Emergency department process

What constitutes emergency medical treatment?

The International Federation for Emergency Medicine defines emergency medical treatment as “where medical treatment is necessary because a person’s life or health is in serious danger as a result of disease, injury or ill health”.

“An emergency department is defined as “The area of a facility devoted to provision of an organized system of emergency care that is staffed by emergency medicine specialist physicians and/or emergency physicians and has the basic resources to resuscitate, diagnose and treat patients in emergencies.”

The triage process

Because the volume of patient admissions to an emergency department cannot be precisely planned, Netcare uses the South African Triage Scale for the assessment of all patients presenting at its emergency departments.

The aim of the triage system is to assess the severity of the condition of the patients and assign treatment priorities according to clinical urgency in order to ensure that staff members are able to deliver time-critical treatment for patients with life-threatening conditions. These individuals are triaged either red or orange.

The system uses a physiology and symptom-based scale, which gives the patient a score which is derived by assigning a number between 0 and 2 for each of the patient’s vital signs. The higher the score, the greater the urgency. The triage scale is used for all patients whether they are adults, children or infants presenting with medical, surgical or trauma conditions or injuries.

The South African Triage Scale uses a five-step approach to assess the patient:

• Look for emergency signs and ask for the presenting complaint
• Look for very urgent OR urgent signs
• Measure the vital signs and calculate the TEWS (triage early warning   score)
• Check key additional investigations
• Assign a final triage priority level

What information should the patient provide to the nurse conducting to assessment?

The process of triage starts with a question to the patient/parent/carer as to the reason for coming to the emergency department. As this question is being asked and answered the triage process has already commenced with the triage practitioner rapidly assessing the patient for any clinical signs indicating an emergency.

If ‘emergency’ clinical signs are detected, the patient is assigned as a P1 or Red priority level and taken to the resuscitation area without delay.

If ’emergency’ clinical signs are not present, the patient is checked for any ‘Very urgent’ or ‘Urgent’ clinical signs.

In all instances, the patient’s vital signs are measured, a triage early warning score (TEWS) is calculated, key additional investigations are checked and the triage priority is adjusted accordingly.

Emergency department fees

Netcare emergency departments support the principle that patients should be encouraged to use the healthcare system appropriately – non-urgent cases should be seen by general practitioners, family physicians or at walk-in care facilities rather than in the emergency department. The inappropriate use of emergency department services is one of the common problems leading to overcrowding.

Emergency care at Netcare emergency departments is provided by emergency practitioners who are in private practice, i.e. they are independent practitioners and not employed by the hospital.

Patients are entitled to ask for an estimation of the emergency department services costs and the cost of procedures. However patients should note that the final bill may well differ from the estimated cost, since it will depend on the actual care, treatment, procedures and consumables used for the procedures.

Medical scheme patients

The costs of your treatment in the case of a medical emergency should be covered by your medical scheme, but you should be aware that the often high costs of diagnosing your condition in an emergency situation may not always be covered.

Medical schemes are obliged, in terms of regulations under the Medical Schemes Act, to cover all medical emergencies because they fall under the prescribed minimum benefits (PMBs). Your medical scheme may refuse to cover the costs of your visit to an emergency department if the reason for your visit is not classified as an emergency.

Some medical schemes may require co-payments, to ensure that their members use the facilities appropriately and that they use facilities with which the medical scheme has contracted.

You will receive the following bills for your care at a Netcare emergency department.

• A bill from the hospital for the use of the facility (facility fee) and for all consumables used in the emergency department.
• A bill from the emergency doctor practice for the doctor consultation and procedures performed.

If other independent service providers – such as the radiology department, pathology laboratory, medical specialists and other healthcare professionals – have provided services to you, they will bill you separately for such services. 

Private patients

Private patients will be given an estimate for the proposed treatment plan required and will be required to place a deposit for medical management and settle the accounts of all service providers.

Symptoms or health problems to look out for after leaving the emergency department

The doctor and/or the nursing staff who have been involved in your treatment at the emergency department will guide you on symptoms or health problems to look out for after your discharge.

Netcare hospitals with emergency departments