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Classification: Official Publications approval reference: PAR38 Health Building Note 15-02: Facilities for same day emergency care/ambulatory emergency care Health Building Note 15-02: Facilities for same day emergency care/ambulatory emergency care Preface About Health Building Notes • “May” is used for permission, i.e. to indicate a course of action permissible Health Building Notes (HBNs) give best within the limits of the HBN or HTM. practice guidance on the design and planning of new healthcare buildings and Typical usage examples on the adaptation/extension of existing facilities. • “All publicly-funded organisations must ensure that all contracts They provide information to support the established to collect and treat waste briefing and design processes for individual conform to the Public Contracts projects in the NHS building programme. Regulations.” [obligation] • “All low voltage (LV) distributions Language usage in technical should be configured as TN systems.” guidance [recommendation] In HTMs and HBNs, modal verbs such as • “Alcohol hand gels that do not “must”, “should” and “may” are used to contain siloxanes may be rinsed out convey notions of obligation, and the packaging recycled or placed recommendation or permission. The choice into the municipal waste stream.” of modal verb will reflect the level of [permission] obligation needed to be compliant. “Shall”, in the obligatory sense of the word, The following describes the implications is never used in current HTMs/HBNs. and use of these modal verbs in HTMs/HBNs (readers should note that these meanings Project derogations from the may differ from those of industry standards Technical Guidance and legal documents): • “Must” is used when indicating Healthcare facilities built for the NHS are compliance with the law. expected to support the provision of high- quality healthcare and ensure the NHS • “Should” is used to indicate a Constitution right to a clean, safe and recommendation (not mandatory/ secure environment. It is therefore critical obligatory), i.e. among several that they are designed and constructed to possibilities or methods, one is the highest and most appropriate technical recommended as being particularly standards and guidance. This applies when suitable – without excluding other organisations, providers or commissioners possibilities or methods. invest in healthcare accommodation iiii (irrespective of status, e.g. Foundation and Sustainability and ‘Net Zero non-Foundation trusts). Carbon’ targets Statutory standards plus technical stand- Healthcare provision is a significant contrib- ards and guidance specific to NHS facili- utor to the UK’s carbon footprint. (In 2019, ties: this was estimated to be around 5.4% of our greenhouse gases.) Accordingly, all NHS • Health Building Notes organisations have their part to play in • Health Technical Memoranda meeting Net Zero Carbon targets alongside other sustainability measures. • Complete list of NHS estates related guidance In January 2020, Health chief Sir Simon Stevens announced three steps the NHS will The need to demonstrate a robust process take during 2020 to tackle this problem: for agreeing any derogation from Technical a. NHS England has established an Guidance is a core component of the expert panel to chart a practical business case assurance process. route map to enable the NHS to get to ‘net zero’; The starting point for all NHS healthcare b. the NHS Long Term Plan commits to projects at Project Initiation Document (PID) better use of technologies to make and/or Strategic Outline Case (SOC) stage is up to 30 million out-patient one of full compliance. appointments redundant, sparing Derogations to standards will potentially patients thousands of unnecessary jeopardise business case approval and will trips to and from hospital. It is only be considered in exceptional estimated that 6.7 billion road miles circumstances. A schedule of derogations each year are from patients and their will be required for any project requiring visitors travelling to the NHS; external business case approval and may be c. the panel will consider changes that requested for those that have gone through can be made in the NHS’s medical an internal approvals process. devices, consumables and While it is recognised that derogation is pharmaceutical supply, and areas the required in some cases, this must be risk- NHS can influence such as the energy assessed and documented in order that it sector as the health service moves to may be considered within the appraisal and using more renewable energy. approval process. Derogations must be properly authorised by the project’s senior responsible owner and informed and supported by appropriate technical advice (irrespective of a project’s internal or external approval processes). This guidance is not mandatory (unless specifically stated). However, any departures/ derogations from this HBN – including the measures implemented – should provide a degree of safety not less than that achieved by following the guidance set out in this HBN. iii Health Building Note 15-02: Facilities for same day emergency care/ambulatory emergency care Executive summary Same day emergency care (SDEC) is the This HBN specifies the rooms/areas that provision of patient care with an should be considered when planning and investigation and/or treatment within the designing an SDEC unit and also provides a same day for non-elective patients who in generic layout diagram (Appendix 1) the past would otherwise be admitted to a schedules of accommodation (Appendix 2) hospital bed. Under this care model, and room data sheets (Appendix 3). referred patients presenting at hospital with specific conditions can be rapidly The generic layout diagram in Appendix 1 assessed, diagnosed and treated without sets out an example arrangement of being admitted to an in-patient ward. services expected in such a facility. The schedules of accommodation list all the This Health Building Note (HBN) gives rooms, following the patient through the guidance on the planning and design of an SDEC, and giving the floor areas of each. An SDEC department. A well-designed SDEC SDEC Activity Calculator is also provided as unit will help to manage patients effectively an aid to calculating room sizes based on with minimal delays as they move through projected annual attendances. stages of care. Good patient flow is central to patient experience, clinical safety and The core recommendations are: reducing the pressure on staff. It is a key • Where possible, the SDEC facility factor in providing effective healthcare. should be close to a type 1 Emergency The HBN describes: Department. • the patient pathway – the route an • Patients should have access to individual will take through the SDEC; diagnostics within the same time frame as other emergency patients as • the essential and desirable adjacencies acuity and availability allows. – the prime links with other • The SDEC facility should have a departments (for example, Emergency combination of consulting rooms, Department); patient trolleys and chairs for patient • the functional relationships with other assessment and treatment. departments (for example, diagnostic • Beds should not be provided in an imaging). SDEC unit as it may have a negative impact on patient flow. The schedules of accommodation spreadsheet and SDEC Activity Calculator can be downloaded as separate files along with this document from the HBN 15-02 web page. iviv
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