Emergency and Surgical Services

Emergency Services

In addition to inpatient and outpatient departments, most general hospitals will have an emergency department (ED); note that emergency room (ER) is often used interchangeably with emergency department (ED). EDs are designed to handle a wide range of emergencies, from minor injuries to life-threatening situations, and operate 24/7 to address urgent and emergent health care needs.

Some EDs may treat certain populations only, such as children. Due to the large variety in patient acuity, some EDs are subdivided into varying zones such as acute care, sub-acute care, and minor-treatment/ambulatory care.  Patients in the ED department are prioritized by RNs who assess and prioritize their condition. Many hospitals in Canada use the Canadian Triage and Acuity Scale (CTAS) as a triage system to prioritize patient care to ensure that the most critical patients are taken care of first. As the table below outlines, there are five levels of triage, with Level 1 being the most severe (CTAS National Working Group, 2012).

Surgical Services

The earlier sections on inpatient units covered several pre and post-operative surgical departments, for example, the orthopedic unit, general surgery unit, urology unit, or cardiovascular intensive care unit (CVICU).  However, there are also several departments which support the surgical services process itself. Below is a list of the most common units supporting surgical processes, along with basic timelines for their use.

Pre-surgical Clinic (PSC): This outpatient department is where patients are booked two to three weeks prior to surgery, to be educated and prepared for the procedure they will be having. The nurses on this unit perform a variety of tests, including bloodwork and ECGs, and take vital signs and patients’ medical histories to ensure they are in the condition required for surgery to be performed. The surgeon booking the procedure may also require a variety of consultations to be performed at this visit, including an anaesthetic consultation.

Day Surgery Unit (DS): This is the unit where patients having simple procedures that do not require overnight stays are admitted to on the day of surgery. They typically arrive two to three hours before their scheduled surgery and are discharged one to two hours following their procedure once they are stable.

AM Admission Unit/Pre-operative Unit: This is the unit where patients having more complicated surgeries requiring overnight stays are admitted on the day of surgery. They typically arrive two to three hours before their scheduled surgery and are transferred to the appropriate surgical inpatient unit from the PACU when stable.

Operating Rooms (ORs): This is where inpatients and outpatients are administered anaesthetic, and the actual surgical procedures are performed. Effective utilization of OR time is essential within the hospital environment, with surgeries scheduled back-to-back within OR blocks. Many routine surgeries, such as hernia repair or appendectomy, are scheduled for less than one hour, while more complicated surgeries, such as CABG, may be scheduled for four or more hours. Surgeons typically have OR blocks on the same day and time each week, and the staff ensure the time is fully utilized; some surgeons may have blocks at more than one hospital (Allen, 2018).

Post-Anaesthetic Care Unit (PACU)/Recovery Room (RR): This area is where inpatients and outpatients who have received anaesthesia during surgery are taken immediately after their procedure to be monitored until the anaesthesia wears off, typically for one to two hours. Once stable, they will either return to the day surgery unit if they are to be discharged that day or be transferred to the appropriate inpatient surgical unit.

References

CTAS National Working Group. (2012). The Canadian triage and acuity scale: Education manual. Version 2.5. Canadian Association of Emergency Physicians.

Allen, J. (2018, October 5). Optimizing surgical block time. What I’ve Learned as a Hospital Medical Director.