Emergency Unit Management: a guide to better practice Basil Bonner Head: Emergency Unit Milnerton Medi-Clinic

Careful balance Benefits and opportunities of providing effective emergency care Enhance hospital’s image Emergency department viewed as a source of problems in hospital operation

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

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

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

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

Asset management Stock Capital items and equipment Smalls < R300 Furniture

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

Human resources Staffing expectations –Professional / Career –personal Participative management Contracts Hours / leave / other

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

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

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

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

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

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

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

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 patient’s questions Code accurately Mortality reviews Discrepancy reviews of X rays / ECG’ s……..

Quality cycle

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

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

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.

Client service Create forum for client service feedback Everyone’s responsibility! Review of patient opinion surveys Answering calls and complaints Complaints register Link to medico–legal assistance / advice

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

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.