Marsh Regan H, Chalmers Kristen D, Checkett Keegan A, Ansara Jim, Rimpel Linda, Edmond Marie Cassandre, Freni Robert W, Philbrook Joshua K, Stanford Kimberly, Rouhani Shada A
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, US.
Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, US.
Ann Glob Health. 2020 Jan 20;86(1):6. doi: 10.5334/aogh.2568.
Studies from high-income settings have demonstrated that emergency department (ED) design is closely related to operational success; however, no standards exist for ED design in low- and middle-income countries (LMICs).
We present ED design recommendations for LMICs based on our experience designing and operating the ED at Hôpital Universitaire de Mirebalais (HUM), an academic hospital in central Haiti. We also propose an ideal prototype for similar settings based on these recommendations.
As part of a quality improvement project to redesign the HUM ED, we collected feedback on the current design from key stakeholders to identify design features impacting quality and efficiency of care. Feedback was reviewed by the clinical and design teams and consensus reached on key lessons learned, from which the prototype was designed.
ED design in LMICs must balance construction costs, sustainability in the local context, and the impact of physical infrastructure on care delivery. From our analysis, we propose seven key recommendations: 1) Design the "front end" of the ED with waiting areas that meet the needs of LMICs and dedicated space for triage to strengthen care delivery and patient safety. 2) Determine ED size and bed capacity with an understanding of the local health system and disease burden, and ensure line-of-sight visibility for ill patients, given limited monitoring equipment. 3) Accommodate for limited supply chains by building storage spaces that can manage large volumes of supplies. 4) Prioritize a maintainable system that can provide reliable oxygen. 5) Ensure infection prevention and control, including isolation rooms, by utilizing simple and affordable ventilation systems. 6) Give consideration to security, privacy, and well-being of patients, families, and staff. 7) Site the ED strategically within the hospital. Our prototype incorporates these features and may serve as a model for other EDs in LMICs.
来自高收入地区的研究表明，急诊科（ED）的设计与运营成功密切相关；然而，低收入和中等收入国家（LMICs）尚无急诊科设计标准。
基于我们在海地中部一家学术医院米雷巴莱大学医院（HUM）设计和运营急诊科的经验，我们提出针对低收入和中等收入国家的急诊科设计建议。我们还基于这些建议为类似环境提出一个理想的原型。
作为重新设计HUM急诊科的质量改进项目的一部分，我们从关键利益相关者那里收集了关于当前设计的反馈，以确定影响护理质量和效率的设计特征。临床和设计团队对反馈进行了审查，并就关键经验教训达成共识，据此设计了原型。
低收入和中等收入国家的急诊科设计必须在建设成本、当地环境的可持续性以及实体基础设施对护理提供的影响之间取得平衡。通过我们的分析，我们提出七条关键建议：1）设计急诊科的“前端”，设置满足低收入和中等收入国家需求的等候区以及专门的分诊空间，以加强护理提供和患者安全。2）在了解当地卫生系统和疾病负担的基础上确定急诊科的规模和床位容量，并鉴于监测设备有限，确保对患病患者的视线可见性。3）通过建造能够管理大量物资的存储空间来应对有限的供应链。4）优先考虑一个能够提供可靠氧气的可维护系统。5）通过使用简单且经济实惠的通风系统确保感染预防与控制，包括隔离病房。6）考虑患者、家属和工作人员的安全、隐私和福祉。7）在医院内战略性地选址急诊科。我们的原型纳入了这些特征，可作为低收入和中等收入国家其他急诊科的一个模型。
