DR TAHA K. IBRAHIM MD, FRCS, CABS

CONSULTANT TRAUMA SURGEON

DIRECTOR AE DEPT

ALAIN HOSPITAL

General coordinator

Iso project

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issue date  01 March 2003	Issue Number 01
Quality Manual for AE department Quality Management System
Prepared and Reviewed By		1st March 2003
Approved By		1st March 2003

 

 

 

 

 

 

 

 

 

 

Amendment Page

No	Nature of Changes	Page Number	Issue No

 

 

 

 

 

 

 

 

Contents Page

Content	Page Number
Medical Staffing
Mission
Facilities
Access
Process
Emergency Trauma Consultation
Emergency Trauma Response Criteria
Screening & Stabilization
Role of Medical Professionals
Admission Policy to Observation Ward
C M E
Job Description
AE Records
Organization chart
Vision
Values

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A/E dept. in Al-Ain Hospital is considered one of the busiest clinical departments with daily attendance of large number of different kind of patients. There are a lot of promotions in the quality of services achieved in A/E over the last two year, the department capacity increased from 17 beds to 32 beds distributed into different areas with different clinical services. The department has the following setup:

 

 

 

 

ACCIDENT AND EMERGENCY STAFF

Consultant and Head of the Department

Specialists

GP’s

Doctors On-call

Supervising Nurse

Charge Nurse

Staff Nurse

Nursing Aids

Paramedics

Policemen

 

 

MISSION

The mission of Accident and Emergency Department is to provide emergency care for wide range medical and surgical conditions and we thrive to provide the best and most up-to-date service possible in the region.

 

The Ministry of Health is planning to upgrade Accident and Emergency Department by:

1.    Dedicating more physical space for patient care.

2.    Upgrading and completing emergency room facility and equipment.

3.    Updating physicians through providing related CME programs and ATLS courses.

4.    Increasing the work force of A&E Department for better service and patient flow.

5.    Providing treatment guidelines for each medical and surgical emergency condition with co-ordination of related medical specialty according to the common practice in the hospital and UAE.

 

 

 

 

 

 

FACILITY AVAILABLE IN ACCIDENT AND EMERGENCY DEPARTMENT

WALK-IN EXAMINATION ROOM

For minor cold cases equipped with stretcher and for examination of patients.

 

 

OB and GYNAE CONSULTATION ROOM

Equipped with beds, trolleys, and necessary facilities for gynecologic examinations and emergency vaginal delivery, incubator for premature infants, and a special NICU bed for sick baby resuscitation and monitoring.

 

 

EMERGENCY & RESUSCITATION ROOM

A room equipped with bed-stretchers (can be increased to four), anaesthesia units in each bedside, ECG machines, four monitoring devices, defibrillators fully equipped resuscitation trolleys with in-site facility of endotracheal intubations, tracheotomy, thoracic incubation, central line insertion, and in-site closed and semi-open peritoneal lavage, and POP application equipment.  This room is also equipped with these portable equipment (ventilator - two units, suctions, and monitoring devices for transport of severely ill patients to ICU or other facilities.

 

 

SURGICAL ROOM

One room furnished with bed-stretchers and necessary medical equipment instruments for minor surgical operations, suturing, cut-down, abscess drainage, management of minor and major burn cases and application of dressing.

 

 

EXAMINATION BAYS

Individual cubicles, each of them equipped with necessary range of instruments and venisection trays, IV fluid administration facility, Nebulizer facility, wall mounted oxygen supply, and operation wall lamps for minor bedside procedures in each bay.

 

 

 

 

PLASTER OF PARIS (POP) APPLICATION ROOM

POP application with full facility of POP application material for orthopedic emergency purposes.

 

 

 

A/E RADIOLOGY ROOM

A/E radiology room is installed, equipped with portable and mounted machines and capable of taking extremities and potable Chest X-rays.

 

A/E CT SCANNING ROOM

This machine is available for emergency brain CT scanning of head trauma and CVA patients.

 

A/E STAFF’S ROOM

Room with bed and adjoining bathroom for night duty A&E officer.

 

TRANSPORTATION FACILITY

Ambulances fully equipped with necessary instrument of in-site stabilization and resuscitation of emergency situation.  A helipad in vicinity of Emergency Department for rapid transfer of patients to and from hospital.

 

ACCESS

The patient access the Accident/Emergency Department by:

1.    Referrals from MOH primary health care clinics of private clinics if they need further follow-up or cannot be managed there.

2.    Police ambulances bring acute patients that are involved in accident.

 

3.    Acute patients may attend without reference and accepted for treatment all over the day.

4.    Referral from other hospital and usually these patients are for referral for admission to other wards.

 

The conditions required from patients in order to have access:

1.    Administrative requirements, e.g., health card and legal residence in the country.

2.    Referral letter in some cases.

 

 

PROCESS

Once the patient has attended the Accident/Emergency Department, he/she is triaged by the reception nurse into:

1.    Routine cold case

2.    Early attention (Emergency)

3.    Urgent

4.    Received dead

 

The urgent cases are taken immediately to the Resuscitation Room, where different procedures are started and doctors from different subspecialties are called.

 

If there is no urgent cases, the usual waiting time for “early attention” patient is less than fifteen minutes.  The waiting time for routine cold cases depends on how busy the Accident/Emergency Department, and the time of the day, but as a general rule they are served ASAP.

 

The Accident/Emergency Doctor assesses fresh referrals if urgent and the concerned subspecialty is called and if the case is stable, he is referred to the concerned department.

 

 

EMERGENCY / TRAUMA CONSULTATION

Trauma patients meeting the following criteria will be considered emergency.  First On-call Trauma Resident should be present in the Resuscitation area within five minutes.  An emergency trauma consultation should be sought as soon as notification or their status is received from the field of upon arrival in the A/E Department, if they arrive without notice.  It is absolutely essential that the time of response and the seniority of the resident be recorded.

 

 

Emergency Criteria

1.    GGS 12 (excluding clearly isolated head trauma) in isolated head injuries.

2.    GCS 12 or localizing signs the neurosurgeon should be notified immediately.

3.    Initial hematocrit 30 or dropping >5%.

4.    Previously stable vital signs deteriorating to the levels noted above.

5.    Initial chest tube output of >300cc of blood or persistent significant output.

 

6.    Clinical evidence of fail chest.

7.    Perceived indication for emergency diagnostic peritoneal lavage.

8.    Clinical evidence or suspicion of cardiac injury or pericardial tamponade.

9.    Vascular injuries resulting in impaired circulation to an extremity or significant hemorrhage.

10.At the discretion of the A/E Physician.

11.Penetrating injuries of the head (active neurosurgery team).

 

Note:  If BP 90, P>120, RR 10>29, unresponsive to pain the whole Trauma team should be activated via the beeper system.

 

 

Urgent Trauma Response Criteria

Trauma patients not meeting Emergency criteria but meeting the following criteria will be considered Urgent, and the First On-call, or the appropriate First On-call Specialty Doctor will proceed to the A/E within 30 minutes of notification.

 

1.    Clinical evidence or suspicion of penetrating abdominal injury.

2.    Pneumothorax with persistent air leak.

3.    Evidence of gastrointestinal bleeding secondary to trauma.

4.    Penetrating injury in proximity to major vessel.

5.    Two or more proximal long bone fractures.

6.    Pelvic ring fractures with displacement.

7.    Gross hematuria.

8.    Paralysis of a limb.

9.    Discretion of the senior A/E Physician.

 

 

SCREENING AND STABILIZING THE PATIENT IN A/E DEPARTMENT

The main function of Accident & Emergency Department is to screen the patients who need immediate care, sorting-out after the preliminary examination and/or investigation, planned transfer to wards, immediate transfer to wards or operation theatre or admitting the patient to observation wards.  Immediate care also means resuscitation.

 

This means giving the patient immediate care, stabilize the patient so that she/he can be transferred by RMO/Consultant to the ward or other hospital

 

DISEASE PROTOCOL

To follow the disease protocol as outlined by various departments of hospital when providing emergency care.

 

 

ROLE OF MEDICAL PROFESSION IN A/E DEPARTMENT

All the patients presenting to A/E are screened by way of history taking where appropriate physical examination, eliciting relevant signs, ordering relevant investigations are necessary to rule out impending emergency situations and other serious conditions.

1.    The patient who needs expert opinions from other specialties are sorted-out and the first on-call doctors are called to these cases;

2.    Cardiopulmonary resuscitation given to serious cases when needed;

3.    The doctor will decide whether the patients needs treatment in A/E, or for referral to other departments;

4.    Doctor carries out all the procedures such as reading ECG reports, putting the patient on the NIBP Monitor and administers, splinting of fractures, catheterization, incision and drainage of abscess, suturing of wounds.

5.    The A&E doctor may require to examine patients for medico legal purposes when patient is brought in by police and issue the subsequently relevant medical report.

 

 

DOCUMENTS OF NOTES

It is the duty of the A/E doctor to maintain proper record of examination, procedures, and treatment given, and way of disposing the patients with time and date sequence in ER form.

 

 

POLICY OF ADMISSION TO OBSERVATION WARD

Accident and Emergency doctor is in-charge of this ward. He/She has the right to admit patients to this ward.

 

 

 

 

CME PROGRAMME (Continues Medical Education)

There is on-going CME programme with the help of other specialities following yearly programmed, and the following departments are involved:

1.    Cardiac Emergency

2.    Neurological Emergency

3.    Road Traffic Accident

4.    Ortho-Emergencies

5.    Eye Emergencies

6.    ENT Emergencies

7.    Dental Emergencies

8.    Neurosurgical Emergencies

9.    Medical Emergencies

10.Surgical Emergencies

11.Dermatological Emergencies

 

These meetings are being held in the Accident and Emergency Department and coordinated by staff of other departments to teach the practical aspects of some problems.

 

 

AUDIT AND QUALITY ASSURANCE

There is plan to set-up monthly audit and quality assurance programs at the A/E Department.

 

 

 

 

 

 

 

 

 

 

 

 

JOB DESCRIPTION

 

Head of the Department

1. Control and coordinate administratively the function of the units in the department.
2. Enforce discipline and generally improve the efficiency of the whole department.
3. Prepare the duty Rota for all the units in the department and submit the same to the administration well in advance.
4. Bring notice of the administration any matters of indiscipline, insubordination, negligence and other matters affecting the efficiency of the department.
5.  Inform the administration of the need for additional equipment and repair of existing equipment.
6. Organize and conduct departmental meetings for academic advancement and continuing education of the staff.
7. Control and supervise the leave/vacation of the staff so that adequate numbers are left with department at all times.

 

Educational Qualification

FRCS, MD, MS, Arab Board

 

Training and Experience

Should have worked in Medicine, Surgery, Pediatric, and Orthopedic in busy, acute hospital.

 

Performance Required

1.    To work as a team in different shift.

2.    To be able to give emergency care to all the emergencies in Medical & Surgical sub-specialties.

3.    Should have broad medical and surgical knowledge.

4.    Able to keep good relationship with nursing and medical staff.

5.    Able to work long and unsociable hours in stressful circumstances.

6.    Should have good communication skill to deal with public, police, relatives, and patients.

7.    Required making instant decision on medical, social, and psychological problems.

 

 

 

Consultants

1. Administratively and professionally in-charge of the team of doctors working in his unit.
2. Organize and arrange the work in the unit in order to deliver the best possible patient care.
3. Help in the training and advancement of the professional skills of the staff working with him.
4. Assess the professional competence of the doctors in his unit and delegate work and responsibility to them according to their levels of competence.
5. To be available for advice and to perform procedures considered being major or critical beyond the competence of the juniors.
6.  Exercises control and maintain discipline in the level.
7. Control and guide the treatment being given to patients in the OPD and Wards.
8. Observe that harmonious relations are maintained among members of his unit.

 

 

Specialist

1. Working under the direct control of the consultant and perform any duty assigned to him by the consultant.
2. In-charge of certain number of beds and be answerable to the consultant in their management.
3.  Perform operations/procedures, etc. according to his/her experience and take the guidance of the consultant whenever necessary.
4.  Inform the consultant about all decisions on critical matters as early as possible and obtain his approval.
5.  Supervise the work of GP's closely and train them in all aspects of patient care.
6. Supervise the files and see that all information is correctly entered and that no important details are omitted.
7. To do emergency duties from 8:00 AM to 8:00AM (24 hours) according to the Rota prepared by the head of the department.
8. Actively participate in all the academic activities of the unit and the department.
9.  Perform any other professional duties or related matters as determined by the consultant.

 

 

General Practitioner - (GP's)

1. Clerk the patient as soon as he/she is admitted,
2. Make a diagnosis/differential diagnosis and order all relevant investigations.
3. Give I.V. injections under adequate precautions.
4. To start blood transfusion and I.V. infusions except in emergencies, when other doctors are not available for help.
5.  Do daily rounds with the specialist and write day to day progress and treatment in the files.
6. Carry out all the instructions given by the seniors expeditiously and efficiently.
7. Consult the seniors in all important matters and act according to their advice.
8. Perform such minor operations/procedures assigned to him by the consultant or specialist.
9. Actively participate and assist in all the academic activities of the department.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lead the evolution and promotion of the emergency medical services in ALAIN   in a way to assure safe and perfect care for all patients attending emergency department.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• Save life is our main value in emergency.
• Ensure safe environment for the patients and the emergency medical staff.
• Ensure delivery of care for all those who need it irrespective to their race, nationality and religion.
• Ensure privacy and safety of patients.
• Ensure high job satisfaction for doctors and staff.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 AE Organization Chart

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Terminology.
2. AE Records.
3. AE Dept guidelines and polices.

1.     International standards

2.     The vision of AE dept.

3.     The mission

4.     the vision

5.     The values.

6.     Department Targets.

7.     AE department principals.

8.     AE Strategic Plan.

9.     AE Executive plan.

10. AE Organization chart.

11. AE dept committees.

12. Information Exchange system.

13. Internal communication system.

14. Regular Meeting System.

15. Manpower management.

·        Employee Evaluation System.

·        Employee Training programs.

·        Employee Activation System.

16. Patients Affairs

17. AE dept performance indicators.

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According to the Memo from Medical Director on April 2001 & in referral to the Memo by Head of AE dept on April 2001, It has been decided to establish Quality assurance committee in AE department under direct responsibility of Dr Taha K. Ibrahim consultant Trauma surgeon, Deputy Director of AE department .It has been decided that its role and responsibilities as follows:

 

A.    Putting Plans to ensure and maintain high standards of care in AE departments.

B.     Establish general policy in AE department.

C.     To establish and publish the standards and implementation of these standards.

D.    Documentation of all decisions, procedures and activities.

E.     Implementation of all Executive Procedures based on decisions and committees.

F.      Maintenance of Quality assurance system and continuous improvement in performance based on observation and checking according to international standards.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1)    Organization:  Emergency department in AlAin Hospital..

2)     Customers    :  Patient Attending ED.

3)    Suppliers      :   Doctors, Nurses &supportive staff in ED.

4)    Process         :

·        Patient Reception.

·        Triage, patient classification according to their priorities.

·        Patient care.

·        Patient Disposal. (Home, Ward, Theater, ICU, Mortuary).

           5) Product          :    

·        Maximum patient care.

·       Easy and proper flow of patients inside the department.

·        The lowest morbidity & mortality rate.

·        Maximum patient satisfaction.

·        Reasonable patient waiting time

 

 

 

 

 

 

 

 

 

 

AE department contain the following Records:

 

 

1. Doctors affairs.
2. Doctor’s assignment book.
3. Doctors annual leave plan.
4. Doctor’s communication book.
5. Department relation book.
6. Job Description files.
7. Circulars &Memos.
8. Employee affairs.
9. Quality assurance records.
10. Disaster record.
11. Primary health care records.
12. Statistics record.
13. Daily events record.
14. Incidents and complain.
15. .preventive medicine.
16. Public relation.
17. Plans and management records.
18. Guidelines and polices book.
19. Pending records.
20. Nursing affairs.
21. Safety and security records.
22. Nursing in charge report.
23. Medical Catalogue Book.
24. CME Book.
25. Training Book.
26. Patients Satisfaction Records.
27. Department Relation Book.
28. Red crescent Society activities.
29. Researches Records.
30. Minutes of Meetings.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Following guidelines and polices issued in AE department depending based on the data of American Academy of Emergency Medicine (class 1 evidenced based):

 

·        Administrative guidelines :

 

1.     Police Reporting.

2.     Dead Body Certification.

3.     Doctor’s duty in Trauma room.

4.     Doctor’s duty in resuscitation room.

5.     Doctor’s duty in triage.

6.     Doctor’s duty in cubicles.

7.     Guidelines for observation room.

8.     Guidelines for contact with on call doctors.

9.     Guidelines for incidents reporting.

10.  Doctors daily assignments.

11. Duties of Chief Resident.

12. Guidelines for senior in charge of shift.

13. Guidelines for medico legal cases...

14. Guidelines for Sick leave form filing.

                                         

·        Medical Guidelines :

 

1.      Guidelines for Asthmatic attack management.

2.      Guidelines for Acute Allergic Attack Management.

3.      Guidelines for Acute Myocardial infarction management.

4.      Guide lines for Angina attack management.

5.      Guidelines for Abdominal Pain management.

6.      Guidelines for Abdominal Trauma management.

7.      Guidelines for Airway Management.

8.      Guidelines for Bleeding per rectum management.

9.      Guidelines for Heamatemesis management.

10.  Guidelines for Heamoptysis management.

11.  Guidelines for Epistaxis management.

12.  Guidelines for head injury management.

13.  Guidelines for CT scanning in head injury.

14.  Guidelines for Cervical Spine X-ray Interpretation.

15.  Guidelines for Chest Trauma management.

16.  Guidelines for Head injury Observation.

17.  Guidelines for Foreign Body management.

18.  Guidelines for Wound management.

19.  Guidelines for poisoning management.

20.  Guidelines for Toxic Inhalation management.

21.  Guidelines for Dealing with patients with Sexual Assault.

22.  Guidelines for drug overdose management.

23.  Guidelines for Epileptic attack management.

24.  Guidelines for Fainting attack Management.

25.  Guidelines for renal Colic management.

26.  Guide lines for major burn management.

27.  Guidelines for minor Burn.

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 1	Issue No: 1
				Issue date ; 01/03/2003
Title: police Reporting
Prepared By : Dr Taha K.Ibrahim		Signature		Date
Approved by :		Signature		Date

 

 

 

 

 

 

To All Doctors in AE dept

 

SUBJECT: GUIDELINES FOR POLICE REPORT CERTIFICATION.

 

 

It is very important to know that proper filling of police report is mandatory; below you can find the guidelines to do that.

 

 

1. All police cases should be reported to police section in AE dept.
2. All police reports must be finished on the same day of accident.
3. Remember that initial police report is a descriptive one it needs you to describe the following points:

A.     Mechanism of injury.

B.      The date and time of injury.

C.     Sites of trauma.

D.     Extent of trauma .the length of the wound.

E.      Is there any fractures seen by X rays.

F.      The extent of burn if any.

G.     The seriousness of the injury.

H.     The disposition of patients (ward, home, ICU)

I.       What is the specialty to give the final report?

 

4. Don’t forget to finish your reports before going home.

 

 

1. All sudden death.
2. Gunshot wound.
3. Suicidal attempt.
4. Stab wounds.
5. Criminal abortion.
6. Instances where the patient given drugs without his or here knowledge.
7. Rape cases.
8. Drug addiction.
9. Assault cases.
10. Poisoning of suspicious nature including food.
11. All injures that occurred in public places.
12. Electric shock.
13. DOA (death on arrival) cases.
14. Alcoholism.
15. Exposure to explosions.
16. Drowning.
17. Burns.
18. Suspected child abuse.
19. Sexual heroism.

 

Points to remember:

1.       In case of suspicion contact police.

2.       Indicate that in AE sheet.

3.       Indicate the time of police contact.

4.       Don’t give conclusions in your report.

Always remember that police report is a testimony so try to be very precise in writing it.

Your kind cooperation is highly considered.

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 2	Issue No: 2
				Issue date ; 01/03/2003
Title: Dead certification Policy
Prepared By DrTaha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

Below the following guidelines for dead body certification:

 

·        General points:

1.     Dead body can be classified into three categories :

 

·        Dead person who died at home and brought by family for certification

      Persons who died in ED after unsuccessful resuscitation.

      Persons brought in dead from the scene of accident.

      Decomposed and mummified body.

 

2.     CERTIFICATION

 

1.     Those people who died in accidents or after unsuccessful resuscitation certified in ED.

2.     Those people who died at home can be certified by preventive medicine dept.

3.     Those dead decomposed body should be taken to mortuary for forensic medical certification.

4.     Those who died at home far away from the city can be certified by PHC doctors

 

3.     How to Certify?

 

·         Take the body to dead body room.

·         Doctors should be accompanied by nurse in charge.

·         Expose the body.

·         Look for any signs of trauma and violence.

·         Consider the following points before certification :

1.      Age of the patients.

2.      Any history of chronic disease.

3.      Any previous admissions.

4.      Ask for old file if necessary.

5.      Ask for any medication the patients used to take.

·         After the exam fill the following forms:

1.      Police report form.

2.      Death notification form.

3.      Emergency department form.

Note : you should write the following note (after examination no signs of trauma and the death APPERANTLY Looks Normal)

 

Hospital Alain	AE	QP or QI	Doc No. 3	Issue No: 3
				Issue date ; 01/03/2003
Title: doctors duty in Trauma room
Prepared By Dr Taha ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

The following policy will organize the work in trauma room.

1. Doctor in charge of trauma room is responsible about all cases attending the room during his shift.
2. Responsible about triaging patients in his area according their priority.
3. In case of sever injury will transfer the patients to trauma resuscitation area.
4. Will supervise junior doctors attending the room.
5. Will coordinate with the nurse in charge to assure availability of all sundries necessary for patients management.
6. Responsible to inform police about all police cases attending his area.
7. Will fill police report immediately and hand over it to police section if possible.

 

The following cases managed in trauma room.

 

1.      All minor trauma cases.

2.      Al moderate trauma cases with stable vital sings.

3.      All fully conscious patients.

4.      wounds, lacerations and bleeding.

5.      Contusions.

6.      Sprains.

7.      Simple fractures.

8.      Dislocations.

9.      Eye trauma.

10.  Nasal Trauma.

 

 

 

 

 

 

Process

Trauma Cases reception Triage nurse

 

 

 

 

 

Trauma Room     Trauma Resident

Conscious Normal Vital signs

                                                                                                                                                                                                                                                                                                                                                                                                                Yes                                                                                                                                                                                                                                                                                                               NO                                                       

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 4	Issue No: 4
				Issue date ; 01/03/2003
Title: Incident reporting
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

1. Type of Incident:

The following must be reported to head of department:

•  Death in the department.
•  VIP attendance.
• Mass causality incident (>than three victims).
• Doctors –nursing problems.
• Doctor-patients problem.
• Delay of on call response.
• Miss management of cases.
• All revisits with in 24 hour.
• Morbidity cases.
• Cases transferred to other hospitals.
•  Break down of any equipments.
• Damage in the buildings.
• Loss of instrument.
• Unavailability of vital sundry items or drug.
• Absence of doctors from the shift.
• Situations which need urgent solutions.
• Disaster.
1. Timing of report.

 

The following table will show the timing of incident reporting:

#	Type	Time	Report to whom
1	Death in the department.	Urgent	Head of department
2	VIP attendance.	Urgent	Head of department
3	Mass causality incident (>than three victims).	Urgent	Head of Department
4	Doctors –nursing problems.	2nd day	Head of department
5	Doctor-patients problem.	2nd day	Head of department
6	Delay of on call response.	Urgent	Shift in charge
7	Miss management of cases.	2nd day	Head of department
8	All revisits with in 24 hour.	2nd day	Head of department
9	Morbidity cases.	2nd day	Head of department
10	Cases transferred to other hospitals.	2nd day	Head of department
11	Break down of any equipments.	2nd day	Head of department
12	Damage in the buildings.	2nd day	Head of department
13	Loss of instrument.	2nd day	Head of department
14	Unavailability of vital sundry items or drug.	2nd day	Head of department
15	Absence of doctors from the shift.	Urgent	Chief resident
16	Situations, which need urgent solutions.	Urgent	Shift in charge

 

3. Procedure.

 

• when one of above incidents happened the doctors in the area will inform the shift incharg.
• Shift incharg will try to sort out the problem, he /she will be free to call administrator and nursing supervisor.
• Once the problem settled the incharg would inform head of department or his deputy by Telephone.
• Shift incharg will write detailed report to the head of the department.
• All necessary document must be included with the report.

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 5	Issue No: 5
				Issue date ; 01/03/2003
Title:
Prepared By : Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

1. Receive cases with priority one.
2. Start Resuscitation.
3. Activate codes.
4. Control all activities in his area.
5. Call on call doctors.
6. Control documentation.
7. Responsible about management procedures until the patient is taken by the specialty on call.
8. In case of more than one patient he can ask for nursing backup from nursing shift coordinator.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Process

 

 

 

 

 

 

 

 

Endorse Document

Activate Code

Initiate resuscitation

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 6	Issue No: 6
				Issue date ; 01/03/2003
Title:
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

1)   Unstable patients who need close monitoring will not go to observation area.

2)   Psychiatric patients are not allowed to be kept in observation

3)   All patients admitted to observation room requires a physician’s order with the A&E medical specialist’s and Head nurse’s approval and signature

4)   Patients admitted to the observation room will be limited to 12 hours.  After this period, a decision will be made by the attending physician to either admit the patient to the hospital or discharge the patient.

5)   Patients admitted to observation room will be under the case of a physician at all times and if the attending physician’s time is over, before he leaves the hospital, he has to endorse his case to incoming A&E medical specialist.

6)   If the patient’s condition deteriorates, the attending physician has to be notified immediately to reassess and to transfer the patient to emergent area.

 

Cases to be transferred to observation room are:

a)     Gastroenteritis

b)     High grade fever

c)      Allergies

d)     Bronchial Asthma

e)     Gastritis

f)      Scorpion string

g)     Heat exhaustion

h)     Renal Colic

i)       Constipation

 

 

 

1.     Criteria for admitting Head Injury Patient for Observation:

1.      Glasgow coma scale below 15

2.      Skull fracture

3.      Headache and vomiting

4.      Neurological signs

5.      Clinical signs of fracture base of skull

6.      H/O trauma with fits

7.      CSF leaks

8.      Suspected non accidental Injury

9.      Difficulty in assessing the patient (For example: alcohol intoxication, children with fever and convulsion)

10.  Patients with associated medical problems (For example: coagulation disorders, on anti coagulation treatment, senility, CVA, epilepsy, etc.,)

11.  Social conditions (For example: lack of responsible adult to observe the patient at home)

12.  Patients who need to be admitted but demanding for private room which is not available

13.  Patients with multiple trauma (For example: Head trauma with fractures, head trauma with multiple lacerations)

14.  Patients who are discharged home from A&E with head injury instructions and back to A&E with neurological problems.

15.  Patients who needs more than over night neurological observation or more than 12 hours observation.

 

 

 

Assessment room and Minor OR:

          Patients admitted to assessment room are those with minor injuries like abrasions, nail prick, contusion etc.  Patients with stabilized fractures have to be referred by the A&E resident to the orthopedic surgeon and the patient has to be transferred to the orthopedic room.

          In minor operating theater, there are referred cases that comes from assessment room with minor laceration for suturing or from orthopedic room for exploration or from male or female non-emergent areas for incision and drainage.  The A&E surgical specialist and the register will be held responsible for this area but for orthopedic cases, it is the orthopedic surgeon.

 

Note: Attached are the forms used in A&E department

 

Admission Policies in Non-Emergent area:

          Patients are assessed and triaged by the triage doctor and nurse patients will be directed to male or female non-emergent area.  The A&E resident will be notified by the attending nurse. Any referred cases for ENT, ophthalmologist or psychiatric on call, the attending doctor has to talk to the concerned doctor, so with the admissions.

 

Discharge policies in A&E department:

1.     Patients will be discharged per doctor’s order by the attending doctor

2.     Patients or relatives insisting on discharge prior to treatment ordered or before the arrival of laboratory reports has to sign the “Request for discharge against medical advise” form with the stamp and signature of the attending physician and the nurse

3.     The patients or relative refusing admission to other hospital units has to sign “Request for Discharge Against Medical Advise” form before discharge

4.     Suitable authorities will be notified before discharge if indicated by police or other Health departments

 

The following list indicated or must be reported to the police:

1.     Sudden Accident deaths, RTA’s

2.     Gunshot wounds

3.     Suicidal Attempts

4.     Stab wounds

5.     Violent death (suspicious, unusual circumstances)

6.     Criminal Abortion

7.     Instances where patient was given drug without his/her knowledge

8.     Rape case

9.     Drug Addiction

10. Assault

11. Poisoning of suspicious nature including food

12. All Injuries which have occurred in public places

13. All D.O.A’s are patient who died in A&E dept.

14. Electric Shock

15. Exposure, Explosion

16. Fire Arms

17. Gas Poisoning

18. Hanging strangulation

19. Suffocation, near drowning

20. Alcoholism

21. Fights

22. Sex offenses

23. Burns

24. Suspected child abuse

25. Death of person where attending physician cannot be found and have not been seen by a physician within one week before sudden death

 

A&E nurses will inform the policeman and he will fill-up the police paper.  The attending physician has to complete it with his signature and stamp all the copies.  The first two copies will be attached to the patient file and the 3^rd copy will be submitted to the policeman

ACTIVATING CODE

          The Accident & Emergency Department provides the means by which prompt application of cardiopulmonary resuscitative measures will be available to sustain life in victims of sudden, unexpected death caused by cardiac or respiratory arrest.

          A resuscitation care is located in the Resuscitation department for adults and pediatric patients as well.  In addition, resuscitation carts are available in trauma room, cardiac room, non-urgent area and observation area.

          The Al Ain Hospital plan for resuscitation is called “Cardiac Arrest”. The cardiac arrest bleep number is. Inform bleep station of nursing unit and room.  For example: “Cardiac arrest, A&E department, cardiac room”.

          Inherent in the Accident and Emergency Department plan for resuscitation will be continuous programs of staff education and training. Al Accident and Emergency department employees will be certified as a basic rescuer by American heart association standards and this plan will be undated every 2 years.

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 7	Issue No: 7
				Issue date ; 01/03/2003
Title: Triage Guidelines
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

 

 

 

 

PATIENT CLASSIFICATION:

PRIORITY 1 [EMERGENT]

          If there are Life threatening problems or cases. Patients should be immediately directed to emergent area like RTA’s, any H/O fall, trauma cases should be kept in trauma room, uncontrolled HTN, respiratory distress, drug overdose, near drowning etc. should be kept in resuscitation room and patients with pain in cardiac room

 

Example

1.     Respiratory distress

2.     Chest pain / Angina

3.     Uncontrolled or suspected sever bleeding

4.     Acute allergic reactions

5.     Major burns

6.     Poisoning / overdose

7.     Near drowning

8.     Unconscious

9.     Shock

10. Penetrating wounds (chest, abdomen, head)

11.  Complicated fractures (compound fracture, dislocated hip, tendon or nerve injuries)

12. Blunt trauma to chest, abdomen, and GI tract

13. Most multiple trauma

14. Sudden acute or suspicious (spontaneous pneumothorax), suspected ectopic pregnancies, ruptured aortic aneurysm)

15. Head trauma with LOC and loss of sensation

16. Amputations

 

PRIORITY II [NON URGENT AREA (MALE & FEMALE)]

Those conditions that are not life threatening if prompt intervention is begun

 

Examples:

1.     Minor burns

2.     Stabilized fractures

3.     Lacerations

4.     Abdominal pain

5.     Ambulatory back injuries

6.     Bronchial asthma

7.     Eye foreign body (non – penetrating)

8.     Sprains / strains

9.     Head trauma without LOC

 

PRIORITY III [NON URGENT AREA]

Those conditions, which are not life threatening at present and cause no potential harm to the individual and can wait

 

Examples:

1.     Influenza symptoms

2.     Diarrhea

3.     Possible GIT infections

4.     URTI

5.     Epistaxis

6.     Undescended testis

7.     Renal colic

8.     ENT cases

9.     Eye cases

10. Infectious diseases

11. Psychiatric cases

12. Mild bronchial asthma

13. Other medical conditions which need intervention and treatment

 

          The triage doctor and nurse will ascertain priority of care. Patient will be immediately triaged and admitted to the emergent area if they are suffering from acute problem. In each designated area like resuscitation room and cardiac room, a medical resident or a medical specialist has to attend the patient whereas in trauma room for any trauma cases or surgical cases, the A&E surgical specialist or registrar has to attend the patient.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 8	Issue No: 8
				Issue date ; 01/03/2003
Title:   Calling On call doctors
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

 

 

 

 

The following guideline must be followed:

1.     Write down time of referral.

2.     Write down clear provisional diagnosis.

3.     Write down your justification for referral.

4.     Inform clerk to page the on call doctor.

5.     Referral must be through direct doctor-to-doctor contact.

6.     Write down any notice given by on call doctors.

7.     If there is delay of on call doctors to reply or no response follow the following Rules:

·         Contact second on call.

·         If no response contact third on call.

·         If no response call nursing in charge and administrative officer in charge and inform them about the situation.

·         Call head of emergency and inform him about the situation.

·         Head of emergency will try to inform medical director about the situation.

·         Head of the department to which the cases is referred must be notified.

8.     If on call refused to come to see the patients the same previous rules must be applied.

9.     All cases of that type must be reported in written form to department head next day.

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 9	Issue No: 9
				Issue date ; 01/03/2003
Title:   Doctors assignment policy
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

                                                                                                                                                                                                                                                                                                                                                                                 

·         Duty assignment organized by head of department or his deputy daily morning include duty distribution between doctors to cover the following areas:

1.     Triage

2.     Trauma Room

3.     Resuscitation room.

4.     Cubicles.

5.     Observation room.

6.     Death certification.

7.     Incharg of the shift.

8.     On call consultant or specialist.

 

·   Any change in duty roster not allowed with out the knowledge of head of department or chief resident.

·   All problems in the shift must be monitored and solved by shift incharg.

·   Morning shift must be covered with three GP+ one specialist .

·   Afternoon time must be covered with three GPS.

·   Evening shift must be covered with three GPs+ one specialist at least.

·   Night shift must be covered with two GP +specialist on call.

·   Morning shift starts 7.30 am.

·   Afternoon shift start at 1.00 pm.

·   Evening shift starts at 6.00 pm.

·   Night shift will start at 11.00 pm.

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 10	Issue No: 10
				Issue date ; 01/03/2003
Title:   Chief resident Policy
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

                                                                                                                                                                                                                                                                                                         

The chief of residents chosen by Head of department to do the following jobs:

 

1. Responsible about monthly Duty Roster arrangements.
2. Responsible about annual leave plan arrangement to be submitted in January every year to the head of department for approval.
3. Responsible about changes in duty roster.
4. Submit to head of department the total working hours report for all doctors.
5. Responsible about leave application forms.
6. Participates in doctors evaluation.
7. This position will be submitted to change every year according to his performance.

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 11	Issue No: 11
				Issue date ; 01/03/2003
Title:       Senior Shift in charge policy
Prepared By :Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Senior in charge of shift will do the following duties:

1.      Guide and control all activities during his shift.

2.      Attend all resuscitation cases.

3.      Coordinate with nurse shift incharg and the administrator to solve any problem.

4.      Call specialist or consultant on call in case of :

·         VIP cases.

·         MCI (mass causality incident) > three victims.

·         Problems that cannot be sorted out.

5.      To be sure that all doctors are working in their areas.

6.      In case of delay of cases by on call doctors should call the second on call or third on call.

7.      In case of delay in patient admission, he should coordinate with nurse supervisor to clear ER from patients as soon as possible.

8.      In case of food poisoning, he must be sure that notification form sends immediately to PMD.

9.      Contact head of department in case that above problems is not solved.

10.  Report to head of department about all problem through doctors communication book.

 

Hospital Alain	AE	QP or QI	Doc No. 12	Issue No: 12
				Issue date ; 01/03/2003
Title:         Medico legal cases policy
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

The following Guide for medico legal cases

1.      Examine the patient with attendance of the police and nurse shift incharg.

2.      All details of history must be clearly documented in AE sheet.

3.      Any specimen must be taken from the patient after signing consent form or in special record.

4.      All specimens must be taken in the attendance of the police and nurse shift incharg & must be documented in special records with signature of them.

5.      All specimens must be clearly labeled with the patient label form.

6.      The details of the events must be clearly documented in the police report form.

7.      The police report form and the case record must be controlled and only given to the attending policeman after signature and given record number.

8.      be sure that the specimens taken are kept in a suitable test tubes and well protected from damage.

9.      For those cases with the need for opinion of other specialties this must be clearly referred to them and document this in police report and medcolegal records.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Alain	AE	QP or QI	Doc No. 13	Issue No: 13
				Issue date ; 01/03/2003
Title:   Sick leave policy
Prepared By Dr Taha Ibrahim		Signature		Date
Approved by		Signature		Date

 

 

 

 

 

 

 

 

 

Guidelines for Sick leave form filing.                                                                                                                                                      

 The following is policy, procedure & Guidelines for filling the Sick leave form :

 

1.      Write the name of the patient clearly or use patient label on Two copies.

2.      Write Patient AE number.

3.      Write the time of attendance and the time of discharge.

4.      Write the diagnosis clearly.

5.      Write the duration of the sick leave.

6.      Write the date of issue and the date of end of the sick leave.

7.      For police personals don’t give more than one day and refer to police clinic.

8.      For the staff give only one day and refer to staff clinic except in very sick patient refer him/ her to on call doctor.

9.      Give one copy to the patient to be stamped in the clerk station and second copy attached to patient sheet.

10.  All sick leaves must be documented on AU paper that the patient was give sick leave.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List of performance indicators

 

ID No.	Loc	Description/title	D.code	Report
1	ER	Total number of registered visit /24 hours		Monthly/annually.
2	ER	The number of patients who register but leave before care completed.
3	ER	The number of patients admitted directly for inpatient care from outpatient service location.
4	ER	Number of patients transferred to other hospitals in UAE.
5	ER	Total register outpatient death/24 hour
6	ER	Total registered death on arrival (DOA) to ER
7	ER	Mean waiting time for patients.
8	ER	Total number of patients with second visit with in 24 hours
9	ER	Total number of patients admitted after being discharged from ER
10	ER	Total number of patients sent for investigation /24 hour registered number.

 

 

 

 

 

 

 

 

 

 

 

 

We communicate in ED through the following ways:

1.      Doctors communication book.

2.      Regular meetings.

3.      Memorandums.

4.      Emails and messages.

5.      Direct letters.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Process index

 

#	Process name	Responsibility
1	Police Reporting.	Receiving doctors
2	Dead Body Certification.	Resuscitation room incharg
3	Doctor’s duty in Trauma room.	Trauma resident
4	Doctor’s duty in resuscitation room.	Resus room incharg
5	Doctor’s duty in triage.	Triage Doctor
6	Doctor’s duty in cubicles.	ER physician
7	Observation room.	ER physician
8	Contact with on call doctors.	ER physician
9	Incidents reporting.	ER physician
10	Doctors daily assignments.	Head of the department
11	Duties of Chief Resident.	Head of the department
12	Senior in charge of shift.	ER physician
13	Medico legal cases...	ER physician
14	Sick leave form filing.	ER physician

 

 

 

 

 

 

 

 

 

 

 

 

 

Process flow chart

 

Police Reporting.