Planning and Designing Accident and Emergency Departments

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Health Building Note 15-01: Accident & emergency departments Planning and design guidance

April 2013

The College of Emergency Medicine

Health Building Note 15-01: Accident & emergency departments Planning and design guidance

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Health Building Note 15-01: Accident & emergency departments

© Crown copyright 2013 You may re-use this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives. gov.uk/doc/open-government-licence/ or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. This document is available from our website at www.gov.uk/government/organisations/department-of-health ii

Executive summary

Strategic design
Differentiating levels in decision-making can be a helpful way of handling the expectations of different stakeholders – in what is discussed and when – during capital projects.

This guidance is aimed at the multidisciplinary team including clinicians, design teams, estates planners and managers involved in the strategic and operational planning of an accident & emergency (A&E) service and built space. It sets out the strategic background, uncertainties and evidence-base for key decisions that need to be made in the design and planning of a new or refurbished A&E department. Type 1 A&E is defined as “a consultant-led 24-hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients”. The four key components crucial to the success of a new build or refurbishment are: a. design; b. processes; c. communication and d. the ability to change. The A&E department is part of a whole system approach to emergency care. It requires specific design features, focused on flow, but needs to operate as part of an integrated health system. This should be delivered within an individual trust’s strategy for emergency care, which should reflect the importance of acute medicine, surgery and the wider networks of care. Increasing attendance at A&E departments needs to be addressed. It is important to understand why people attend A&E departments as the number and type of patients attending the department will influence the design required.

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Health Building Note 15-01: Accident & emergency departments

Delivery of services within the A&E department is dependent on both flows of patients into the department and flows out (that is, those patients who are referred on or discharged). Most A&E attendances can be predicted within a range, allowing the department to deliver a planned service to some extent. Matching demand to staff availability and skills for patient mix is very important. The methodology by which the multidisciplinary stakeholder groups will address the longer term (the 5–20 year timeframe) and wider service vision through multidisciplinary group work should be agreed, enabling consideration of spatial and infrastructural limitations. The Big Front Door concept should be used to appraise the strengths, weaknesses, constraints and opportunities of local networks and community care providers to help manage future attendance at the A&E department. It is essential to identify the range of stakeholders required for decision-making as well as the role or roles each plays in the process of service design. It is important to involve stakeholders at the correct levels (strategic, operational and spatial), to ensure appropriate decisions are made on matters relevant to the time and detail outlined in the business plan, design, construction and fit-out stages. Consideration should be given to the timescales for making decisions and receiving feedback from wide-ranging stakeholder groups in developing and measuring the performance of the design before and after the project.

The design team needs to resolve any contradictions that may occur...
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