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Objectives of patients flow map
For easy identification of life and limb-threatening condition For smooth flow of patients To prevent unnecessary overcrowding Control non emergency case Proper quality auditing Research purposes
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What we need for proper patient flow
Good ED design Well equipped different sections Well trained staff Systems guidelines and policies Good administrative support Follow up and quality measure plans
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ED design Easy axis Clear entrance Open cubicles Central stations
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Station and sections Pre-hospital service Decontamination room Triage
Resuscitation room Main ED room Minor procedure room Fast tract Waiting area
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Knowledgeable personnel
Triage Room Place Knowledgeable personnel Triage system First station Identify life-threatening cases Prioritize patient Smooth patient flow Observe waiting area (Re-triage)
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Parameters used in triage
Quick look Brief history Vital signs Diagnostic tools
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Triage Category Acuity level Physiological Status 1 2 3 4 5
Canadian Triage and Acuity Scale Triage Category Acuity level Physiological Status 1 Resuscitation Resuscitation/actual life-or limb threatening presentation 2 Emergent Unstable/ potential life – or limb threatening presentation 3 Urgent Potentially unstable 4 Less urgent Stable 5 Non urgent Routine
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Resuscitation Room
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Resuscitation Room Close Monitor Many interventions Well equipped
Well staffed - one to one
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What interventions in Resuscitation
CPR Management of Airway Breathing Circulation Disability It need team work
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What interventions in Resuscitation
Airway Assess the need for intubation Perform intubation Crush RSI
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What interventions in Resuscitation
Breathing : Assess breathing Manage tension pneumothorax Assist ventilation Bronchodilator Manage Pulmonary edema
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What interventions in Resuscitation
Circulation : Fluid resuscitation Consider blood Consider inotropes Stop bleeding
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What interventions in Resuscitation
Disability : Assess LOC ( GCS ) Stop seizures Manage acute stroke
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Monitoring Blood pressure Pulse Respiratory rate Oxygen Saturation
Cardiac rhythm LOC
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Acute area Few simple intervention Less monitoring Less staff needed
Usually Category 111
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Acute area Most of the patient are those stable , but may need admission Patient who need IV fluid or IV medication Patient who need further investigation
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Fast Track Simple cases No intervention No/simple investigation
Prescription and go Consider Triage-out
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Waiting area Confortable place Easy observed by triage team
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Well trained staff CME Courses Workshops Simulation sessions
Bed-side teaching
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Systems guidelines and policies
Triage system Clinical guidelines for common presentation Hospital and ED policies Code system Referral and transfer system
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Good administrative support
Strict application of interdepartmental policies Easy disposition of patient Good diagnostic facilities ( Lab & Image ) Support ED decisions Participating and follow quality measure
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Follow up and quality measure plans
For proper follow up Documentation Quality committee Identify key-point indicators Data collection Analysis and recommendation
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Key-point indicators Time to physician of different categories
Number of patients and admission percentage Length of patient stay in ED
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Summary of patient's flow
Station Place Patient Category Parameter Responsibility First Reception Life threatening General Look Nurse Second Triage room Potential life threatening Brief history & Vital signs Third Triage Room2 Emergency cases Details history & Examination Physician
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Triage Nurse Resuscitation Main area Triage physician ECG Glucocheck
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Key-Point Any patient with non traumatic chest pain ECG shall be done and interpreted within 10 minute Any patient with decreased level of consciousness glucocheck shall be done
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Prescription and discharge Send in for possible admission or Procedure
Triage physician Prescription and discharge Investigation And reassess Send in for possible admission or Procedure Triage out
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