'Emergency Department' circular by the Ministry of Health

The Ministry of Health made new arrangements for emergency department services with a view to preventing overcrowding in emergency departments.

As per the circular signed by the Minister of Health Dr. Ahmet Demircan which was distributed to all provincial health directorates and which includes arrangements for emergency department services, "Office Hour Shifting or Shift Branch Outpatient Clinic" practice will be conducted for standard outpatient clinic services. Of the patients presenting to emergency departments, those whose general conditions are the least serious and who should be examined in the “green zone” will be given “Green Zone 1” code and it will be ensured that they are cared in general physician examination outpatient clinics in the emergency department.

“Office Hour Shifting or Shift Branch Outpatient Clinic" practice will be conducted with “Green Zone 2” code primarily for the branches of pediatrics, internal medicine, otorhinolaryngologic diseases, orthopedics and traumatology as well as the other branches where green zone patient ratio requires opening additional outpatient clinics in emergency departments of hospitals provided that they will be located out of emergency departments but will be close to them. Eligible patients will be referred to the outpatient clinics of the relevant branch through an efficient triage process actualized by the healthcare personnel. A required number of general physician outpatient clinics will be opened within the scope of “Green Zone 2” except for the outpatient clinic services provided by specialist physicians of the relevant branch within the scope of Office Hour Shifting or Shift Branch Outpatient Clinic practice. It will ensure that patients will not accumulate and wait in emergency departments. The relevant circular is as follows:

                                                                                                                                                             

CIRCULAR

2018/

FOR DISTRIBUTION

Amendment works for emergency healthcare service notice, which aim at finding underlying reasons of problems encountered by certain specialty and overcrowded hospitals and solving them, have been completed and the said notice is currently at the stage of publication. At this stage, hospitals included in the enclosed list are supposed to immediately conduct the following works so as to reduce patient density and increase patient satisfaction:

  1. To conduct “Office Hour Shifting or Shift Branch Outpatient Clinic" practice for standard outpatient clinic services at hospitals;
  1. To ensure that the healthcare personnel conduct an efficient triage application on patients presenting to emergency departments; to give patients, who do not require yellow zone examination and who should first be cared in green zone of emergency departments, “Green Zone 1” code; and to ensure that they are cared in general physician examination outpatient clinics in emergency departments;
  2. To conduct “Office Hour Shifting or Shift Branch Outpatient Clinic" practice with “Green Zone 2” code primarily for the branches of pediatrics, internal medicine, otorhinolaryngologic diseases, orthopedics and traumatology as well as the other branches where green zone patient ratio requires opening additional outpatient clinics in emergency departments of hospitals provided that they will be located out of emergency departments but will be close to them and to make sure that eligible patients will be referred to the outpatient clinics of the relevant branch through an efficient triage process actualized by the healthcare personnel;
  3. To ensure that a required number of general physician outpatient clinics will be opened within the scope of “Green Zone 2” except for the outpatient clinic services provided by specialist physicians of the relevant branch within the scope of Office Hour Shifting or Shift Branch Outpatient Clinic practice and that patients will not accumulate and wait in emergency departments;
  4. To plan yellow zone examinations and short stays in a way not to exceed 2 hours; to ensure that patients who require emergency observation or follow up for more than 2 hours are observed and treated in emergency inpatient services within emergency departments;
  1. To prevent long stays and follow up of clinical patients in emergency departments;
  1. To restrict the ordinary hospitalization authority of the branches, which have patients in emergency departments and which keep them under observation for more than 8 hours and do not refer them to clinics, through the Central Hospitalization Automation systems until the said patients are hospitalized;
  2. To expedite the radiology and laboratory processes of emergency department patients, to work overtime for ordinary laboratory and imaging services for Office Hour Shifting or Shift Branch Outpatient Clinic practice if possible;
  3. To ensure that the hospital administration turns the beds of clinics which do not have a heavy patient population into the beds of clinics with a high emergency admission ratio when necessary;
  4. To ensure that an intensive care officer determines the intensive care bed needs of the patients especially whose emergency surgical indications are identified;
  5. To organize postop intermediate care units in order not to go suffering on the part of the emergency patients if there is no bed available in the intensive care units;
  1. To accelerate the consultation process in emergency departments;
  1. To make sure that clinics with sufficient physician resources certainly assign a physician for consultation within the framework of daily workflow; to ensure that emergency service consultations which are not included in the scope of blue code are included in it in 30 minutes at the latest; to submit the lists of consulting physician to the administration and inform the administration on average response durations;
  1. To make simple physical improvements in emergency departments;
  1. To immediately conduct minor repair works as well as simple construction works in the relevant emergency departments; to increase the opportunities and comfort of patients and their relatives;
  2. To extend the scope of vehicle entrance and exit and parking lot facilities in the relevant emergency departments and to provide emergency patients with parking opportunities and facilities.

I kindly request you to take necessary actions to transmit data to the provincial health directorates on a daily basis and to ensure that the relevant provincial health directors and health facility managers follow up practices on-site and in a timely manner with a view to ensuring that the abovementioned arrangements are immediately conducted and that daily patient numbers and average waiting time in green, yellow, red and office hour shifting outpatient clinics are followed up by the Ministry in a timely manner and in full.
                                                                                                                                                                                                                                                                                

                                      
 Dr. Ahmet DEMİRCAN

 The Minister of Health  


Updated: 06/02/2018