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Hm 2012 session iv opd,er, wards


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

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Hm 2012 session iv opd,er, wards

  1. 1. Hospital Management OPD, ER, WardsSession IVWednesday, February 15, 2012Dr. Ashfaq Ahmed Bhutto MBBS, MBA, MAS, DCPS, MRCGP, (PhD)
  2. 2. Module 1OUTPATIENT CLINICS 2
  3. 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 3
  4. 4. Patient flowin OPD 4
  5. 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. 5
  6. 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. 6
  7. 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. 7
  8. 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. 8
  9. 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. 9
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  11. 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. 11
  12. 12. OPD Entrance 12
  13. 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. 13
  14. 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. 14
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  22. 22. Module 2EMERGENCY DEPARTMENT 22
  23. 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. 23
  24. 24. SignageA hospital with anemergency departmentusually has prominentsignage readingEmergency or Accidentand Emergency (often inwhite text on a redbackground) and anarrow to indicate wherepatients should proceed. 24
  25. 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 25
  26. 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 26
  27. 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. 27
  28. 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 28
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  36. 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 36
  37. 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 37
  38. 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. 38
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  40. 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 40
  41. 41. Emergency Department Patient Flow Concept MapED to Wards 41
  42. 42. ED Performance Reports 42
  43. 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. 43
  44. 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 44
  45. 45. Core specialties required Full anaesthetic service with ICU General medicine General surgery Gynaecology Paediatrics Radiology Trauma and orthopaedics Pathology and blood transfusion. 45
  46. 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. 46
  47. 47. Essential of ER design High visibility Flexibility Greater efficiencies Disaster planning Security Patient care Collaboration 47
  48. 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 48
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  51. 51. ER waiting area 51
  52. 52. Hallway 52
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  55. 55. TriageTriage is a system used by medical oremergency personnel to ration limitedmedical resources when the number ofinjured needing care exceeds theresources available to perform care so asto treat those patients in most need oftreatment who are able to benefit first. 55
  56. 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 Napoleons army. 56
  57. 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. 57
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  59. 59. TriageTriage separates the injured into fourgroups:DECEASED: who are beyond helpIMMEDIATE: the injured who can behelped by transportationDELAYED: the injured whosetransport can be delayedMINOR injuries: The walkingwounded who need help lessurgently. 59
  60. 60. Module 3INDOOR 60
  61. 61. Core bed requirement 61
  62. 62. Space allowances for the single room and 4-bed room from the schedules ofaccommodation 62
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  67. 67. The Nightingale wardThis is an open-plan wardcontaining 25-30 beds.Services are located ateither end of a long,rectangular ward; staffsupervision is in the aislebetween the two rows ofbeds. This is the noisiesttype of ward. 67
  68. 68. Straight, single-corridor wardThis simple layout has manyadvantages: all of the rooms canbe lit and ventilated naturallythrough windows. Service roomsand the nurses station arecentrally placed, and distancesare minimized. Staff can seedown the full length of thecorridor, making supervisioneasier than in other forms. Theywill know where other staff areworking and can callthem quickly in an emergency. 68
  69. 69. L-shaped wardIn this layout, the patient beds areon the two legs of the L, and thesupport services and staffsupervision are on the junction.Services and supervision areconcentrated at the entrance, withminimal penetration into thePatient areas. 69
  70. 70. The race trackIn this type of ward, the patientareas are laid out at the peripheryof a deep rectangle, and theservices and staff areas are in themiddle. Patients are given a view,but the staff has no view (andperhaps no ventilation when theWARD central air-conditioning isnot working!). Staff have longdistances to travel, andcommunication between them isdifficult. 70
  71. 71. The cruciform planIn this plan, the patient roomscomprise a peripheralarrangement, and the supportand supervision areas are laidout at the intersection of thearms. This form results in a lotof cross-traffic. It is used indouble wards, where there aretwo separate ward units butonly one set of supervisorystaff. 71
  72. 72. T -shaped wardThe advantages of this formAre similar to those of the L-Shaped ward. Support andsupervision areconcentrated on the verticalarm, and the patient areasare located on the horizontalarm. 72
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  77. 77. Space to transfer a patient to and from abed 77
  78. 78. Thank You 78