Emergency Unit Management: a guide to better practice

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Emergency Unit Management a guide to better
practice

• Basil Bonner
• Head
• Emergency Unit
• Milnerton Medi-Clinic

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Careful balance

• Benefits and opportunities of providing effective
  emergency care
• Enhance hospitals image

• Emergency department viewed as a source of
  problems in hospital operation

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Scope of EU management

• Complex interplay of factors pertaining to the
  productive functioning of the Emergency Unit
• Operational
• Financial -assets , stocks, expenses
• Staffing and interpersonal issues
• Clinical and client focus

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Operational issues

• Chain of command relationship between hospital
  administration and medical staff
• System of Unit Management
• nursing Unit manager and Clinical Head /
  director
• Clinical environment consultative,
  diagnostic/therapeutic and procedural

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Operational issues cont..

• Administrative functions related to patient
  registration and interaction
• Access to other related clinical and non clinical
  services
• Disaster plan ready
• Relationship with EMS and disaster planning
• General management function - POLC

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Financial management

• Volumes vs. staffing
• Billing and re imbursement
• Debt management and financial reports
• Monthly assessments of all aspects of business
• Budgets - heads / capital / smalls

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Asset management

• Stock
• Capital items and equipment
• Smalls lt R300
• Furniture

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Staffing issues

• Choosing right mix and balance
• Getting the numbers right
• Nursing /medical /admin /support services
• Back up and on call / standby
• Communication network

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Human resources

• Staffing expectations
• Professional / Career
• personal
• Participative management
• Contracts
• Hours / leave / other

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Personal development Training

• Personal development plans
• Liaison with training dept.
• Performance appraisal
• Training budget
• Maintain professional standards , encourage
  growth
• Library and IT access / look up

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Clinical management

• Clinical governance
• Medico-legal considerations
• Risk management
• Ethical
• Quality improvement

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Clinical Governance defined

• framework through which organisations are
  accountably improving the quality of their
  services, and creating an environment in which
  excellence in clinical care can occur
• Scally, G. BMJ 4 july 1998

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Clinical governance Key Issues

• Clinical audits and critical outcome reviews
• Risk assessment review and strategy
• Communication strategy
• Client service and experience
• Personnel development
• Data acquisition
• Research and education

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Medico-legal issues

• EU lends itself to possibilities for liability
  risk
• Risk management strategy required to minimise
  risk
• Knowledge of patients and staff rights very
  important

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Risk management

• Documentation standards
• Regular review of patterns in EU
• Drug register audits
• Identification and Review of all potential risks
• Financial
• Ethical / moral
• Attitudes
• Clinical standards

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Risks

• IH transfers stability of patients.
• Substance abuse
• Long/excessive duty shifts
• Telephonic advice
• Written admission orders
• Shift change over times
• Multi-trauma / complex medical problems
• Refuse Hospital Treatment / Against Medical
  Advice
• Poor record keeping
• Patient who presents twice in 24 hours

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Strategies for risk management

• Document all incidents
• Maintain good communication
• Use specialists appropriately and judiciously
• Provide adequate staff cover docs and nurses
• Prescribe carefully
• Allow time for patients questions
• Code accurately
• Mortality reviews
• Discrepancy reviews of X rays / ECG s..

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Quality cycle
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Research and Development

• Essential component of clinical governance
• Reviews and audits
• Original research (ethics approval)
• Participative studies and trials

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Clinical standards

• Must set norms and standards for
• Practice
• Policy and procedures
• Clinical guidelines
• Communication
• Appropriate and professional Referrals
• Updates/training

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Policy and Procedures

• Operational plan to meet local needs
• Staffing and organising emergency system
  responses
• Integration with other depts. In hospital
• Ongoing education for all personnel
• Admissions register
• Quality assurance control.

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Client service

• Create forum for client service feedback
• Everyones responsibility!
• Review of patient opinion surveys
• Answering calls and complaints
• Complaints register
• Link to medicolegal assistance / advice

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Ethics and emergency medicine

• Each decision must be made for the individual,
  with compassion, based on ethical principles and
  available scientific information
• Principles must prevail of
• autonomy
• beneficence
• non malevolence
• justice
• Patients bill of rights

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summary

• EU management must
• Provide a place where patients can feel wanted
  and cared for
• Provide high quality emergency patient care
• Attract and maintain personnel with necessary
  skills and attitudes
• Support a vision that sets sights at ever
  increasing standards of service delivery .