EMERGENCY UNIT

 

 

Background:

The Emergency Unit of the Hospital performs its operations within a building located adjacent to the administrative block of the hospital. The Emergency Unit is the gate way to the hospital. It is the first place of contact for any person accessing the services of the hospital. It is managed by a team of mental health professionals. Services required by Patients for immediate care are readily accessible within this Unit except laboratory and psychological services. The emergency services have a 24 hour coverage.

 

 

Emergency Unit professionals:

• Doctors: Consultant Psychiatrists, Resident doctors (both junior and senior residents), youth corps doctors, trainees from other specialties.
• Nurses: Assistant directors, chief nursing officers, assistant chief nursing officers, principal nursing officers, senior nursing officers, nursing officers and nursing students.
• Pharmacists: Pharmacists and Pharmacy Interns.
• Social welfare: senior social welfare officer.
• Health Record Officers.
• Health Attendants.
• Crisis Intervention Officers.
• Account Officers.
• Information Officers.

 

 

Emergency Unit operations:

The services rendered in the emergency are organized in a threefold approach.

• Assessment and management of first-time Clients.
• Management of all emergency cases.
• Management of Patients on short stay care.

Training and research activities also take place on a daily basis at the Unit

 

 

First time Clients:

The assessment of first-time cases commences at 8.00am daily. Clients with or without relatives/caregivers are triaged and assessed by the most senior doctor available on the team. Clients who will benefit from the Psychiatric Services are given registration slips which they proceed to pay a sum of N4000 at the pay point before proceeding to the Records officer for full registration. Clients who require management by other specialists are referred appropriately. After the completion of the registration, Clients’ folders are sent to the Nurses’ station for vital signs checks and recording. A random blood sugar test is also done at this point at a sum of N300 for each person.

The Client and his/her available informants then proceed to see the doctor when it gets to their turn. Consultation and appropriate reviews take about 90 minutes to two hours for each Client. Management plans are decided along with Client or relevant caregivers/ informants before completion. The direction of Client’s care could be outpatient, long inpatient or short stay care.

This year, about seventy-two new Clients were seen weekly with an average of 15 to 20 new Clients during the active week days.

Emergency cases:

On arrival, cases are triaged on the basis of severity and appropriate interventions are ensured. The status of Client is determined as either returning Patient or first-time Patient. After stabilization of condition, the registration process is ensured for new Clients and retrieval of records for old Clients. Clients whose conditions do not require urgent intervention, but have genuine complaints are sorted and seen accordingly by the doctors after retrieval of records and assessment of their vital signs. The channel of management could be as an outpatient, short stay or long inpatient care.

 

 

Observation Unit:

Often Clients require brief stay before full stabilization and return to the community. This is rendered in the Emergency Unit which has eight beds for this purpose. Duration of stay here ranges from a day to 3 days. Clients pay N5000 for a 24 hour stay and N25000 for a 3 day stay.  This fee is for the 3-day stay is inclusive of a N10000 deposit for medications. Personal care requirements are also asked to be procured for a smooth stay. The team reviews the Clients on a regular basis during the period of admission here. At the end of the paid service period, Clients may need to extend their stay in the short stay Unit, may proceed for a long stay admission on the Ward or referred for a multidisciplinary approach as determined by the Psychiatrist.

 

 

Training:

All members of the team have scheduled periods for a joint internal training on relevant skills needed for holistic Patient care. It is a forum where challenges of the process of care are tackled and innovations are upheld.

Individual professional specialties also have direct internal trainings of their interns and residents on a continuous basis.

At intervals of two months, stakeholders consisting of heads of each sub-unit of the department have a meeting where the running of the department and welfare of personnel are discussed with required innovations and interventions done.

 

Functions of Sub-Units:

Doctors:

 Two Consultant Psychiatrists lead the group and ensure that service, training and research activities are well coordinated. The Resident doctors are rotated every quarter to other sub specialties.

Daily one on one teaching holds amongst doctors and a weekly joint seminar on Mondays.

Nurses:

This Sub-Unit is led by the most senior Assistant Director of Nursing Services in the Unit. They are rotated on a two-yearly basis to other sub specialties in the hospital. They are the Supervisors of the Health Attendants and managers of the resources used in the care of Clients.

Pharmacy:

The department has an in-house Pharmacy manned by a Senior Pharmacist with a supporting junior Pharmacist. It runs a 24-hour service. Pharmacists from the general pool hold fort during call periods from 4pm to 8am on week days and in two shifts during the weekends.

Social welfare:

The Social Welfare Unit is manned by a very Senior Social Works Officer with support from other officers from the department on a twice daily shift basis which ends at 6pm. They are responsible for a comprehensive social assessment of Clients, support for indigent Clients and unknown Clients, conducts proper linking of Clients with relevant needs in the society and collaborates with relevant Agencies as regards Clients’ care

Registration/ Records:

This Unit is manned primarily by one accredited records personnel with support from junior officers in the Unit. It is accessible on a 24 hour basis. The Unit is responsible for the provision of stationery and access to Clients’ records on request.

Information Desk:

The department has two information officers. They operate within the hours of 8am to 4p.m daily. Their duties span across attending to all enquiries both internally and externally via phone calls, giving directions of care and easing Clients’ access within the department.

 

Crises intervention officers:

They are essentially support staff of the male gender whose duties are carried out under close supervision. They assist in stabilizing aggressive, violent and restless Patients by physically holding them during administration of chemical restraints. They also help in ensuring the safety of staff and Patients within the facility.

Cashiers:

They are responsible for collection of all forms of payment for specified services within the facility at the payment point. Every payment made is issued a corresponding receipt at this point.

Cleaners:

There are three Cleaners attached to the Unit. They are responsible for the overall cleanliness of the facility on a daily basis.

 

 

Achievement

• There was successful engagement of all services all year round and a relatively smooth operation despite a full month of industrial action by Resident doctors.
• Effective team efforts were displayed by all personnel.
• A fairly conducive environment was ensured for both staff and Clients.
• Clients attested to improvement in conditions after commencement of management.
• Protocols were established for smooth operations.
• Personnel benefitted from some internal training.
• Research Activities commenced in the Unit.

 

Mortality:

Unfortunately, we had three mortalities of Patients on short stay care during the year under review.

 

Challenges:

In the course of the year, the team encountered many challenges. They are:

1. Inadequate personnel across all Sub-Units thus increasing pressure of work and Clients’ waiting period.
2. Inadequate consumables for daily operations.
3. Inadequate furniture especially chairs and tables for personnel.
4. Lack of computers, printers, scanners to facilitate database maintenance, Clients’ follow up and research work.
5. Poor Inter Agency collaborations with related Agencies e.g State/ national welfare organization, police department and other uniformed personnel, community representatives.
6. Inadequate tools for management of aggressive Clients.
7. Space constraint especially with management of Clients during emergencies/admissions, this increases pressure during peak periods.