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WAYFINDING


Lynch, in his book The Image of the City to refer to strategies designed for navigating cities. Subsequently, the concept evolved to encompass the intuitive orientation of individuals. The concept of ‘wayfinding’ is divided into four stages: l Orientation, which refers mainly to positioning awareness in relation to nearby elements.


l Choice of the route, which deals with decision-making on the preferred way to the desired destination.


l Observation of the route, which concerns the analysis and confirmation of the chosen path.


l Recognition of the destination, which is specifically the realisation of the arrival.


The concept of wayfinding requires the application of a number of principles, such as: l The creation of identity for the places. l Use of reference points to help orientation.


l Subdivision of environments/spaces in regions with visual identities.


l Establishing key routes that direct individuals.


l Provision of maps with location points. l Differentiated references in areas that require changes of direction.


Complex environments, such as hospitals can generate feelings of “embarrassment, frustration, anxiety and stress”, when individuals become lost.7,8


However, the


‘cognitive map’, fundamental for the wayfinding process, can be assisted by interacting with the environment and by using signage, architecture and reference points as aids.9,10


Organisation of emergencies in the Brazilian Unified Health System (SUS) The configuration of the physical structure, as well as the signs used in emergency care services play a fundamental role, since they directly influence the quality of care provided. It is important to consider the psychological state of the patients – their pain, anguish and insecurity, when seeking care. The environment should help positively influence users without causing additional stress,11


particularly in reception


areas and patient risk classification. The setting should also minimise the stress of healthcare workers operating in these sectors.12


Environments in emergency


services must function in such a way as to facilitate access, traffic and work processes, effectively and quickly, facilitating high quality patient care and safety. In Brazil, urgent and emergency services are organised according to the Manchester Protocol, as follows: l Red area: Emergency - Needs immediate attention;


l Yellow area: Urgent – Needs service within 15 minutes;


88 Yes


Greater urgency


No


Yellow room


Green room


Blue room Social service


No


Arrival


Emergency bulletin


Emergency No Welcome


Vital data – nursing technician


Risk-rating nurse


Yes


Red room Emergency


Immediate medical attention


Yes


Urgent


Prioritised medical care


Figure 2.


l Green area: Non-urgent priority – Needs service within 60 minutes;


l Blue Area: Low complexity queries – Performed according to order of arrival. The waiting time may vary up to 4 hours, or the patient may be referred to another unit.


Case study: Federal Hospital of Bonsucesso in Rio de Janeiro The emergency services project of the Federal Hospital of Bonsucesso, in Rio de Janeiro, Brazil, coded its care spaces by colour, to make it easier to understand the areas and uses assigned to them (Fig 3). The colours chosen refer directly to the risk classification system, which follows the Manchester Protocol. In order not to overwhelm the environments, colours have been applied to elements such as floors, doors, box curtains between beds. A signalling system was also developed


consisting of signs and floor orientation strips to assist in locating sectors and facilitating movement between areas. Signalling begins at the entrances to


the emergency and urgenct care sector, advising patients, caregivers and other users about the correct places of entry to emergency services. In addition, signalling is provided from the emergency department to the diagnostic and hospitalisation areas, as well as areas with controlled access – where members of the public pass through to visit patients under observation in the green and yellow areas.


In the red area, where emergency patients are treated, there are stabilisation care units – including rooms for invasive procedures, waiting areas, and spaces where psychological support is provided for family members and caregivers. The yellow area houses patients


IFHE DIGEST 2020


Non-priority medical care


Health Centre scheduling


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