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Organization and Management of the Emergency Room of a Hospital

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Organization and Management of the Emergency Room of a Hospital - ROJoson - March 1, 2018

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Organization and Management of the Emergency Room of a Hospital

  1. 1. Organization and Management of the Emergency Department of a Hospital Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg March 1, 2018
  2. 2. Greetings and Salutations From REYNALDO O. JOSON, MD, MHA, MHPEd, MSc Surg 0918-804-03-04 rjoson2001@yahoo.com
  3. 3. Organization and Management of the Emergency Department of a Hospital Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
  4. 4. Organization and Management of the Emergency Department of a Hospital All hospitals must have an emergency department. (Levels 1 to 3 Hospitals – DOH AO 2012-0012)
  5. 5. Organization and Management of the Emergency Department of a Hospital Nomenclature EMERGENCY Emergency Department – Emergency Room – Emergency Center – Accident and Emergency
  6. 6. Organization and Management of the Emergency Department of a Hospital Nomenclature EMERGENCY Emergency Department – Emergency Room – Emergency Center – Accident and Emergency
  7. 7. Organization and Management of the Emergency Department of a Hospital Nomenclature EMERGENCY Emergency Department – Emergency Room – Emergency Center – Accident and Emergency
  8. 8. Organization and Management of the Emergency Department of a Hospital Nomenclature EMERGENCY Emergency Department – Emergency Room – Emergency Center – Accident and Emergency
  9. 9. Organization and Management of the Emergency Department of a Hospital Nomenclature EMERGENCY Emergency Department – Emergency Room – Emergency Center – Accident and Emergency
  10. 10. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  11. 11. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  12. 12. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  13. 13. Emergency Department (ED) Purpose of ED A facility in the hospital that is put up to cater to patients needing and seeking emergency medical services without prior appointment 24/7. Emergency medical services = immediate attention and management for patients with serious medical conditions (serious - by medical and layman’s perceptions)
  14. 14. Emergency Department (ED) Purpose of ED A facility in the hospital that is put up to cater to patients needing and seeking emergency medical services without prior appointment 24/7. General Functions (Authorized) of ED Cater to patients consulting and brought to ED needing and seeking emergency medical services without prior appointment 24/7. Provide emergency medical services to patients consulting and brought to ED without prior appointment 24/7. Specific Functions (Authorized) of ED
  15. 15. Emergency Department (ED) General Functions (Authorized) of ED Provide emergency medical services to patients consulting and going to ED without prior appointment 24/7. Specific Functions (Authorized) of ED • To provide emergency medical services 24/7 to the following patients consulting or brought to the ED: 1. Traumatic and non-traumatic patients 2. Victims of mass casualty incidents 3. Patients who perceive they have serious medical conditions
  16. 16. Emergency Department (ED) General Functions (Authorized) of ED Provide emergency medical services to patients consulting and going to ED without prior appointment 24/7. Specific Functions (Authorized) of ED • To provide the following general emergency medical services to patients consulting or brought to the ED: 1. Cardiopulmonary resuscitative measures to patients with life-threatening medical conditions 2. Medical examination and assessment 3. Medical treatment within the limits of the ED 4. Referral to appropriate physicians for follow-up or definitive management after being seen in the ED
  17. 17. Emergency Department (ED) General Functions (Authorized) of ED Provide emergency medical services to patients consulting and going to ED without prior appointment 24/7. Specific Functions (Authorized) of ED • To provide a system of triaging and response during patient surges particularly from mass casualty incidents. • To provide a system of triaging to identify patients who need to be placed in special areas (such as isolation rooms and decontamination rooms) and who need to be transferred to another hospital for one reason or another. • To network with emergency departments of nearby hospitals particularly during mass casualty incidents. • To network with other hospitals for transfer of patients who cannot be admitted into the ED or hospital.
  18. 18. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Quality Control Congruent / Compliant with expectations (implied or expressed) of • Community • Department of Health • PhilHealth Benchbook • International standards (JCI, ACI, others) • Owners Provide documentary evidences.
  19. 19. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Emergency Medical Services 24/7 For Traumatic and non-traumatic patients; victims of mass casualty incidents; patients who perceive they have serious medical conditions Resuscitation measures Medical assessment Medical treatment Referral Management of patient surge Triaging with special areas Networking with other hospitals Services to Provide Emergency medical services 24/7 • For specified types of patients • Resuscitation • Medical assessment • Medical treatment • Referral • Management of patient surge • Triaging with special areas • Networking with other hospitals
  20. 20. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  21. 21. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  22. 22. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Emergency medical services 24/7 • For specified types of patients • Resuscitation • Medical assessment • Medical treatment • Referral • Management of patient surge • Triaging with special areas • Networking with other hospitals Goal: Integrated value-based services at ED Services that improve health care outcomes per unit cost of care through integrated management systems Use of integrated management systems to create value in the delivery of health care services Examples of Integrated Management Systems (within ED and with whole hospital system) Quality Management System Risk Management System Financial Management System Records Management System IT system Training Program
  23. 23. Integrated Value-based Healthcare Services For every healthcare service rendered, on the part of the patient-clients, there is a perceived value for the money spent. Cost of the service may be the running rate or higher. However, as much as possible, efforts must be exerted to bring the cost down to reasonable and acceptable level to both the clients and healthcare service providers. Value is usually defined as health outcomes over cost of delivery of the outcomes.
  24. 24. Integrated Value-based Healthcare Services The adjective “integrated” is used to emphasize the need for optimal integration among the different healthcare services and providers so as to produce excellent health outcomes within reasonable and acceptable cost.
  25. 25. Integrated Value-based Healthcare Services Integrated value-based healthcare services are expected to lead to patient-clients’ delight. With patient-clients’ delights, the hospital will be more attractive to the community. Being more attractive, the hospital will have more patient-clients’ seeking its services which in turn will promote sustainability of the hospital.
  26. 26. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Emergency medical services 24/7 • For specified types of patients • Resuscitation • Medical assessment • Medical treatment • Referral • Management of patient surge • Triaging with special areas • Networking with other hospitals Goal: Integrated value-based services at ED Services that improve health care outcomes per unit cost of care through integrated management systems Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability
  27. 27. Emergency Department (ED) Key Performance Indicators Financial Viability and Sustainability Positive net income with at least an acceptable operating margin every year Maximal Utilization of Existing Services (maximal number of patients / number of procedures that can be maximally done in ED in a year)
  28. 28. Emergency Department (ED) Key Performance Indicators Excellent Clinical Outcomes of Patients Served (excellent treatment results; lowest possible adverse event rate per year) Overall and by type of medical condition Excellent Turn-around Time for Patients Served Overall and by type of medical condition
  29. 29. Emergency Department (ED) Key Performance Indicators Excellent Patient-Client Feedback Amount of returning (patronizing) patients per year Amount of patients expressing delight Amount of patients complaining Amount of medicolegal suits
  30. 30. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  31. 31. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Emergency medical services 24/7 • For specified types of patients • Resuscitation • Medical assessment • Medical treatment • Referral • Management of patient surge • Triaging with special areas • Networking with other hospitals Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability
  32. 32. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  33. 33. ED integrated throughputs • Equipment and material • Human resource • Data, documents, records program • IT-enabled system • Business development program • Risk management program • Physical structure • DOH licensing & structural requirements • Architectural design, engineering, and construction • Budget program Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Hospital concept and design; governance - operations policies and procedures Interfacing units operations policies and procedures
  34. 34. ED integrated throughputs • Equipment and material • Human resource • Data, documents, records program • IT-enabled system • Business development program • Risk management program • Physical structure • DOH licensing & structural requirements • Architectural design, engineering, and construction • Budget program Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Hospital concept and design; governance - operations policies and procedures Interfacing units operations policies and procedures Develop and provide documents – design and development plans; licenses; records; etc.
  35. 35. Emergency Department (ED) Policies and Procedures Policies and Procedures for Clients Policies and Procedures for Staff • Communicated • Oriented • Educated • Implemented
  36. 36. Manual of Policies and Procedures for Staff Emergency Department (ED)
  37. 37. Manual of Policies and Procedures Importance •Guide for present and future staff •Promotes effectiveness and efficiency Should be reviewed and revised periodically Emergency Department (ED)
  38. 38. Manual of Policies and Procedures • Service • Training • Research • Governance Emergency Department (ED)
  39. 39. Emergency Department (ED) Policies and Procedures • Emergency Medical Services at ED • Referrals (Internal / External) • Account Settlement • Deposit • Triaging • Emerging and Re-emerging Infectious Diseases • Patient Surge Situations • DOA • DNR • Firearms • Others
  40. 40. Emergency Department (ED) Policies and Procedures Pertinent Statutes and Administrative (Regulatory) Orders • Deposit • Emerging and Re-emerging Infectious Diseases • Reporting of Reportable Diseases
  41. 41. ER – DOH Standards Department of Emergency Medicine Tertiary care hospitals shall be given until 2010 to comply with this requirement. If the hospital has no Department of Emergency Medicine, it must have an Emergency Service.
  42. 42. Emergency Department (ED) Clinical Practice Guidelines on common (initially) and all medical conditions encountered in ED • Stroke • Heart attack • Trauma • Cardiopulmonary Resuscitation • Asthma • Others
  43. 43. Emergency Department (ED) Clinical Pathways on common (key) medical conditions encountered in ED • Stroke • Heart attack • Trauma • Cardiopulmonary Resuscitation • Appendicitis • Others
  44. 44. Emergency Department (ED) Service Pathways • Account settlement • Referral to other hospitals • Others
  45. 45. The Medical Referral System Only immediate medical treatment that can be rendered within the limits of the ED setup are administered. Emergency Department (ED)
  46. 46. The Medical Referral System Most patients will be needing follow-up or further treatment. Emergency Department (ED)
  47. 47. The Medical Referral System Contributes to effective and efficient achievement of objectives of ED Emergency Department (ED)
  48. 48. ED integrated throughputs • Equipment and material • Human resource • Data, documents, records program • IT-enabled system • Business development program • Risk management program • Physical structure • DOH licensing & structural requirements • Architectural design, engineering, and construction • Budget program Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Hospital concept and design; governance - operations policies and procedures Interfacing units operations policies and procedures
  49. 49. Emergency Department (ED) Equipment and Materials Needed to provide effective and safe, efficient, and prompt services in ED See Services to Provide See Policies and Procedures, Clinical Practice Guidelines, Clinical Pathways, Service Pathways
  50. 50. Emergency Department (ED) Equipment and Materials In consideration of the key functions and services of the unit, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system , identify equipment and materials needed to facilitate an effective and efficient functioning of the ED.
  51. 51. Emergency Department (ED) Equipment Equipment should have preventive maintenance and calibration at planned intervals to ensure accuracy and safety in their use and longer life span.
  52. 52. Equipment and Facilities Emergency Department (ED)
  53. 53. Equipment and Facilities Based on objectives, minimum essential - cardiopulmonary resuscitation - those needed to resuscitate and stabilize patients with life-threatening conditions before a more definitive treatment can be done within the hospital proper. Emergency Department (ED)
  54. 54. Equipment and Facilities General Determining Factors: •government regulations •needs and expectations of the community •allowance for future expansion - anticipated increase in patient load and new trends in ED medicine •cost-benefit considerations Emergency Department (ED)
  55. 55. Equipment and Facilities •Effective and of high quality •Efficient in carrying out objectives of ED -Stored in cabinets with proper labeling -Always available when needed -Convenient to use by personnel Emergency Department (ED)
  56. 56. Equipment and Facilities •Airway adjuncts •Breathing adjuncts •Electrocardiographic equipment •Emergency drugs and IV fluids •Surgical equipment and supplies Emergency Department (ED)
  57. 57. Equipment and Facilities •Obstetrical equipment and supplies •Diagnostic equipment and facilities •Record system •Transport system •Telecommunication system Emergency Department (ED)
  58. 58. Equipment and Facilities • At least one ambulance - extension of the ED - fully equipped with at least basic and advanced life support system Emergency Department (ED)
  59. 59. ED integrated throughputs • Equipment and material • Human resource • Data, documents, records program • IT-enabled system • Business development program • Risk management program • Physical structure • DOH licensing & structural requirements • Architectural design, engineering, and construction • Budget program Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Hospital concept and design; governance - operations policies and procedures Interfacing units operations policies and procedures
  60. 60. Emergency Department (ED) Human Resource Requirements • Physicians • Nurses • Nursing Aides • Clerks • Security guards • Driver of ambulance • Others Adequate in number and in competency
  61. 61. Emergency Department (ED) Human Resource Requirements Medical Staffing •By Interns •By Residents •By Consultants •By Physicians hired by the hospital
  62. 62. Emergency Department (ED) Human Resource Requirements Pattern of medical staffing is dependent on: 1. Presence of trainees 2. Willingness of consultants to go on duty 3. Economic feasibility and viability of employing MDs to man the ED 4. Consent of medical staff and administration
  63. 63. Emergency Department (ED) Human Resource Requirements Whatever be the pattern of medical staffing there should be adequate coverage by competent physicians who are physically present in the ED and who are supported by medical staff with full clarification of all professional, legal, and financial implications.
  64. 64. Emergency Department (ED) Human Resource Requirements Who should man the ED? •Any full-pledged MD will do as long as he knows what he is supposed to do However, the best person will be an emergency room specialist.
  65. 65. Emergency Department (ED) Human Resource Requirements The Emergency Department Officer A physician who has a license to practice medicine and who mans the ED
  66. 66. Emergency Department (ED) Human Resource Requirements The Emergency Department Officer Five general functions: •Administrator •Physician •Medicolegal Officer •Trainor •Patient Surge Incident Commander
  67. 67. Emergency Department (ED) Human Resource Requirements The Emergency Department Director Five competencies expected: • Administration • Emergency Medicine • Health Profession Education • Research • Risk and Disaster Management
  68. 68. ED integrated throughputs • Equipment and material • Human resource • Data, documents, records program • IT-enabled system • Business development program • Risk management program • Physical structure • DOH licensing & structural requirements • Architectural design, engineering, and construction • Budget program Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Hospital concept and design; governance - operations policies and procedures Interfacing units operations policies and procedures
  69. 69. Emergency Department (ED) Data, Documents and Records Program In consideration of the key functions and services of the unit, statutory and regulatory requirements, and other objectives like business development, risk management, and IT-enabled system , identify the data, documents, and records needed to facilitate an effective and efficient functioning of the ED.
  70. 70. Emergency Department (ED) IT-enabled System Use of computing technology, such as hardware, software, networking, and Internet •to promote efficiency in performance of functions and accomplishment of services ; •to manage information of unit – getting, storing, protecting, processing, transmitting as necessary, and later retrieving as necessary;
  71. 71. Emergency Department (ED) IT-enabled System Use of computing technology, such as hardware, software, networking, and Internet •to create interconnection with other units in hospital for timely communication, coordination and collaboration in accomplishment of services of unit; •to communicate with the patient- and physician- clients both in and out of hospital.
  72. 72. Emergency Department (ED) Business Development Program Presence of a structured and comprehensive program that will develop the business of unit to make it viable and sustainable!
  73. 73. Emergency Department (ED) Business Development Program The objective of program is to attract new patient- clients and maintaining previous patient-client base. Another objective of program is to attract new physician-clients and maintaining previous physician-client base.
  74. 74. Emergency Department (ED) Business Development Program Strategies: Marketing Public Relations Reputation Enhancement Attractive to patient-clients and physician-clients to utilize services of ED!
  75. 75. Emergency Department (ED) Risk Management Risk management program is a planned and systematic process / program to reduce and/or eliminate the probability of a “risk” that usually results in injuries, losses, and legal suits.
  76. 76. Emergency Department (ED) Risk Management It consists of three distinct, yet interrelated areas: • risk identification and loss prevention; • loss reduction; • risk financing.
  77. 77. Emergency Department (ED) Risk Management Risk Identification Types / Categories of Risks in ED • Risk for natural disasters (earthquake, flood, tsunamis, fire, etc.) • Risk for man-made disasters (fire, felony, bomb threat, terrorism, etc.) • Risk for medico-legal suits (arising from patient care) • Risk for non-medico-legal suits (not arising from patient care) • Risk for tarnished reputation
  78. 78. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure DOH Licensing Requirements DOH Guidelines in the Planning and Design of a Hospital And Other Health Facilities – 2004 Safe Hospital Initiative – structural, non-structural, and functional indicators Building Code Fire Code Local government requirements Others
  79. 79. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure Physical structure of a unit refers to a geographical space or area in the hospital, constructed to receive patient- and physician-clients requesting for services and to house the staff who will perform the functions of the unit.
  80. 80. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure Determinants: Statutory and regulatory requirements DOH Licensing Requirements DOH Guidelines in the Planning and Design of a Hospital And Other Health Facilities – 2004 Safe Hospital Initiative – structural, non-structural, and functional indicators / Building Code / Fire Code Local government requirements / SPECIALTY requirements Business development program Quality Standards Community expectations Efficiency Case load Owners’ wants
  81. 81. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure Indicators: • Compliant with DOH and other requirements– particularly on location and size • Accessibility – with clear signage • Adequate size (not cramped for staff and client movement) • Adequate lighting • Adequate ventilation • Aesthetics – attractive, with a welcoming, friendly and therapeutic environment • Provision for privacy as needed • Comfortable waiting areas
  82. 82. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure The Location •Accessible to the public Not deeply situated inside the hospital • Adequate road signs and signboards
  83. 83. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure The Location •near supportive departments such as labs and radiology • where hospital routines will NOT be disrupted when there is a sudden and great inflow of patients to the ED
  84. 84. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure The Size Can adequately house • essential equipment, facilities, and personnel for it to function effectively and efficiently • usual number of patients coming in at any given time for consultation and treatment
  85. 85. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure The Size General Determining Factors: •government regulations •needs and expectations of the community •allowance for future expansion - anticipated increase in patient load and new trends in ED medicine •cost-benefit considerations
  86. 86. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure The Architectural Design •Must be guided by how an effective and efficient function can be maximally achieved. •Must consider equipment personnel functional areas patients facilities
  87. 87. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure The Architectural Design General Determining Factors: •government regulations •needs and expectations of the community •allowance for future expansion - anticipated increase in patient load and new trends in ED medicine •cost-benefit considerations
  88. 88. Emergency Department (ED) Architectural Design, Engineering, and Construction / Physical Structure OB & Pedia Area Conference Room Sink Cardiac Area Trauma Area EmergencyMeds. Info/Reception Coffee Area
  89. 89. Treatment Areas Entrance Triage Counter Reception Monitoring Center Treatment Areas Treatment Areas Treatment Areas
  90. 90. The Architectural Design Some Tips Entrance must be of a size that can accommodate a standard stretcher bed. Emergency Department (ED)
  91. 91. The Architectural Design Some Tips Curtains or varifolds are recommended for cubicle dividers. To give a larger space when needed Emergency Department (ED)
  92. 92. The Architectural Design Some Tips Stretcher-beds are preferred over stationary examining tables and standard hospital beds. For mobility and flexibility Emergency Department (ED)
  93. 93. The Architectural Design Some Tips Piped-in gases and suction contribute to convenience and efficiency. Emergency Department (ED)
  94. 94. Emergency Department (ED) Budget Program Objectives: •To project future income and expenses of the unit which are reflected in a document (budget). •To use projected future income and expenses of the unit (budget) as guide for day-to-day performance and financial evaluation at planned intervals.
  95. 95. Emergency Department (ED) Budget Program Expected Outputs: •Achievement of financial targets •Effective and efficient utilization of resources •Controlled expenses
  96. 96. Emergency Department (ED) Budget Program Processes / Procedures: • Formulate a structured business plan for the forthcoming year inclusive of new and existing programs / projects /activities, staff requirements, equipment and materials, renovation, etc. • Quantitate / project income (if any) and expenses in pesos
  97. 97. Emergency Department (ED) Budget Program Processes / Procedures: • Prepare document that contains the two abovementioned processes which is designated as “budget” of the unit • Have the budget approved by an office in charge of hospital budget
  98. 98. Whole Hospital Concepts and Design Whole Hospital Governance Policies Procedures Whole Hospital Operations Policies Procedures Interfacing Units Operations Policies Procedures Emergency Department Design and Development Framework Regular Performance Evaluation and Continual Improvement Program Administrative Design and Development Program Architectural Design / Engineering / Construction Functions (authorized) Services (authorized) Leadership IT-enabled System DOH Licensing & Structural Requirements Policies & Procedures / Clinical Practice Guidelines/ Clinical Pathways Risk Management Program Physical Structure (Location, space) Human Resource Program Equipment / Material Program Data / Documents Records Program Business Development Program Budget Program Goals Client Engagement Performance Excellence Quality and Safe Health Care Services Cost-efficient / Value-based Services Maximal Utilization of Services
  99. 99. Emergency Department (ED) Regular Performance Evaluation and Continual Improvement Program Appraising extent of accomplishment of the unit in its authorized functions and business plans at planned intervals (quarterly, biannually, and annual). To determine areas of improvement and to act on them.
  100. 100. Emergency Department (ED) Regular Performance Evaluation and Continual Improvement Program At the start, must have performance measures, performance indicators, and targets, which must be measurable and realistic. Use of “balanced scorecard” – financial, customer, process, and learning and growth perspectives
  101. 101. Emergency Department (ED) Regular Performance Evaluation and Continual Improvement Program Always and forever looking for ways to improve something in the system, with details on what work is to be done, by whom, when, and what means or resources will be used.
  102. 102. Emergency Department (ED) Regular Performance Evaluation and Continual Improvement Program As a commitment to excellence. Minimum of one new structured continual improvement project per year. Can have a duration of 1-3 years for total completion and institutionalization. A 2- to 3-year project should be broken down into annual milestones.
  103. 103. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Emergency medical services 24/7 For specified types of patients Resuscitation Medical assessment Medical treatment Referral Management of patient surge Triaging with special areas Networking with other hospitals Goal: Integrated value-based services at ED Services that improve health care outcomes per unit cost of care through integrated management systems Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Regular Performance Evaluation and Continual Improvement
  104. 104. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Emergency medical services 24/7 For specified types of patients Resuscitation Medical assessment Medical treatment Referral Management of patient surge Triaging with special areas Networking with other hospitals Goal: Integrated value-based services at ED Policies and Procedures Clinical Practice Guidelines Clinical Pathways Service Pathways Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability Regular Performance Evaluation and Continual Improvement
  105. 105. Emergency Department (ED) Purpose, General Functions, Specific Functions of ED Services to Provide Emergency medical services 24/7 • For specified types of patients • Resuscitation • Medical assessment • Medical treatment • Referral • Management of patient surge • Triaging with special areas • Networking with other hospitals Goal: Integrated value-based services at ED Services that improve health care outcomes per unit cost of care through integrated management systems Services of Value to Clients Prompt services Effective services Efficient services Cost-effective services Client delight Maximal utilization of ED services ED Sustainability
  106. 106. Emergency Department (ED) Key Performance Indicators Financial Viability and Sustainability Positive net income with at least an acceptable operating margin every year Maximal Utilization of Existing Services (maximal number of patients / number of procedures that can be maximally done in ED in a year)
  107. 107. Emergency Department (ED) Key Performance Indicators Excellent Clinical Outcomes of Patients Served (lowest possible adverse event rate per year) Overall and by type of medical condition Excellent Turn-around Time for Patients Served Overall and by type of medical condition
  108. 108. Emergency Department (ED) Key Performance Indicators Excellent Patient-Client Feedback Amount of returning (patronizing) patients per year Amount of patients expressing delight Amount of patients complaining Amount of medicolegal suits
  109. 109. Common Problems Emergency Department (ED) Categories Common Problems Suggested Strategies MAN Consultants Residents Colleagues in other units Chief of Hospital / bosses Competencies Quantity Integration, coordination, collaboration Personality Leadership and managership Investor in People Standards Managing your boss Use of a multisectoral / multi-professional committee memberships
  110. 110. Common Problems Emergency Department (ED) Categories Common Problems Suggested Strategies SYSTEM AND METHOD Lack of systematization Lack of standardized procedures Use DOH requirements Use quality standards (PhilHealth Benchbook, JCI, ACI) Policies and procedures Clinical practice guidelines Clinical pathways
  111. 111. Common Problems Emergency Department (ED) Categories Common Problems Suggested Strategies MACHINE / EQUIPMENT Lack of management system Lack of calibration Lack of preventive maintenance Policies and procedures MONEY Other resources Limited Leadership Innovativeness
  112. 112. Common Problems Emergency Department (ED) Categories Common Problems Suggested Strategies TRENDS Rapid changes - difficulty in coping Knowledge management system (constant tracking and continual education) Benchmarking Innovativeness
  113. 113. The Trends Emergency Department (ED)
  114. 114. The Trends Types of Patients Any person with whatever medical problem who walks into or is brought to the ED should be served. Emergency Department (ED)
  115. 115. The Trends Types of Patients Do not discriminate anymore whether the patient has real emergencies or not. Assume all patients in ED have an emergency problem. Emergency Department (ED)
  116. 116. The Trends Emergency department medicine is already established as a specialty. Emergency Department (ED)
  117. 117. The Trends The most qualified emergency room physician will be a graduate of a training program in emergency room medicine. Emergency Department (ED)
  118. 118. Welcome Feedback and Queries REYNALDO O. JOSON, MD, MHA, MHPEd, MSc Surg 0918-804-03-04 rjoson2001@yahoo.com

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