WAYFINDING
RENATA PASCOAL FREIRE – HEALTH SYSTEMS AUDITOR, THE FERNANDES FIGUEIRA INSTITUTE, BRAZIL CRISTIANE N SILVA – HEAD OF INFRASTRUCTURE, THE FEDERAL HOSPITALS MANAGEMENT CENTER, BRAZIL
Increasing efficiency and safety in A&E
Renata Pascoal Freire and Cristiane N Silva describe how the combination of the Manchester Protocol and Wayfinding can optimise flow in emergency departments, promoting safe and efficient care.
Emergency environments receive a large number of patients, often in situations of high stress. Providing effective spatial orientation can help reduce queues and enable the prioritisation of care, according to risk – which is essential to ensuring safe, quality emergency care. With this in mind, architects must find design solutions that facilitate spatial orientation by providing visual information to facilitate patient access to services. The use of wayfinding precepts, together with the Manchester Protocol (a risk- based tool for prioritising care), contribute to the organisation of emergency flows. This article describes the application of these practices in an emergency unit in Rio de Janeiro, Brazil.
Manchester Protocol Risk classification is a dynamic process of identifying patients who need immediate treatment, according to their potential risk, health problems or degree of suffering. Care should be prioritised according to the clinical severity of the patient – not in
Figure 1. 12
Evaluate the patient upon arrival at the emergency service
Quickly release
emergency and
ambulatory environments
3
Reduce the time to
medical care by early
establishing severity in patient health
4
Facilitate access to
specific areas of care as needed – such as
orthopaedics or cardiology
5
Evaluate, estimate and inform of possible waiting times
6 Provide
information to family members and other companions
terms of the order of arrival.1
A necessary
tool in emergency services, risk classification enables effective management, but must be performed by a properly trained professional, in an appropriate environment, to ensure the safety of patients, awaiting their first medical intervention.2
Renata Pascoal Freire
Renata Pascoal Freire is a Nurse and sanitarist, with a PhD in Public Health from ENSP/FIOCRUZ. Renata has a Masters in Business
Administration, and is a specialist in Hospital Management (ENSP/ FIOCRUZ). She is currently a health systems auditor at the
Fernandes Figueira Institute/FIOCRUZ and a professor of public health policies and systems management, with emphasis on hospital management at INBEC's Postgraduate Programme in Hospital and Laboratory Architecture and other institutions.
Cristiane N Silva
Cristiane N Silva holds a PhD in Architecture from the Federal University of Rio de Janeiro – PROARQ/FAU/UFRJ, has a specialises in Health Network Management from the Joaquim
Venâncio National School of Public Health – ENSP/FIOCRUZ and specialisation as a supporter of Hospital Ambiance led by the Ministry of Health in Brazil. She is currently head of the
infrastructure sector at the Federal Hospitals Management Center in Rio de Janeiro. She has experience in healthcare building architecture, hospital building maintenance and contractual process management.
IFHE DIGEST 2020
To achieve this goal, the National Humanisation Policy recommends the adoption of protocols that stratify the risk according to five levels. Among the most widely used protocols in the world are: l The North American: Emergency Severity Index
l The Australian: Australasian Triage Scale
l The Canadian: Canadian Triage Acuity Scale
l The English protocol: Manchester Triage System.
There are also a number of protocols developed in Brazil.3
However, the
Manchester Protocol has been adopted by many countries and is one of the most widely used in Brazil, to direct care to urgent and emergency units.4
the level of risk, signs and symptoms are used to guide the investigation, and colour coded red, yellow, green and blue.5 This has several advantages: it
organises the flows in urgent and emergency care, promoting an efficient and safe reception for patients, while minimising delays to receiving care – thereby improving potential outcomes.6
Wayfinding Precepts The term ‘wayfinding’ emerged in discussions of architecture during the 1960s and was coined by urbanist, Kevin
87
To establish
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