Planning any development to an endoscopy service will depend on the environment under consideration. Whether a new build, refurbishment of an existing service or of an adjacent area there is no one size that fits all in respect of what plans should look like. However, within the financial implications of any development there are principles to be considered that will ensure a JAG compliant service.
This guidance is not exhaustive but provides useful suggestions when planning alterations to a service. It should be read in association with the environment guidance and consideration of the listed resources (see appendix) that will help in the planning phase.
Involve all key stakeholders
It is important to involve all key stakeholders in the planning phase. In addition to the medical, nursing and admin team, planning should include patient representation, the infection prevention team and any other potential users of the service. Perspectives of all stakeholders whether aspirational or otherwise will ensure that all aspects of the service are considered. It is not uncommon to neglect important considerations such as storage, equipment flows and staff facilities (changing areas, rest rooms).
The most critical consideration is to ensure that plans are modelled against a robust analysis of the current activity and projected service growth, to ensure that they are future proofed against ongoing expansion. Even where rooms may not be immediately commissioned, inclusion in plans at the build/refurbishment stage will be financially viable in the long term and empty spaces can support other functions in the interim.
Use of space
Start planning by looking at the floor space/site available. Imagining an empty space with just the retaining walls, start by brainstorming the layout of the unit or alterations you would like to see in an ideal world. JAG recommends letting as many people as possible undertake this exercise, and recommends a ‘workshop’ type event to gather feedback. All proposals should be reviewed and the numbers of rooms, facilities and flows should be considered. The number of options can then be narrowed down to reduce those presented. Architects can then be involved in looking at scale and what is feasible and practicable.
Creating a one-way flow in the patient pathway from admission to discharge creates a calmer environment. The flow of inpatients, staff, endoscopes (between the procedure room and the reprocessing unit) and other services (including waste) through the service should be considered. Mapping each pathway on plans early on will help to identify bottlenecks or areas where pathways cross.
Gender separation applies in England only. JAG advises that all nations consider this option if undertaking a new build to future proof against any policy changes.
Separation of clinical from non-clinical areas
There should be clear separation of clinical and non-clinical areas. This means creating separation of areas accessed by relatives and friends from those accessed by patients and staff. It also means ensuring that patient areas (such as recovery) are not used as a thoroughfare by non-essential staff to access areas within the service, including office space. Meeting rooms and offices should be situated where they can be accessed without entering patient areas. The environment guidance gives more detailed information on what is considered as acceptable separation. Consideration should be given in particular to where admission and second stage discharge will be situated to allow the presence of relatives/friends at these stages.
Access and security
In separating clinical from non-clinical areas consideration must be given to how access to clinical areas is secured effectively. This includes but is not limited to access to the unit or clinical area from the reception area, access to procedure rooms and access into the decontamination area including where endoscopes are stored.
Location of decontamination
Moving decontamination services out of a unit may provide the space to create an additional procedure room. Whether centralising decontamination or keeping it within the unit it is imperative to ensure that the impact on the service and ability to provide sufficient decontaminated equipment in a timely fashion is considered. The service should consider:
- Governance and management arrangements – If decontamination is centralised then policies should reflect joint responsibilities (noting that it is the responsibility of the endoscopist to ensure that the endoscope they are using is fit for purpose).
- Sufficient numbers of endoscopes – To provide sufficient equipment for both the immediate and long term increases in capacity.
- Sufficient numbers of Endoscope Washer Disinfectors (EWDs) - That allow for timely turn around of instruments factoring in planned preventative maintenance and down time.
- Movement of endoscopes off the unit – If scopes are being moved off the unit, ensure that they are stored and transported safely and securely and in a timely fashion.
Advice and algorithms for setting up a decontamination service can be found in the HSE document (see appendix)
Consideration should be given to smaller details which should be included in any planned changes. This is not an exhaustive list but should include consideration of things such as:
- The number and position of sockets including IT access points.
- The safety and security of trailing cables (particularly in the procedure rooms)
- Positioning and access to call bells.
- Appropriate accessible storage.
- That all surfaces are of medical grade, wipeable quality.
- Doors – opening and release to facilitate ease of trolley movement.
- Numbers of and access to toilet facilities.
- Access and storage of medical gases (including piped access to procedure rooms and recovery areas)
- Air handling units and ventilation requirements
Health Service Executive (Oct 2017) Health Service Executive Standards and Recommended Practices for Facility Design and Equipping of Endoscope Decontamination Units https://www.hse.ie/eng/about/who/qid/nationalsafetyprogrammes/decontamination/hse-standards-and-recommended-practices-for-facility-design-and-equipping-of-edus-qpsdd022.pdf
Department of Health (2007) Health Building Note 10-02: Day surgery facilities https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/142696/HBN_10-02.pdf
Department of Health (2009) Health Building Note 11-01: Facilities for primary and community care services https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2014/07/health-build-pc.pdf
HEALTH BUILDING NOTE 52 VOLUME 2 Accommodation for day care Endoscopy unit 1994 (revision note 2013) http://www.wales.nhs.uk/sites3/documents/254/HBN%2052%20Vol2%203217269.pdf