accident and emergengy service

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

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

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

4. Clinical and client
focus
Staffing and related
Matters
Financial
factors
Operational
issues
Emergency
Unit

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
2. Determine solution
5. Monitor and analyse
7. Document and educate 3. Implement solution
6. review accordingly 4. Communicate the process
I Identify a problem

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 .