In the emergency room, which is equipped with modern medical devices, the first treatment and observation of the patients are carried out by experienced physicians.
STRUCTURE OF THE EMERGENCY SERVICE Emergency health services department; consists of patient welcoming consultation, patient registration, triage, patient examination room, resuscitation room, observation room, isolation room, emergency operating room, waiting area, attending physician, nurse and other assistant staff rooms.
WELCOMING THE PATIENT AND DIRECTING Patients and their relatives who apply to the emergency department are welcomed and accompanied by the patient welcoming and referral officer if they need to be directed. Patients invite consultants to receive training on interpersonal communication, ethics, patient rights and responsibilities, and patient satisfaction at least once a year.
EMERGENCY POLYCLINIC PATIENT ADMISSION Patients who come to the Emergency Health Services Unit by ambulance, 112 and stretcher are directly taken to the yellow room. Those who are in critical condition and life-threatening are taken into the red room. Other applications are directed to the triage area before the registration process. The necessary emergency procedures are initiated for the patients who are evaluated medically by the doctor. Barcodes are issued by the emergency secretary by registering on HBYS. The procedures of patients who do not have relatives are carried out by emergency personnel. Patients who are examined in the green room are given prescriptions. Patients whose general condition is good and requiring further examination are directed to the polyclinic. Patients who are referred to the yellow room and whose medical examination is initiated, the outpatient treatment decision is arranged and discharged. Patients who are decided to be decided are taken into observation by wearing a white (red color for allergy patients) identification identifier. Patients are directly admitted to the service or intensive care according to their medical condition. If there is no empty bed in the hospital, the patient is referred to other health institutions with the coordination of 112. General Forensic Examination Report is filled, stamped and signed by the patient's doctor for the patients in the scope of trauma and forensic cases who apply to the emergency. For patients in the forensic case, the police are informed. The patient's arrival time, identity information and reason for arrival are recorded in the forensic case section on the computer. Forensic case file is created and archived. A copy of the report is delivered to the police.
TRIGAGE APPLICATION Color coding is applied for an efficient service delivery in the emergency unit. The application of the clutch is performed by the physician or nurse, health officer (public health) and similar health personnel during the emergency application. Accordingly, red, yellow and green colors are used. Application regarding color coding;
GREEN AREA: They are outpatients and are not critically injured, they can walk and take care of themselves NORMAL PATIENTS It needs to be intervened within 24 hours.
YELLOW AREA: Patients in this group can be kept a little longer than those in the red group. The delay in the care of that patient who needs medical care in an injured way but while caring for other patients will not cause that patient to die. Yellow patients are not outpatients and require a stretcher for transport. They are SECONDARY EMERGENCY PATIENTS. They must be intervened within 60 minutes.
RED AREA: It is an emergency group. Critically severely injured patients whose problems or injuries need to be treated promptly. Those who need to receive health service or transplant are evaluated in this group. They are the PRIMARY EMERGENCY PATIENTS and are treated immediately. Regardless of whether or not enrollment has been made for critically ill patients, the necessary medical intervention is immediately applied. Necessary arrangements regarding the automation system have been provided so that the registration of critical patients can be done first.
The triage procedures of all patients who apply to the emergency department are completed as soon as possible. Following this, their registrations are opened, they are put in order for diagnosis and treatment procedures considering their medical conditions, and they are taken to the field in accordance with the triage code.
APPLICATION FOR THE REGISTRATION OF THE PATIENT All patients who apply to the Emergency Health Services Unit (patients applying to the red and yellow areas) are accepted regardless of their health insurance and ability to pay. Emergency service is prepared for cases that will be brought to the unit by 112 emergency ambulances, first assessment and necessary medical intervention are performed and the patient is stabilized. In this context, the content of the "Emergency Health Services Presentation Circular" and the decisions of the Provincial Emergency Health Services "ASKOM" are applied completely. . Every patient who applies to the Emergency Health Services Unit is recorded. Emergency (red) patients are intervened without questioning their identity. The procedures are completed later. Patient Information Form is filled in order to determine the identity information and address of the patients who apply to the emergency services but cannot submit a valid identity document, health record or patient referral document for any reason, and to inform the patients and their relatives. No promissory note or letter of undertaking is received from these patients. Admission of Foreign National Patients; Passport photocopy and ID photocopy of the patient are registered by the cashier unit, and the patients are charged after their treatment. Patients who certify that they are forensic foreign patients and refugees are not charged. In accordance with the Prime Ministry circular, Syrian patients are registered with a copy of their passport and identity card. There is absolutely no charge for any treatment or application.
PATIENT EXAMINATION, DIAGNOSIS AND INTERVENTION PROCEDURES Emergency intervention is made to patients who are taken into the red room. Those who become stable are put into service or intensive care according to their condition. When necessary, it is sent to other health institutions with the coordination of 112. Patients with Ex are notified to the officer in charge and their procedures are started.
The patient, who is examined in the yellow room, is taken into observation for intervention. Diagnosis and treatment tests are carried out by the physician and the nurse, after informing them.
For laboratory tests, blood samples are taken by the nurse and blood gas by the physician. The examinations are automated by the secretary and delivered to the laboratory by the staff.
For the radiological examinations requested in the emergency unit, the staff takes the patient to the emergency radiology department. Results are given by HIMS system or as a film within 15 minutes at the latest.
Patients with critical medical conditions during imaging and similar procedures are accompanied by a healthcare professional as required by their condition. It is sent with a stretcher or wheelchair if the patient needs it.
The findings of the patients evaluated in the yellow room are recorded in the Emergency Service Outpatient Evaluation and Follow-up Form. Identity verification is made for every patient taken into observation before any procedure to be performed.
Examinations may be requested from the patients who are examined in the green room. For examinations requested by the physician, they are directed to the relevant data entry staff and their prescriptions are given after the results are evaluated. Patients whose general condition is good and requires further examination are directed to the polyclinic.
CONTRACTING PROCESS The name of the drug, the time of administration, the administration dose and the duration are clearly indicated in the orders of the patients who are taken into observation. It is legibly written on the front of the Emergency Service Outpatient Evaluation and Follow-up Form by specifying and stamping the date and time by the doctor.
There is a nurse call bell and a medical gas system at the head of each bed in the observation room. Care and cleaning are followed by the responsible nurse. The follow-up and treatment of the patients taken to the hospital is done by the nurse and the application method, time and the name of the practicing nurse are recorded in the nurse observation section on the back of the Emergency Service Outpatient Patient Assessment and Monitoring Form. Intern students make their treatment practices in the company of a nurse, and the name of the accompanying nurse is recorded.
The samples required for examination and analysis are taken at the patient's location and the sample is delivered by the staff in charge. If the ECG is requested from the patient, it is taken by the nurse. It is evaluated by the specialist physician in charge and the result is recorded in the observation form. If monitoring is required, the patient is monitored.
Patients whose physician's decision of monitoring is taken into the monitorization area. Heart rate and rhythm, O2 saturation and blood pressure are monitored and recorded in the “Emergency Service Outpatient Evaluation Form”. Invasive monitoring can be done in the emergency red area. Patient privacy, medical ethical rules and principles of patient rights are respected during all kinds of medical procedures performed in emergency services. Notification is made to the responsible person of Material vigilance with 'Notification Form'. Problems that occur during the use of consumables (easy breakage, deformation, defective product, etc.) are recorded in a report and information about the sample sample (brand, model, lot number, expiration date, etc.) and the sample is added to the sample and sent to the material vigilance officer.
Hospitalization of the patients In emergency services, it is essential that patient follow-up in the observation room does not exceed 24 hours. During this period, patients whose definitive diagnosis could not be made or the indication for hospitalization was not determined, and patients with hospitalization indications and related to more than one clinic are evaluated by the chief of emergency department or on-duty specialist physicians, and the relevant clinic chief or responsible specialist physician is informed by hospitalization in the most appropriate clinic required by their medical condition. Hospitalization priority is given to emergency patients waiting for admission to clinics in the emergency department. Patients who are decided to be hospitalized for care and treatment in the emergency department are admitted to the intensive care or the next service. If there is no room in the next service, it goes to the services with an empty bed. Patients who are decided to be hospitalized are processed according to the "Safe Patient Transfer Instruction" within thirty minutes, and delivered to the service staff. A diagnosis is made and a treatment plan is determined, does not require urgent intervention, is stable but is in a stable condition, but in order to provide further examination and treatment, another health Unless necessary, patients who are sent from the facility and who have not developed an acute medical problem requiring immediate intervention during transport are not re-evaluated in the emergency department. Such patients are hospitalized immediately without waiting in the emergency department and are admitted to the clinic of the relevant specialty. Depending on the patient's condition, the patient is sent with a transport vehicle or a wheelchair.
DELIVERY OF PATIENTS OUTSIDE THE HOSPITAL After the first evaluation of the patients who applied to the emergency department, the specialist physician plans to refer the patient to another health facility and to provide the necessary health service in the relevant health facility if the conditions that can provide the examination, intervention, care and treatment required by the patient's medical condition in terms of medical equipment and empty bed. Unstable patients are not referred unless they reach the level to maintain their hemodynamic status under the transport conditions. However, if the emergency treatment procedures of the patient cannot be provided and the referral is absolutely necessary, appropriate conditions are provided and the referral to the relevant health facility is planned. It is recorded in the "Emergency Service Outpatient Evaluation Form". The specialist in the relevant branch or emergency department physician or on-duty specialist informs the patient / patient's relatives about the patient referral, transfer and risks and obtains transfer approval. The approval obtained is recorded in the "Emergency Service Outpatient Evaluation Form". ASKOM decisions are applied in patient referrals. In the Emergency Health Services Unit, patients are referred according to the "Safe Patient Transfer Instruction". These procedures are carried out in coordination with the 112 Crisis Command Center. The emergency doctor on duty receives approval from the institution to be referred. The physician contacts the 112 Command and Control Center and is informed about the patient's condition. After the attachment 3 form is printed and the signature of the referring physician and the signature of the deputy chief physician are completed, it is archived by the secretary in charge. In case of duty conditions, additional 3 forms are signed by the referring physician and duty chief and archived by the on-duty secretary.
Appendix-9 in patient referral and transfer procedures between health facilities; The Case Transfer Request Form Between Health Facilities is prepared by the relevant branch specialist who makes the patient referral and transfer decision, or the physician in charge of the emergency service or the specialist physician on duty. The physician fills in the Annex 9 Case Transfer Request Form and the Epicrisis, and submits it to 112 staff. During the transfer process, the necessary emergency response set (oxygen tube, intubation set, ambu etc.) is available in accordance with the clinical situation. In addition, during the transport process, continuous rhythm monitoring is performed using a transport monitor or defibrillator if necessary.
The patient is discharged and delivered to the 112 physician or Emergency Medical Technician. The transfer of the patient is completed with the 112 Emergency Aid Ambulance, accompanied by the 112 physician and / or Emergency Medical Technician. The necessary preliminary preparations are made for the admission of the patient referred to the emergency unit from another institution and the treatment is started without causing any waiting.
INFORMING THE PATIENT AND RELATIVE In order to guide and inform patients and their relatives, to prevent unnecessary crowds in the emergency unit, to help elderly and disabled patients, security, patient welcoming and guidance staff work together at the emergency entrance door. For patients who need to wait in line, the emergency physician verbally about the reasons for waiting and estimated times The patient or his relatives are informed by the physician in charge of the medical condition of the patient and the medical applications to be performed.
Discharge Procedures The discharge and transport procedures of the patients in the field of consultation are provided by the specialist physician in charge. The bed of each patient discharged from the hospital is quickly changed and prepared for the new patient.
COORDINATION PROCESSES WITH OTHER INSTITUTIONS AND ORGANIZATIONS IN THE SCOPE OF EMERGENCY HEALTH SERVICE According to the Clinical Situation of the Patient, 112 is Called and a Communication is Provided with the Appropriate Hospital in Teleconference.
SAFETY MEASURES IN EMERGENCY HEALTH UNIT The necessary precautions for the safety of patients, relatives and employees in emergency services are provided by private security personnel and with the support of sufficient number of security cameras.All entrances are closed at 17:00, except for the entrances where emergency patients are taken by duty personnel, ambulance, patient transport vehicle or stretcher. . Entries and exits to the hospital are kept under control. In the emergency unit, patients are examined by the physician in charge, accompanied by the patient's attendant if deemed necessary by the nurse and physician. The patient's relative can accompany him / her for procedures such as the patient's identity information and history taking. All patient relatives are not allowed to enter the examination and observation areas.
Necessary security measures are taken with sufficient lighting, surveillance cameras and security personnel in the parking areas connected to the emergency service.
EMERGENCY PERSONNEL COMMUNICATION Contact information of all specialist physicians in the emergency clinic is available.
