ARC070

HOSPITAL

EMERGENCY DEPARTMENT

SUBMITTED TO : AR. CHETAN SACHDEVA

SUBMITTED BY : RICHIKA (11906109) &

DOLAR (11916595)
 1. WHAT IS A EMERGENCY
DEPARTMENT/UNIT?
An emergency department (ED), also known as an accident and emergency department (A&E),
emergency room (ER), is a medical treatment facility specializing in emergency medicine, the acute
care of patients who present without prior appointment; either by their own means or by that of an
ambulance. The emergency department is usually found in a hospital or other primary care center.

Due to the unplanned nature of patient attendance, the department must provide initial treatment for
a broad spectrum of illnesses and injuries, some of which may be life-threatening and require
immediate attention. In some countries, emergency departments have become important entry points
for those without other means of access to medical care.

The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be
varied in an attempt to reflect patient volume. The patients are brought to the by an emergency
ambulance or they come by themselves.
● The primary role of emergency department is to deal with serious casualties and accidents
so it should be located on ground floor.
● Separate emergency entrance with minimum vehicle headroom 3.5m.
● Clear signposting to the drive-in entrance is important.
● There should be a separate approach, other than the OPD with a spacious parking area for
cars and cycles.
● It should be located just adjacent to the OPD so the sources can be pooled in case of major
disaster.
● The emergency department (ED) plays an important role in providing patients with
prompt and effective clinical care. It is the healthcare entry point responsible for
receiving, sorting, assessing, stabilizing, and managing patients arriving at its door with
different degrees of urgency and complexity. Conditions of patients requiring an
emergency care vary from major trauma and stroke to intoxication and mental disorders.
Therefore, ED is considered to be an extremely complex system.
 FUNCTIONAL AREAS IN ER

ENTRANCE / RECEPTION / TRIAGE:

1. Receiving of patients and visitors and administration
2. Assessment for patients

PATIENT TREATMENT AREAS:

1. Assessment and treatment areas including Resuscitation, Acute Treatment
rooms, Seclusion Room and Decontamination Facility, Paediatric patient areas,
Procedure rooms.
2. Short-Stay Ward/ Emergency Medicine Unit/ Observation Unit;
3. Primary Care Area - for patients with low acuity conditions;
4. Stepdown Area - for patients awaiting test results, considered safe, but requiring
observation prior to admission or discharge.

STAFF AND SUPPORT AREAS :

1. Clean and Dirty Utility Rooms
2. Store rooms
3. Linen
4. Waste Holding/ Cleaners rooms
 5. Staff amenities, administrative and teaching functions.
6. Ambulance facilities.

The main aggregation of clinical staff 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 Area is the focus of initial presentation.

1. In addition to standard treatment areas, some departments may require additional,

specifically designed areas to fulfil special roles, such as:
2. Management of paediatric patients
3. Management of major trauma patients
4. Management of psychiatric patients
5. Management of patients following sexual assault
6. Extended observation and management of patients
7. Undergraduate and postgraduate teaching
8. Transport and retrieval services
9. Telemedical referral/ consultation service

ENTRANCE AREA :
The entrance to the Emergency Unit must be at grade-level, well-marked, illuminated, and
covered. It shall provide direct access from public roads for ambulance and vehicle traffic, with
the entrance and driveway clearly marked. A ramp shall be provided for pedestrian and
wheelchair access.

The entrance to the Emergency Unit shall be paved to allow discharge of patients from cars
and ambulances. Temporary parking should be provided close to the entrance.
WAITING AREA :
The Waiting Area should provide sufficient space for waiting patients as well as relatives. The
area should be open and easily observed from the Triage and Reception areas.
Seating should be comfortable and adequate. Space should be allowed for wheelchairs,
prams, walking aids and patients being assisted. There should be an area where children may
play.

From the Waiting Area there must be access to:

1. Triage and Reception Areas
2. Toilets
3. Baby Change Room
4. Light refreshment facilities which may include automatic beverage dispensing machines
5. Telephone and change machines
6. Health literature

RECEPTION / CLERICAL AREAS :

The Reception Area is required to accommodate-
1 Reception of patients and visitors
2 Registration interviews of patients
3 Collation of clinical records
4 Printing of identification labels
 TRIAGE/RECEPTION:
The Reception / Triage and Staff Station shall be located where staff can observe and control access
to treatment areas, pedestrian and ambulance entrances, and public waiting areas. This area
requires a duress alarm. The Reception / Triage area should have clear a vision to the
Waiting Room, the children’s play area (if provided) and the ambulance entrance. The
Reception / Triage Area may perform observations and provide first aid in relative privacy.

Triage can be defined as the prioritization of patient care based on the severity
of injury,illness, prognosis, and availability of resources.

For those responsible for the triage of patients arriving in the emergency
department, the purpose of triage is to determine to which predesignated
patient care area the patient should be sent.The locations to which the
patients are 'triaged' establishes priorities for care.
 ACUTE PSYCHIATRIC EMERGENCY CARE AREA :
The patient who is suffering from an acute psychological or psychiatric crisis has unique and
often complex requirements. An Emergency Unit should have adequate facilities for the
reception, assessment, stabilisation and initial treatment of patients presenting with acute
mental health problems.

Interview Room (Mental Health):

Designed in such a way that observation of the patient by staff outside the room is
possible at all times; this may be backed up with closed circuit television for the safety of staff.
Arranged to ensure that patients have no access to air vents or hanging points. This room should
have two exit doors, swinging outward and lockable from outside, to allow for the escape of staff
members when one exit is blocked.

Examination/ Treatment room (Mental Health):

The Examination/Treatment Room should be immediately adjacent to the Interview room. It
should contain adequate facilities for physical examination of the patient, however the
inclusion of unnecessary and easily dislodged equipment should be avoided.

ACUTE TREATMENT AREAS:

Acute Treatment Areas are used for the management of patients with acute illnesses.
 PATIENT TOILETS/ SHOWERS:
In an Emergency Unit the Patient Toilet/ Ensuite facilities will be
separate for Male and Female.

CONSULTATION AREAS:
Consultation Room/s are to be provided according to Unit size and requirements for
examination and treatment of ambulant patients. Consult Rooms are to comply with
Standard Components - Consult Room.

DECONTAMINATION AREA :
An Isolation Room should be available for patients who are contaminated with toxic
substances. In addition to the requirements of an Isolation Room, this room must:
1. Be directly accessible from the ambulance bay without entering any other part of the
unit
2. Have a flexible water hose, floor drain and contaminated water trap.

LABORATORY AREA:
A designated area for performing laboratory investigations such as arterial blood gas analysis
and microscopy should be considered in Units of Levels 5 or 6.
 PHARMACY / MEDICATION AREA:
A Pharmacy / Medication area is required for the storage of medications used within
the Emergency Department. Entry should be secure with a self-closing door. The area
should be accessible to all clinical areas and have sufficient space to house a refrigerator,
which is essential for the storage of heat sensitive drugs.

RESUSCITATION AREA :
The Resuscitation Room/ Bay is used for the resuscitation and treatment of critically ill or
injured patients.

STAFF STATION:
The Staff Station should have an uninterrupted vision of the patients. It should be centrally
located and be constructed as an enclosed area to ensure confidential information can be
conveyed without breach of privacy and to provide security to staff, information and privacy.

SHORT STAY WARD / EMERGENCY MEDICAL UNIT (EMU):

This facility may be provided either within or adjacent to the Emergency Unit for the prolonged
observation and ongoing treatment of patients who are planned for subsequent discharge
(directly from the EU). Patients may be kept in this Unit for diagnosis, treatment, testing or for
medical stabilisation.
The Emergency Unit will require ready access to the
following key functional areas:
1. Medical Imaging Unit
2. Operating Unit - rapid access is highly desirable for surgical emergencies
3. Coronary Care Unit
4. Pathology / Blood Bank Unit
5. Clinical Records Unit
6. Inpatient Accommodation Unit
7. Pharmacy Unit - proximity is required
8. Outpatients (if an outpatient service is provided adjacent to the Emergency Unit)
9. Mortuary

—-----------
2. SPACE REQUIREMENTS OF THE
FUNCTIONAL SPACES
Reception Area : 150-25 sq.ft.
Examination area: 100 sq.ft.
Resuscitation room: 400 sq.ft.
X-ray : 80 sq.ft
Laboratory: 200 sq.ft.
Minor OT : 350 sq.ft.
Recovery Room : 70 sq.ft.
 PUBLIC SECTOR AREAS
• Entrance for patients arriving by ambulance , other modes
of transportation, or conveyances
• Entrance for walk-in patients
• Control station
• Public waiting space with appropriate public amenities

TREATMENT FACILITIES
• Patients' observation room
• Treatment cubicles
• Examination rooms
• Cast room
• Critical care rooms Emergency Department
 3. EMERGENCY RECEPTION
Parts and components of the division :
1. Entrance + waiting room
2. Registration
3. Staff room
4. Mini surgery
5. Test room
6. Medical utilities
7. Mini sterilization room

LOCATION: 1. Very close to the exit door of emergency

2. Very close to the radiology
3. Close to the pharmacy, laboratories & central sterilization
4. Direct access to the stairs and elevators
 AREA OF THE DEPARTMENT:
1. U.S. Public Health Services (USPHS)
100 bed hospital area = 100 m.sq.
200 bed hospital area = 215 m.sq.

Ex - 100 bed
hospital
4. DELIVERY SUITE UNIT/MATERNITY UNIT :
The delivery suit unit be located near to operation theatre & located preferably on the
ground floor. The delivery Suit Unit should include the facilities of accommodation
for various facilities as given below:
• Reception and admission
• Examination and Preparation Room
• Labour Room (clean and a septic room)
• Delivery Room
• Neo-natal Room
• Sterile Store Room
• Scrubbing Room
• Dirty Utility
• Doctors Duty Room
• Nursing Station
• Nurses changing Room
• Group C & D Room
• Eclampsia Room
MATERNITY DIVISION
• PARTS & COMPONENTS OF THE DIVISION :
1. Open room 20-40 m.sq.
2. Operation 26 m.sq.
3. WCs
4. Utilities 8 m.sq.
5. Office 15 m.sq.
6. Cleanup room 5 m.sq.
7. Storage 10 m.sq.
8. Waiting area 10 m.sq.
9. Corridors w=2.2m
fig. Diagram showing the maternity unit and the delivery
rooms
 5. OPERATION THEATRE:
The location of Operation theatre should be in a quiet environment, free from noise
and other disturbances, free from contamination and possible cross infection,
maximum protection from solar radiation and convenient relationship with
surgical ward, intensive care unit, radiology, pathology, blood bank and CSSD.
Operation theatre usually have a team of surgeons anaesthetists, nurses and sometime
pathologist and radiologist operate upon or care for the patients.

6.FOR STORAGE OF VACCINES & OTHER LOGISTICS :

Cold Chain Room: 3.5 m × 3 m in size
Vaccine & Logistics Room: 3.5 m × 3 m in size

7. MORTUARY :
It provides facilities for keeping of dead bodies and conducting autopsy. The Mortuary shall be
located in separate building near the Pathology on the Ground Floor, easily accessible from the
wards, Accident and emergency Department and Operation Theatre. It shall be located away
from general traffic routes used by public.
 CHARACTERISTICS OF ED
Characteristics of an Emergency Department that make it a unique environment and present
design challenges include:
• The changing models of care within Emergency Departments and the emergence of
associated and colocated inpatient departments;
• The varying levels of staff associated with certain models of care;
• The varied case mix of acutely unwell patients who are often suffering from time critical and
life threatening illnesses;
• The role of the Emergency Department/hospital e.g. whether it functions as a major trauma service
• The presentation of patients with undifferentiated conditions;
• The presence of patients, relatives, carers or friends who are stressed and anxious;
• The presence of patients suffering from an acute psychosocial crisis;
• The high patient turnover;
• The varied patient admission and discharge pathways;
• The ‘front loading of patient care’ by health professionals primarily stationed in the ED, rather
than in the ward, in order to expedite their care; and
• The Emergency Department providing a growing number of unique and important services, mostly
by specialist Emergency Physicians.
 8. DESIGN : The design of an efficient Emergency Department in which care is coordinated and
carried out in an appropriate environment depends on the productive collaboration between a number of key
stakeholders involved in the building or redevelopment process. The process of Emergency Department
design should consider:
• Functionality – an Emergency Department’s design needs to be practical and reflect how
health professionals manage and treat their patients who have different clinical conditions;
• Form – spatial considerations and relationships that promote effective interaction
between staff and patients, relatives, carers, and the flow of clinical care. Consideration
that Emergency Department models of care will change over time is needed, as well as
consideration of the relationship between the Emergency Department and the greater
hospital. Over time, clinical treatment spaces will be reallocated, so many spaces need to ‘
have flexibility built into them to ensure future proofing.
• Patient and staff needs – the aim of health care is not only to treat disease, but also to create a
healing environment for patients that is safe and free of psychosocial elements created through
poor design. Additionally, the workplace needs of Emergency Department staff can be promoted
through the application of Occupational Health and Safety (OH&S) standards that ensure a work
environment that is as safe as possible. The psychosocial wellbeing of staff should be considered
through design and space use. This should not be underestimated given that staff will occupy the
Emergency Department spaces much longer than any patient, relative or carer.
• The Emergency Unit should be located on the ground floor for easy access. It
should be adequately signposted.
• Car parking should be close to the Entrance, well lit and available
exclusively for patients, their relatives and staff. Parking areas should be
available close to the Emergency Unit for urgent call in staff.
• The emergency unit should be clearly identified from all approaches.
Signposting that is illuminated is desirable to allow visibility at night.
• The use of natural light should be maximised throughout the Unit. Natural
Lighting contributes to a sense of wellbeing and assists orientation of
patients and visitors and minimises staff disorientation.
 9. PURPOSE OF EMERGENCY DEPARTMENT
The purpose of the Emergency Department is to receive, triage, stabilise and provide
acute health care to patients. This includes patients requiring resuscitation and
those with emergent, urgent, semi-urgent and lessurgent conditions (Australasian
Triage Scale (ATS) categories 1-5 [2]). An Emergency Department also requires the
capacity to deal with mass casualty and disaster situations. There are particular
patient types seen in the Emergency Department that may have specific psychosocial
and treatment needs. These include:
• Major trauma patients;
• Elderly patients;
• Children and adolescents;
• Patients with physical and mental disabilities;
• Victims of child abuse, domestic violence, or sexual assault;
• Patients with mental health issues;
• Patients with infectious diseases or who are immunocompromised;
• Custodial patients; and
• Patients affected by chemical, biological or radiological contaminants
Pathways that a patient may follow on arrival to the Emergency
Department:
 10. HOSPITAL EMERGENCY CODES
Hospital emergency codes are used in hospitals worldwide to alert staff to various
emergencies. The use of codes is intended to convey essential information quickly
and with minimal misunderstanding to staff, while preventing stress and panic among visitors
to the hospital. These codes may be posted on placards throughout the hospital, or printed on
employee identification badges for ready reference.

EMERGENCY CODE AND PREPAREDNESS: What Is An Emergency Code? An emergency code is a

notification of an event that requires immediate action. Preparing for the Unexpected Emergencies can strike
anywhere and at any time. In the spirit of proactivity we encourage you to have your own emergency
preparedness plan.
TYPES OF CODES : 1.Code Blue : Cardiac arrest
2. Code Red : External disaster
3. Code Brown : Internal disaster
4. Code Pink : Baby disaster
5. Code Grey : Security threats / workplace violence
6. Code Orange : Medical emergency team(MET)
SOME OF THE MORE WIDELY USED CODES IN HOSPITAL INCLUDES:
• code pink: infant or child abduction
• code orange: hazardous material or spill incident
• code green: emergency activation
• code violet: violent or combative individual
• code yellow: disaster
• code brown: severe weather
• code white: evacuation
• code silver: active shooter
Thank you!