Accessibility requirements

As attendance in an emergency department is not planned, people with disabilities will not have let the hospital know in advance of any support needs.

“The infrastructure of each facility in the ECN (Emergency Care Network) must meet the needs of patients with a physical disability, thus ensuring they are cared for in a safe environment.

Emergency Department infrastructure should also accommodate patients’ family members, carers, Emergency Department staff and other hospital staff who have physical disability.”¹⁶ In addition

to an accessible treatment space, equipment can also be helpful. Examples include a height-15 See The National Emergency Medicine Programme – A strategy to improve safety, quality, access and value in Emergency Medicine in Ireland - Section 21.5.1.1, Patient Passport and Section 21.5.1.2, Acute needs assessment.

16 See The National Emergency Medicine Programme – A strategy to improve safety, quality, access and value in Emergency Medicine in Ireland - Section 21.6 People with Physical Disability

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adjustable trolley or examination couch, and hoists to assist a wheelchair user to safely move onto an adjustable trolley / examination couch from their wheelchair.

It is part of essential care to ensure that patients are hydrated, that basic comfort needs are met and that any additional interventions are undertaken to prevent the risk of build-up of pressure sores, particularly if they have to wait on a trolley for more than two hours.

A person with a disability may have specific support needs around basic activities, such as eating, drinking, turning to prevent pressure sores or going to the bathroom. For example, if a person is in the emergency department for long periods of time on a trolley, they may need to be turned regularly to prevent the risk of pressure sores, or they may need assistance with any feeding and hydration required.

This support is especially important if the person does not have a family member, personal assistant or care worker with them. However, even if they are available and may wish to assist in the process, family carers and other support persons should never be used to replace general nursing or medical care staff.

While many of the support needs around basic activities will be routinely met as part of the professional standards adhered to by staff providing essential care, staff may need to be made aware of specific needs during handover processes, and other disciplines of staff may need guidance on their role. In a busy emergency department, it is important to ensure that specific requirements of someone with a disability are not overlooked.

• Ensure that relevant staff have received appropriate training to assist

• Handover between staff in different disciplines should routinely include a briefing on specific accessibility needs

• Where necessary, develop an agreed approach to ensure that specific care needs are managed at appropriate intervals as required

The emergency department staff may need to liaise with appropriate services to identify specific needs. This might include the person’s GP or specialist (for example, the psychiatric team or community mental health team) or their disability support service. See Section 16 of the National EMP Strategy for information on the roles of therapy professionals and medical social workers in emergency care including physiotherapists, occupational therapists, orthoptists, speech and language therapists, dieticians, podiatrists and medical social workers.

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See Guideline 4: Communication for more information on communicating with patients and service users with specific disabilities.

If admitted to hospital, it is essential that a person’s accessibility requirements are passed on to all relevant staff, including receptionists, porters and catering staff. Inform the person with a disability of any information that is being passed onto other staff or service providers.

11.4 Waiting to be seen

“Emergency Department clinicians and hospitals have a duty of care to patients who may need to be accommodated in a waiting room area.” See Section 19.9.2. Recommendations for Patient Care in Emergency Department Waiting Rooms of the National EMP Strategy.

Use this time as an opportunity to find out if there are any specific requirements while the person is waiting.

The triage process will identify the priority in the treatment of patients, based on the severity of their condition which can lead to delays for other patients.

Some patients and service users may experience significant distress or anxiety in unfamiliar, crowded or noisy environments; for example, a person with a mental health difficulty, an acquired brain injury, an intellectual disability or a person with dementia. If the Emergency Department has the space and/or capacity, the following measures may be helpful for service users in this situation.

However, it should be noted that these suggestions are not to provide a person with a disability a preferential service over any other patient or service user, but rather to ensure that compassion is shown in a situation where a person’s disability directly leads to significant distress or anxiety which could be alleviated. Please note, the following suggestions are dependent on local resources:

• Ask a person if they would prefer to wait in a quiet room / elsewhere and call them when their turn is near

• Inform a person if there is to be a long wait and how long it will be, if this is known. This may allow them an opportunity to go away and get a cup of tea or a meal. Send a text message or call them on their mobile phone if they are near the top of the queue

Make sure that systems are in place to ensure that people are informed appropriately when it is their turn to be seen if they have impaired vision or are Deaf, hard of hearing or deafblind.

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• Where possible, plan to have both spoken and visual announcements

• If this is not possible, people with impaired vision can be alerted by a gentle tap on their shoulder or arm

• People who are Deaf or hard of hearing can be alerted visually by a hand movement, such as a discreet wave, or by tapping the person gently on their shoulder or arm

If there is a television in the emergency department waiting room, make sure that it displays subtitles and can be accessed by people who are Deaf or hard of hearing.