The adult emergency service – full medical attention

What's at the core of this system? Specialists with experience in emergency care and with top-notch technical skills. They follow a tried-and-true protocol of procedures that leaves a lot of space for discussions and sharing with colleagues as well as patients. If the interaction with the patient is short (no more than a dozen hours – admitted to care before midnight for outpatient examinations),  the patient must not be allowed to go home without someone outside the hospital to accompany them. "Our service prioritises personalised care for our patients by offering them a friendly reception, efficient care and follow-up by their attending physician," explains Dr Véronique Lambert, the doctor in charge of the adult emergency services. She is a specialist in internal medicine and emergency medicine.

Whatever decisions need to be made once the diagnosis has been determined will be done with the approval of the patient's attending physician. "The idea is to set up a real partnership with them and with the different clinical entities of the canton to ensure any forthcoming  treatment, and, generally speaking, to see to the wellbeing of the patient," says Dr. Lambert. The protocol for admitting a patient in an emergency situation is very precise. It always begins with "care triage" carried out by an experienced nurse in charge of assessing patients when they arrive at the reception desk.   The selection is done according to the "Swiss emergency triage scale." The assessment is based primarily on the results of different measures and medical tests, on the explanations given by the patient, and on the clinical sense of the nurse. This produces a rapid estimate of the degree of urgency (1st degree:  immediate and vital; 2nd degree:  real emergency, care must be given within 20 minutes following arrival, because the patient is potentially in danger; 3rd degree: no immediate emergency, but care must start within two hours  following admission; 4th degree:  ambulatory emergency, for instance, for a sprain). 

This protocol implies admission according to the actual medical urgency rather than the arrival time of each patient.  Patients assessed with 3^rd or 4^th degree emergencies (the majority of cases) may have to wait a bit, even if everything is being done to shorten waiting periods.

Harmony and trust

Because of the diversity of interventions and situations encountered, an emergency service demands excellent coordination among the medical teams.  They are usually composed of about 30 active physicians, including some still in training (because the Clinique des Grangettes is a well-known centre of training), as well as about 20 nurses and caregivers. Four staff members handle the reception and the structure's administration. All professionals, whatever their level of training and status within the service, must find the place that will allow them to best apply all their skills.  In addition, the Clinique has an ultra-modern technical platform, with a laboratory and a number of services, including conventional radiography, magnetic resonance imaging (MRI) , an operating block (managed by the doctor on duty) and specialisations – for instance, otorhinolaryngology (ORL) and orthopaedics (managed by a specialist). 

Ever since it was founded in 2003, the adult emergency service has been continuously improving  its patient care. These efforts met with success in June 2010, when the service obtained double certification: ISO 9001:2008 and GMP, Good Medical Practice. Because activity had reached 22,000 consultations a year for 2013 alone, the Clinique had to envisage moving the emergency service to the brand new building located right next to the route de Chêne. The move was positive for many reasons.  On the one hand, the adult emergencies service is now opposite the paediatric emergencies, which makes a lot of sense. On the other hand, the additional space allows for enhanced outpatient services, so the Clinique could open what amounts to a small day hospital.