Hunter Area Health Service
Operational Policy Statement
D R A F T
Department Emergency
1.Description of Unit
LOCATION
The Emergency Department is located on level 2, adjacent to the main entrance of The John Hunter Hospital.
DEFINITION OF FACILITY, FUNCTION AND RESPONSIBILITY
John Hunter Hospital is a Principal Referral Hospital
The ED is a Level 6 Emergency Care Unit
A Level 6 Emergency Care Unit requires access to: -
NEUROSURGERY AND CARDIOTHORACIC SURGERY ON SITE.
Major Sub-specialty consultants are available on rosters and registrar cover on site
24 hrs.
Support services on site, including ICU and CCU.
Operating Suite and Anaesthetic Support 24 hours per day.
Pharmacy, Pathology and Medical Imaging including Nuclear Medicine available after hours.
PAEDIATRIC SERVICES:
Designated Paediatric Service (Tertiary Referral and Trauma); one of three in NSW
Paediatric trauma services require an organised team with experience and training in paediatric trauma. The service is capable of providing all the needs of a child who has significant injury.
MAJOR TRAUMA SERVICE:
Designated Major Trauma Service for Adults and Paediatrics
Major trauma services require the capacity to provide total care for every aspect of an injury from initial notification through to rehabilitation.
RETRIEVAL SERVICES:
Retrieval Services at JHH cover the Hunter and Northern NSW in collaboration with the Helicopter Rescue Service
All helicopter primary response patients, including trauma, are received in the Emergency Department. Also inter hospital retrievals not required to go to the Intensive Care Unit are received in the Emergency Department.
Description of Unit (continued)
DISASTER SERVICES:
The JHH is located in the Hunter Emergency Management District, as described in accordance with Section 21 (1) and (2) of the State Emergency and Rescue Management Act, 1989. In co-operation with other Emergency Services, including but not limited to, Police Service, Fire Brigades, Bush Fire Brigades, Ambulance Service, State Emergency Service, Volunteer Rescue Association, and any other Agency which manages or controls an accredited rescue unit, the service plays a major role in any designated disaster.
EDUCATION
Accreditation by the Australasian College for Emergency Medicine for Advanced Training.
Graduate Certificate in Emergency Nursing
Close Affiliation with Newcastle University participating in undergraduate and postgraduate programs.
New Areas
The new area will include the following rooms:
Entrance/Reception/Triage, Resuscitation Area Emergency Room, Paediatric Emergency Room, Ambulatory Area, Storage, Staff & Education Facilities,
Administrative Unit.
Entrance and Waiting
Separate entrances for ambulance and pedestrian patients will provide the requisite degree of physical and visual separation.
The pedestrian entry will be via the hospital main entrance and will access directly to Triage, Clerical Reception & Main Waiting area. The ambulance entry, via Triage, will have direct access to the Resuscitation, Emergency Room and Paediatric Areas.
Waiting Areas
Separate waiting areas will be provided for adults and children.
Adult
The adult waiting area will be located at the pedestrian entrance to the Department under the supervision of the triage and reception staff thus contributing to the safety of patients.
Public amenities will be adjacent to the waiting area.
Television will be provided within the waiting room.
Paediatric
A waiting area will be provided for children and their parents with access to baby change and feeding facilities, and play area.
New area (continued)
Clerical/Administration
Main Reception
The main patient reception will be located at the ambulant patient entry, adjacent and linked to Triage.
Staff Bases
There will be two Staff Bases; located in the main Emergency Room. One will act as the central control base for the whole department. The other is provided for the paediatric area.
The main Staff Base will be equipped with central monitoring, and Xray storage and viewing will be located close by. Each base will be located and designed to achieve maximum observation over the beds and facilities which each serves.
Facilities for staff write-up functions will be incorporated into the staff stations, Resuscitation Bays and in each cubicle and special function rooms.
Staff Office Area
Office accommodation will be a mix of single and 4 person rooms with open plan workstations. Occupants will include medical, nursing, allied health & clerical staff. Generally offices will be designed as a “Suite” and located away from main clinical areas.
Ambulance Communications Room
This is an office for 2-3 persons, usually ambulance personnel which will serve as the communications base in disaster situations. It will be located adjacent to the ambulance entrance bay.
Assessment/Resuscitation/Examination/Treatment Facilities
Triage
The Triage Office will be designed and located to give maximum observation over ambulance and ambulant entrances and the Waiting Room. There will be an internal links between Triage, Clerical Reception and the Ambulance Entry. These links will also act as an “escape” route if necessary.
Principal Clinical Areas
The accommodation of the facility will be grouped into Clinical Areas around central workstations:
New Areas (continued)
Principal Clinical Areas
Adult Emergency Room
Paediatric Area comprising
Ambulatory Area comprising
Medical Imaging Room
Non-Clinical Areas comprising
Waiting Room
Administration Area/Offices
Education Area
Storage Rooms
Adult (Main) Emergency Room
Patients who are seriously ill or injured but who do not require resuscitation will access the Emergency Room from triage.
The Emergency Room will comprise: 3 Resuscitation bays, 2 multipurpose rooms and 27 examination/treatment bays as follows:
- 8 Acute
- 9 Semi Acute
- 8 Paediatric treatment bays
- 2 Multipurpose rooms with ensuite
- 2 Multipurpose procedure rooms
Resuscitation Bays
All patients requiring resuscitation will be treated in a Resuscitation Bay.
There will be 3 resuscitation bays, identically equipped for both adult and paediatric patients. The Resuscitation Bays will be directly accessible from the ambulance entrance. They will form part of the main Emergency Room, close to the Staff WorkStation, and observable from the main staff station.
Following resuscitation, patients may be moved to either:
-Emergency Room
-Paediatric Emergency Room
-Other Hospital Units:
-Operating Suite
-Intensive Care Unit
-Coronary Care Unit
-General inpatient units
- Other Hospitals
A proportion of patients will access other diagnostic units of the Hospital.
The Radiology Suite will be accessible from the Adult & Paediatric Areas.
New Areas(continued)
Resuscitation Bays
During the course of their stay, patients may access the Medical Imaging Room, the Procedure Rooms and/or the Plaster Room. These facilities will be located within the department.
The Paediatric Procedure Room will be located in the Paediatric Area.
The Plaster Room will be accessible from both the Adult & Paediatric Areas.
Unisex assist shower/toilets will be located to serve the Emergency Room.
Interview rooms and rooms for distressed relatives will be accessible from both adult and paediatric areas.
Ambulatory Area
Low acuity ambulant patients requiring examination and treatment will be triaged to the Ambulatory Care Area via the main Waiting Area as necessary. Staff will collect the patient from the Waiting Room
This area will comprise
- 4 exam/treatment cubicles (one of which will be designated as ENT/Eye room)
- Plaster room (2 bays)
- Procedure Room
The Plaster Room (2 bays) will include a storage area for crutches, walking sticks etc.
A unisex assist shower/toilets will be located to serve the Adult Ambulatory area.
Interview & Distressed Relatives Rooms
Interview rooms will be provided in the Paediatric Area and the Emergency Room.
A room for distressed relatives will be located near Resuscitation and close to Triage. This room will also be available for interview purposes.
Paediatric Emergency Room
This area will comprise:
8 beds (of which 2 will be isolation beds)
Paediatric Procedure Room
Play area
Child protection services will be provided in one of the Single/Interview Rooms in the Paediatric Emergency Area.
Medical Imaging Facilities
Radiology facilities will be located within to the Emergency Department.
Waiting Room and Amenities
Public toilets (male, female and disabled) will be provided off the main waiting room.
The waiting room will have children’s play area. The play area will be off the Paediatric Waiting area so that parents and staff have supervision over children.
New Areas(continued)
Parents Room
This room will be located close to the Waiting area to allow parents to feed infants in private and will have the capacity to take strollers/prams.
Staff Amenities
Staff Lounge
This area will be located away from the clinical areas
Staff showers and toilets should be adjacent to the staff lounge
Staff toilets
Staff toilets will be located near: -
Reception/triage area
Staff lounge area
Staff Office area
Disposal Facilities
Clinical Hand-Wash Bays will be provided at a ratio of 1 to 4 bed spaces
Dirty Utility Rooms
Two Dirty Utility Rooms will be provided for the Emergency Room and a third located in the Ambulatory Area.
Disposal Room
There will be a Disposal Room for the temporary holding of full soiled linen bags and waste prior to collection.
Storage Facilities
Trolleys
Spare trolleys will be located in a storage area within the department.
Equipment
A central store will house new equipment, and will include a section for equipment not in regular use or awaiting repair/ service.
Clinical Trolleys
Clinical trolleys in regular use will be stored in bays in the Adult & Paediatric Areas of the Emergency Room, and in the Ambulatory area.
Disaster Store
The Disaster Store will be located within the Entrance/ Reception/Triage Suite near the ambulance entry.
New Areas(continued)
Storage Facilities (Continued)
Linen
Clean linen will be stored on trolleys in bays in the Adult Emergency Room, Paediatric and Ambulatory areas.
Staff Property
Lockers will be provided for staff belongings and will be centrally located.
Teaching Facilities
A Tutorial Room will be provided for staff tutorials and meetings. The room should accommodate 15-20 persons. Facilities for teleconferencing will be included.
2.Patient Flows
ADMISSION POLICIES
Whilst admitted patients remain in the Department pending ward bed availability their ongoing care remains the Department's responsibility. However, the admitting team is responsible for their ongoing medical management. The Emergency department staff will manage emergency situations as required pending attendance by the admitting team.
THE TARGET IS TO ADMIT TO A WARD BED WITHIN 2 HOURS OF THE DECISION TO ADMIT.
Upon a decision to admit a patient the Emergency Department staff will complete the "Admission Screen" in the Emergency Department Information System.
The John Hunter Hospital Bed Manager (or After Hours Nurse Manager) is responsible for locating an appropriate inpatient bed. The Division of Emergency Medicine has an Emergency Medicine Unit (located on ward K3) which may be able to accommodate the patient until an appropriate inpatient bed is available. If there are significant delays in finding inpatient beds the Bed Manager will contact the Chairperson and Director of Nursing of the relevant Division.
EMERGENCY DEPARTMENT ADMISSIONS
Patients may be admitted under the care of the Staff Specialist Emergency Medicine. Currently these are patients requiring to remain over night for further investigations or observation with the reasonable expectation of discharge in 24 hours
DISCHARGE PROTOCOLS
Any patients not admitted who require ongoing care or review must be given a discharge letter for their local doctor.
Patients and their relatives must be given instructions regarding diagnosis, management to date, follow-up arrangements and alternative options for seeking care
Patient Flows (continued)
DISCHARGE PROTOCOLS
should the condition exacerbate. This may be a return to the Emergency Department if no other alternative exists.
No patient should be discharged prior to appropriate arrangements being made for their ongoing care and safety. Special services are available for patients who meet specific criteria; e.g. Emergency to Community Program, Customer Coach Service or the Post Acute Care Program. Special consideration must be given when discharging elderly patients at night
Follow-Up Arrangements
Patients should attend their own GP or outpatient clinics for follow up care. In certain circumstances it may be appropriate to advise patients to represent to the Emergency Department for further review. If patients are recalled for review they should be seen as soon as possible.
Evaluation Procedures
The Emergency Department utilises a Quality Management Framework. This involves the assessment, planning, implementation, and evaluation of systems, services and practices within the Division of Emergency Medicine to ensure safe practices and optimal outcomes of emergency service provision. This includes participation in Australian Council on Health Care Standards (ACHS) and Department of Health (DOH) Clinical Indicator Programs.
Clinical Services
Patients presenting to the Emergency Department may require the services of the following clinical specialties:
- Emergency Medicine
- Trauma
- Medicine
- Surgery
- Obstetrics
- Gynaecology
- Paediatrics
- Nursing
- Radiology
- Pathology
- Psychiatry
- Allied Health: Social Work, Physiotherapy, Aboriginal Liaison Officer,
Interpreter Service
Pharmacy
Pastoral Care
Patient Flows (continued)
Medical and Nursing Services
Medical and nursing services will be provided by full time specialist staff and trainees in the requisite disciplines.
Obstetric & Gynaecological Emergencies
Obstetric patients will be treated in the Department or transferred to Delivery Suite as appropriate
Paediatric Services
The Paediatric section of the Emergency Department will be managed as an integrated element of the Department under the overall direction of the ED Medical Director.
Nursing staff will have the necessary paediatric qualifications or experience and will be assigned to the Paediatric Emergency Room on a rotational basis.
The Paediatric facility will include a waiting and child play area and amenities for infant changing and feeding.
Children will be assessed by the Triage Nurse using the National Triage Scale and then directed to the appropriate area or waiting room. Resuscitation bays will be designed and equipped for either adults or children.
The Department will form the necessary links with such organisations as the Sudden Infant Death Association (SIDA) to ensure that physical and emotional needs of parents are met.
Sexual Assault Services
Facilities will be provided for adult and paediatric sexual assault cases for assessment, examination and counselling under the auspices of the Area-wide Sexual Assault Services.
Facilities required by the Service comprise an examination room with en suite, ready access to an interview room for counselling, and space for the storage of forensic materials, clothing etc. The facilities will be located within easy access of the main Waiting Room without having to pass through other treatment areas.
Design will not preclude use of these facilities for other purposes.
Ophthalmology & Ent
One consulting/examination room will be equipped for ENT and ophthalmic examinations. Design will not preclude its use for other purposes and it may be used for adults or children.
Disturbed Patients
There will be a purpose-built room for the management of seriously disturbed patients. The room will be designed to ensure the safety of both patients and staff members, by the use of a discrete storage system for equipment, and documentation etc. The entrance door will have one-way glass and security system.
Design will not preclude use of these facilities for other purposes.
Patient Flows (continued)
Deaths in Department
Deaths within the Department may be Coroner's cases. The exceptions are when Emergency treating staff or the patient's usual doctor is able to issue a certificate of cause of death.
Following death patients will be accommodated in the designated viewing room. This room will provide a private environment for the patient's family and for coronial identification.
Special attention will be paid to the needs of parents with a sudden infant death.
Medical & Nursing "Hand-Over"
Shift-to-shift hand-over will take place at the Staff WorkStation.
Pathology Services
The Hunter Area Pathology Service will provide pathology Services.
A vacuum tube system will be used for specimen transport. In the event of tube system failure the Emergency Department wardspersons will transport the specimen.
Blood bank services will be available round the clock.
Medical Imaging Services
A general x-ray room will be built within the Emergency Department. A mobile x-ray unit will be located adjacent to the resuscitation rooms.
An Image Intensifier will be located in the Plaster Room.
Nuclear Medicine and other specialised radiological services will be provided under existing arrangements.
Social Work Services
There will be one Social Worker rostered to the Department full time. After hours, on call services will be available.
Physiotherapy Services
Physiotherapy services will be provided as required.
Interpreter Services
Interpreter services will be provided by the NSW interpreter service. Non-English speaking peoples who access the Department will also be supported by the
provision of multi-lingual health information pamphlets in the waiting area, and sign posting in the international language symbols.
Pastoral Care Services
Pastoral Care Services will be available on a 24 hour on call basis