typical emergency department has several
different areas, each specialized for patients with
particular severities or types of illness.
 The triage area
 The resuscitation area
 The majors, or general medical area
 A pediatric area
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51. ER waiting area
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52. Hallway
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54. 54

55. Triage
Triage is a system used by medical or
emergency personnel to ration limited
medical resources when the number of
injured needing care exceeds the
resources available to perform care so as
to treat those patients in most need of
treatment who are able to benefit first.
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56. History of triage
The word triage is a French word meaning
"sorting", which itself is derived from the Latin
tria, meaning "three".
The term has historically meant sorting into three
categories, although this is no longer necessarily
the case. The credit for modern day triage has
been attributed to Dominique Jean Larrey, a
famous French surgeon in Napoleon's army.
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57. START
(Simple Triage and Rapid Treatment)
START is an expedient triage system that
can be performed by lightly-trained lay
and emergency personnel in
emergencies.
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59. Triage
Triage separates the injured into four
groups:
DECEASED: who are beyond help
IMMEDIATE: the injured who can be
helped by transportation
DELAYED: the injured whose
transport can be delayed
MINOR injuries: The walking
wounded who need help less
urgently.
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60. Module 3
INDOOR
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61. Core bed requirement
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62. Space allowances for the single room and 4-
bed room from the schedules of
accommodation
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67. The Nightingale ward
This is an open-plan ward
containing 25-30 beds.
Services are located at
either end of a long,
rectangular ward; staff
supervision is in the aisle
between the two rows of
beds. This is the noisiest
type of ward.
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68. Straight, single-corridor ward
This simple layout has many
advantages: all of the rooms can
be lit and ventilated naturally
through windows. Service rooms
and the nurses' station are
centrally placed, and distances
are minimized. Staff can see
down the full length of the
corridor, making supervision
easier than in other forms. They
will know where other staff are
working and can call
them quickly in an emergency.
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69. L-shaped ward
In this layout, the patient beds are
on the two legs of the L, and the
support services and staff
supervision are on the junction.
Services and supervision are
concentrated at the entrance, with
minimal penetration into the
Patient areas.
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70. The race track
In this type of ward, the patient
areas are laid out at the periphery
of a deep rectangle, and the
services and staff areas are in the
middle. Patients are given a view,
but the staff has no view (and
perhaps no ventilation when the
WARD central air-conditioning is
not working!). Staff have long
distances to travel, and
communication between them is
difficult.
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71. The cruciform plan
In this plan, the patient rooms
comprise a peripheral
arrangement, and the support
and supervision areas are laid
out at the intersection of the
arms. This form results in a lot
of cross-traffic. It is used in
double wards, where there are
two separate ward units but
only one set of supervisory
staff.
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72. T -shaped ward
The advantages of this form
Are similar to those of the L-
Shaped ward. Support and
supervision are
concentrated on the vertical
arm, and the patient areas
are located on the horizontal
arm.
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77. Space to transfer a patient to and from a
bed
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78. Thank You
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