The Accident and Emergency Centre (i.e., Emergency Department) of the Korle-Bu Teaching Hospital serves as the receiving point for all trauma, medical and surgical emergencies. The department provides 24-hour emergency services and receives both referred and unreferred cases from within the capital, other regions as well as within the West African sub region. It serves as the main entry point for in-patient admissions to other departments such as Surgery and Internal Medicine and Therapeutics.
The current head of department is Dr. Frederick Kwarteng who doubles as the head of Trauma and Orthopedics. The staff in the department include medical officers, emergency medicine junior and senior residents, emergency medicine physicians and fellows. There are about 250 nurses in the department including emergency nurse specialists, emergency nurses and other caliber of nursing staff. The department also has pharmacists as well as other administrative staff all providing support.
Core Functions
Service
Provision of emergency care including resuscitation and stabilization of all surgical, trauma and medical patients admitted at the emergency unit. Emergency procedures including resuscitation, suturing, intubation, point of care ultrasound, chest tube insertion, central line insertion among others are carried out at the emergency department.
Training
The department has commenced emergency medicine residency for doctors under the Ghana College of Physicians and Surgeons (GCPS). This includes membership and fellowship trainings. The training started in 2021 with 3 residents under the membership program and 4 senior residents under the fellowship program. The centre also serves a training site for nurse residents pursuing emergency medicine nursing training under the Ghana College of Nurses and Midwives (GCNM).
Research
The department is rich with clinical data which is vital for the conduct of research. With the introduction of electronic medical records-LHIMS, data can easily be obtained.
Clinical Areas
The Accident and Emergency Centre has eight clinical areas. These are the triage area, casualty/trauma area, examination room/holding bay, pharmacy and four wards namely red, yellow, orange and CDU. Patients who are seen at the emergency are initially managed and stabilized by the emergency department doctors. Patients are then assigned to the various specialties such as internal medicine, surgery and its subspecialties, orthopedics and plastics based on their diagnosis. The various specialties then continue the management of the patients and transfer them to their wards for further management.
Patient Flow Through The Emergency Department
The triage area is the first point of entry. Patients who present to the emergency department are first seen at triage where their vital signs are taken. Triage is a systematic process of sorting patients based on their immediate presentation to ensure that they receive care on time. The South African Triage Scale (SATS) is used at the KBTH accident and emergency. The scale determines the urgency of the health condition using physiologic parameters and clinical discriminators. Physiologic parameters are measured using the Triage Early Warning Score (TEWS). Parameters used are blood pressure, heart rate, temperature, mobility, neurologic status and presence or absence of trauma. Patients with a TEWS >6 are designated red (emergency-should be seen immediately) a TEWS of 5 to 6 are designated orange (which means very urgent, needs attention within 10 minutes) a TEWS of 3 to 4 are designated yellow (means urgent, needs attention within 60 minutes, green (general case/routine, can be seen within 4 hours). The cdu (critical decision unit) ward serves as an overflow ward for the other three wards as well as for patients awaiting procedures/surgeries, discharge or transfer to the ward. Discriminant parameters such as hypoglycemia, seizures, chest pain, acute dyspnea can move a patient to a higher priority group. Green cases are directed to the Korle Bu Polyclinic for management.
