A New Look for the Emergency Department

In the Emergency Department renovation project, the architecture makes the function and the function is supported by the architecture in the sense that the configuration of the infrastructures is adapted to the way emergency medicine is to be practiced.  Central to this approach is the “Moving Forward” concept that is used by the most modern Emergency Services.

The “Moving Forward” concept places the patient at the centre of a continuous flow.  The  patient consequently progresses through dedicated care zones in which the hospital architecture and the duo of  emergency nurse and doctor both play a role in ensuring an attentive and fluid global care from admission through to discharge. This approach permits a more rapid care and treatment for emergency patients. Our aim is of course to be as efficient as possible while remaining person-centred and attentive to the needs and circumstances of the individual patient

Within this concept, the first care zone consists of the reception area and waiting room for adults and for paediatric emergencies. The central zone is occupied by 3 triage areas that are essential to the mechanisms of the “Moving Forward” concept. 
 

“We have also developed a specificity for the medical triage (triage 3) with the creation of what we call an “Ultra Ultra Short” triage that is for managing “non-urgent” emergencies that can be quickly dealt with and do not require the patient to enter the care zone  reserved for more serious cases. This zone has a dedicated waiting room.”  

It is these three areas, as well as a rest room to ensure the well-being of staff, that occupy the new Emergency Department space that is scheduled to open in May.  

The rest of the renovation concerns the present Emergency Department that is currently being “updated” including structural modifications to enable us to work per care zone. Specifically:  

• Triage zone 4, dedicated to (minor) medical pathologies that do not require hospitalisation.
• Treatment zones 1, 2 and 3 where patients are sorted depending on the seriousness of their condition and importance of receiving treatment.The most urgent (i.e. serious) cases are directed to the shock lab.

“We also have a new integrated Surveillance Unit  (SU) that equips the Emergency Department with 6 to 8 provisional hospitalisation beds.”  

The SU is designed for:

• Patients who need to be kept under surveillance for 3 to 6 hours before returning home (in the case of a concussion, for example, or pain management);
• Patients who need to be kept under surveillance for 12 to 24 hours before returning home;
• Patients who have to be hospitalised while waiting for a bed to become free in the department to which they will be subsequently transferred.

Respect for the patient remains throughout, starting with patient reception and extending to consideration for accompanying family members. 

Trauma care is a well defined zone for treating surgical and orthopaedic pathologies.  

Its strategic location next to emergency radiology also ensures better care. The SU and trauma care (yellow and pink zones respectively) were renovated in 2024.  

The next stages in this project 

The next stages in this project are the most complex with the renovation of the isolation room and psychiatry consulting rooms, renovation of the medical examination rooms and of the entire medico-nursing work space. This phase of the works is more complex as it will be carried out without interrupting activity and thus in zones where patients are present.  Fortunately we have the support of the Department of Infrastructures (DIHJ) that will manage this phase by playing musical chairs with the areas where patients are present and those where they are not. Our aim is to complete all the works by the end of this year.  

“The changes we are making at the Emergency Department are inspired by values of respect, caring, and listening to the patient and care teams. The patient is at the centre of all we do.”  

In terms of functioning, we are fortunate in having emergency nurses and doctors of the highest quality.  

“We are in the process of creating a model that is unique in Belgium, a multidisciplinary emergency team consisting of accident and emergency doctors as well as internal specialists (who watch out for rarer pathologies: you find what you look for), anaesthetists, surgeons and senior paediatricians. It is this panel of cumulated skills that makes our department so effective in-patient care while at the same time functioning as a teaching class for trainee doctors. Another specificity of our department is that, from the moment of arrival, the patient is followed up by a doctor-nurse duo, this clearly improving the quality of care, a fact that has been proved scientifically. *”

With these changes we want to create a more fluid, positive, human and caring patient experience. Our mission is based on three essential notions:

• “Care”, meaning caring for the patient with respect;
• “Cure”, meaning treating the patient;
• “Counsel”, which is based on our obligation to ensure the patient’s medical follow-up.

“No patient leaves us without understanding what is wrong with them. All follow-up appointments are made before discharge. All the information, all the documents and all the prescriptions the patient needs are provided systematically.”  

Special attention is paid to bilingualism at our department. 

There are still a lot of things to be put into place, of course, but we are doing everything possible with the nurses, doctors and SAMU and SMUR ambulance drivers to ensure optimal care and treatment.

*Source : The impact of senior doctor assessment at triage on emergency department performance measures: systematic review and meta-analysis of comparative studies, Maysam Ali Abdulwahid 1, Andrew Booth 1, Maxine Kuczawski 1, Suzanne M Mason 1 , Emerg Med J, 2016 Jul;33(7):504-13.doi: 10.1136/emermed-2014-204388. Epub 2015 Jul 16.