Doh Standard For Emergency Departments
Doh Standard For Emergency Departments
Doh Standard For Emergency Departments
EMERGENCY DEPARTMENTS
AND URGENT CARE CENTERS
June 2021
Document Title DOH Standard for Emergency Departments and Urgent Care Centers
1. Purpose
The purpose of this Standard is to:
1.1. Define the types and levels of Emergency care recognized in Abu Dhabi;
1.2. Define the licensing requirements and minimum service specifications and requirements for
Emergency and Urgent Care Departments in the Emirate of Abu Dhabi that healthcare providers
are required to comply with to be able to provide high quality emergency care; and
1.3. List specific duties that healthcare providers, insurers and TPAs that provide emergency care
must comply with.
2. Scope
This Standard applies to all healthcare providers, public and private, licensed by DOH in the Emirate of
Abu Dhabi that wish to provide and operate emergency department and urgent care services.
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3. Definitions
3.1. ACLS: Advanced Cardiac Life Support.
3.2. ATLS: Advanced Trauma Life Support.
3.3. CASMEET: is a mnemonic acronym used by emergency medical services to communicate the
important details of a patient over to an emergency control center, receiving hospital, or other
definitive care provider.
• Call — sign of the vehicle/unit responding.
• Age — patient's age.
• Sex — whether the patient is male or female.
• Mechanism/Mode — the mechanism of injury or the mode of illness.
• Examination — the clinical findings from the initial assessment of the patient.
• ETA — estimated time of arrival.
• Treatment — any treatment that has already been provided.
3.4. City Definition: city is regarded as an urban area with population of more than 75,000. (1,2)
3.5. CBRNE : Chemical, Biological, Radiological, Nuclear, Explosive.
3.6. Emergency Department: Facilities in a hospital devoted to providing emergency medical care for
all.
3.7. Emergency Medical Care: Patient care for a medical or surgical emergency condition.
3.8. Emergency Condition: An emergency medical condition is defined as "a condition manifesting
itself by acute symptoms of sufficient severity (including severe pain) such that the absence of
immediate medical attention could reasonably be expected to result in placing the individual's
health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily
functions, or serious dysfunction of bodily organs." (3).
3.9. Emergency Medicine:
As per the American College of Emergency Physicians definition used in this Standard,
“Emergency medicine is the medical specialty dedicated to the diagnosis and treatment of
unforeseen illness or injury. It encompasses a unique body of knowledge. The practice of
emergency medicine includes the initial evaluation, diagnosis, treatment, coordination of care
among multiple providers, and disposition of any patient requiring expeditious medical, surgical,
or psychiatric care”. (4)
3.10. Maternity Emergency Department: Facilities in a hospital devoted to providing emergency
maternity care.
3.11. Medical or Surgical Emergency: Injury or illness that occurs suddenly or unexpectedly and
poses an immediate risk /threat to a person’s life, limb, body function or long-term health.
3.12. Medical Screening Examination: The medical screening examination aim to determine if the
patient condition needs urgent attention or patient is stable and safe to seek treatment in
another facility of their choice where they are covered and is to be performed by licensed
medical practitioner or equivalent. Medical screening examination may include some testing to
reach the conclusion of medical stability. (5).
3.13. NCEMA: National Emergency, Crises and Disasters Management Authority.
3.14. NRP: Neonatal Resuscitation Program
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3.15. PALS: Pediatric Advanced Life Support.
3.16. PAT: Pediatric Assessment Triangle (PAT)
3.17. Pediatric Emergency Department: Facilities situated in a hospital devoted to providing
pediatric emergency medical care for children up to the age of 16.
3.18. Planned Care: Care that is scheduled in advance.
3.19. Remote Emergency Department: An Emergency Department that is more than 100 km
distance away from city with population more than 15,000 and annual emergency department
visits more than 10,000 patients. (2)
3.20. TPAs: Third Party Administrators.
3.21. T1, T2, …T5: Triage categories based on 5 level Triage system where T1 is critically ill and
needs immediate attention by healthcare provider and T5 is non-acutely ill and can wait to be
seen when health care provider is available.
3.22. The Emergency Severity Index (ESI): is a five-level emergency department (ED) triage
algorithm that provides clinically relevant stratification of patients into five groups from 1 (most
urgent) to 5 (least urgent) on the basis of acuity and resource needs. (Agency for Health
Research and Quality).
3.23. Urgent Care Centers: Facilities in a hospital that provide initial evaluation, stabilization,
diagnostic capabilities to treat the least minor injuries and illnesses and transfer to a higher
level of care if needed.
5. Emergency Departments and Urgent Care Centers Service Specifications and Requirements
Healthcare Providers that wish to operate Emergency Departments and Urgent Care services must:
5.1. Comply, with all service requirements found in Comply with all the service requirements found in
Appendix 1, Appendix 2, Appendix 3, Appendix and Appendix 5.
5.2. Comply with the specific duties found in Section 6 of this Standard.
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6.1.2.1. Provide medical screening examination and/or stabilizing treatment to all T1 and
T2 patients without delay in order to inquire about payment status and ensure
that assessment is documented on the patient’s medical records.
6.1.2.2. Provide T3, T4 and T5 patients’ medical screening examination beyond initial
triage. Triage is not equivalent to a Medical Screening Examination. Triage merely
determines the “order” in which patients will be seen, not the presence or
absence of an emergency medical condition. The medical screening examination
is to be performed by licensed medical practitioner or equivalent with the aim to
determine if the patient condition needs urgent attention or patient is stable and
safe to seek treatment in another facility of their choice where they are covered.
Medical screening examination may include some testing to reach the conclusion
of medical stability.
6.1.2.3. If a patient’s insurance does not cover ongoing treatment at the receiving hospital
but the patient requires further urgent medical or surgical intervention and is
stable and safe to transfer to another hospital, the receiving hospital should seek
advice and guidance from the patient’s insurance company to identify an
appropriate transfer location. If an alternative, appropriate location is not
identified or available the insurance company must reimburse the receiving
hospital until the transfer is complete. If the patient refuses the transfer then the
patient shall commit to cover all treatment cost and seek insurance refund
afterwards.
6.1.2.4. For those patients not deemed as a medical emergency, in line with the definition
in Section 3.7, the Emergency Department may, following medical screening
exam and where clinically documented as safe to do so, discharge the patient and
advise the patient where they might get the appropriate non-emergency medical
treatment.
6.1.2.5. For patients who do not have health insurance the hospital should recover the
medical expenses direct from the patient, his sponsor, or include it under activity-
based mandates as per the rules and regulations without jeopardising the delivery
of 6.1.2.
6.1.2.6. For patients who refuse medical screening and decide to leave the facility:
• Provide an explanation of the risk of their actions.
• If they insist on leaving, they must sign a “Leaving against medical advice”
form. In case of refusal, the healthcare provider shall document that clearly.
6.1.3. When unable to treat or when not designated by DOH regulation to treat,1 the healthcare
facility must provide an appropriate transfer of an unstable individual to another medical
facility after obtaining the consent of the receiving hospital to accept the transfer.
1
For transfers of Burns, Pediatric, STEMI and Stroke time critical emergencies please refer to DOH triage protocols.
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6.2.1. Reimburse the emergency treatment provided regardless of whether the hospital is in its
insurance network.
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8. Appendix 1: Licensing Requirements and Minimum Service Specifications for Emergency
Departments
Emergency Departments
Open 24hours a day, seven days a week with access to comprehensive emergency
services.
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• The ED shall be led by an Emergency Medicine Consultant. All the staff working in
the ED inclusive of physicians, nursing and non-clinical support staff shall report to
the ED lead.
• At least one Consultant/Specialist in Emergency Medicine per shift.
• All physicians working in the ED with General Practitioner license, specialist
license in Internal medicine or General surgery, need to maintain active
certification in adult, pediatric and trauma resuscitation (ACLS, PALS, ATLS).
Physicians with Emergency Medicine License are exempted from having active
3. Clinical certification.
Staffing • Availability of appropriate mix of multidisciplinary emergency care team, its
members possessing the requisite levels of knowledge and skills in accordance
with their role in providing emergency care to patients of varied acuity levels, and
that staff receive appropriate and up to date training to support quality and safe
emergency care.
• Pediatric Emergency area can be staffed by trained pediatrics emergency
physician (consultant or specialist), trained emergency medicine physicians
(consultant or specialist) or pediatricians with experience in emergency medicine
of no less than 5 years.
• The ED must have processes and policies in place to ensure proper coordination
with incoming ambulances including receiving patient’s condition ahead of arrival
using CASMEET format; and provide medical advice if requested by the
ambulance.
4. Admission &
Handover • Policies and procedures to ensure that all in-patient services listed under "Access"
are available, including consultations and therapies to reduce time to definitive
treatment, as soon as hospital admission is requested.
• Staff scheduling must be designed to ensure safe handover.
• ED quality and safety committee to monitor, assess and improve performance and
report on adverse incidents.
5. Quality &
Safety • Undertake regular clinical audits and review
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7. Patient
Referral, The facility will have in place a patient referral and transfer process
Retrieval &
Transfer
Emergency Department Signage Patient information is appropriate to the facilities
scope of services.
8. Signage &
Patient All Emergency Departments are expected to display the correct signage which is
information published on DOH website on this link https://www.doh.gov.ae/featured/new-
standard-for-healthcare-facilities-emergency-departments-in-abu-dhabi.aspx
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9. Appendix 2: Licensing Requirements and Minimum Service Specifications for Pediatric
Emergency Departments
• The ED must have processes and policies in place to ensure proper coordination with
incoming ambulances including receiving patient’s condition ahead of arrival using
CASMEET format; and providing medical advice if requested by the ambulance.
4. Admission & • Policies and procedures to ensure that all in-patient services listed under "Access"
Handover are available, including consultations and therapies to reduce time to definitive
treatment, as soon as hospital admission is requested.
• Staff scheduling must be designed to ensure safe handover.
• ED quality and safety committee to monitor, assess and improve performance and
report on adverse incidents.
5. Quality & Safety
• Undertake regular clinical audits and review
7. Patient Referral,
The facility will have in place a patient referral and transfer process
Retrieval &
Transfer
8. Signage & Emergency Department Signage Patient information is appropriate to the facilities scope
Patient
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information of services.
All Emergency Departments are expected to display the correct signage which is
published on DOH website on this link https://www.doh.gov.ae/featured/new-standard-
for-healthcare-facilities-emergency-departments-in-abu-dhabi.aspx
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10. Appendix 3: Licensing Requirements and Minimum Service Specifications for Maternity
Emergency Departments
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• The Maternity Emergency Department shall be led by an Obstetric Consultant. All the
staff working in the Maternity Emergency Department inclusive of physicians, nursing
and non-clinical support staff shall report to the Maternity Emergency Department
lead.
• At least one Consultant/Specialist in Obstetrics per shift.
3. Clinical Staffing • All obstetricians and neonatologists need to maintain active certification in adult and
neonatal resuscitation (ACLS, NRP).
• Availability of appropriate mix of multidisciplinary emergency care team, its members
possessing the requisite levels of knowledge and skills in accordance with their role
in providing emergency care to patients of varied acuity levels, and that staff receive
appropriate and up to date training to support quality and safe emergency care.
• The maternity Emergency Department must have processes and policies in place to
ensure proper coordination with incoming ambulances including receiving patient’s
condition ahead of arrival using CASMEET format; and provide medical advice if
requested by the ambulance.
4. Admission &
Handover • Policies and procedures to ensure that all in-patient services listed under "Access"
are available, including consultations and therapies to reduce time to definitive
treatment, as soon as hospital admission is requested.
• Staff scheduling must be designed to ensure safe handover
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11. Appendix 4: Licensing Requirements and Minimum Service Specifications for Remote
Emergency Departments
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• There is at least one room designated as the “Resuscitation” room.
2. Structure • There is a Helicopter Landing Site (HLS) readily accessible from the Emergency
Department. The HLS should conform to Civil Aviation Authority standards.
• The ED shall be led by an Emergency Medicine Consultant. All the staff working in
the ED inclusive of physicians, nursing and non-clinical support staff shall report to
the ED lead.
• At least one Consultant/Specialist in Emergency Medicine per shift.
• All physicians working in the Remote ED need to maintain active certification in
adult, pediatric and trauma resuscitation (ACLS, PALS, NRP, ATLS). Physicians with
Emergency Medicine License working in Remote area only and not covering shifts in
tertiary or secondary hospitals are included.
4. Clinical Staffing • Availability of appropriate mix of multidisciplinary emergency care team, its
members possessing the requisite levels of knowledge and skills in accordance with
their role in providing emergency care to patients of varied acuity levels, and that
staff receive appropriate and up to date training to support quality and safe
emergency care.
• Pediatric Emergency area can be staffed by trained pediatrics emergency physician
(consultant or specialist), trained emergency medicine physicians (consultant or
specialist) or pediatricians with experience in emergency medicine of no less than 5
years.
• The ED must have processes and policies in place to ensure proper coordination
with incoming ambulances including receiving patient’s condition ahead of arrival
using CASMEET format; and provide medical advice if requested by the ambulance.
5. Admission &
Handover • Policies and procedures to ensure that all in-patient services listed under "Access"
are available, including consultations and therapies to reduce time to definitive
treatment, as soon as hospital admission is requested.
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• Staff scheduling must be designed to ensure safe handover.
• ED quality and safety committee to monitor, assess and improve performance and
report on adverse incidents.
6. Quality & Safety
• Undertake regular clinical audits and review
8. Patient Referral,
The facility will have in place a patient referral and transfer process.
Retrieval &
Transfer
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12. Appendix 5: Licensing Requirements and Minimum Service Specifications for Urgent Care
Centers
1. Access
• Provision of urgent care services to be in an appropriate location and in an
environment that is safe and that supports all age groups, considering disability
access.
• Availability of hospital wide escalation policy for when an urgent care center is
approaching full and the associated risks. Criteria for escalation should be
determined locally.
• The Urgent Care Center shall be Consultant led. All the staff working in the Urgent
Care Center inclusive of physicians, nursing and non-clinical support staff shall
report to the Urgent Care Center lead.
• At least one Consultant/Specialist or GP per shift.
• All Urgent Care Center physicians need to maintain active certification in adult and
3. Clinical Staffing pediatric resuscitation (ACLS, PALS).
• Availability of appropriate mix of multidisciplinary Urgent Care team, its members
possessing the requisite levels of knowledge and skills in accordance with their role
in providing Urgent Care to patients and that staff receive appropriate and up to
date training to support quality and safe urgent care.
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• Urgent Care Center quality and safety committee to monitor, assess and improve
performance and report on adverse incidents.
5. Quality & Safety
• Undertake regular clinical audits and review
6. Patient Referral,
The facility will have in place a patient transfer and retrieval agreement per the DOH
Retrieval &
Standard for Inter-facility patient transfer
Transfer
Urgent Care Department Signage Patient information is appropriate to the facilities
scope of services.
7. Signage & Patient All Urgent Care Centers are expected to display the correct signage which is published
information on DOH website on this link
https://www.doh.gov.ae/featured/new-standard-for-healthcare-facilities-emergency-
departments-in-abu-dhabi.aspx
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13. Appendix 6: Key Performance Indicators for Emergency Departments
The Indicators are reviewed and developed annually by the DOH Quality Division with support from local
and international emergence care expertise.
All DOH waiting time guidance can be accessed on this link (JAWDA Quarterly Waiting Time Guidelines for
Specialized and General Hospitals):
https://www.doh.gov.ae/resources/jawda-abu-dhabi-healthcare-quality-index
DOH may revise and update these metrics taking into consideration service needs, performance and
population health challenges.
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14. References
1. List of cities in UAE [Internet]. [cited 2020 Dec 22]. Available from:
http://www.dubaifaqs.com/list-of-cities-uae.php
2. Australian College of Rural and Remote Medicine. Recommended Minimum Standards for small
rural hospital emergency departments [Internet]. 2019 Dec. (Version 02/19 SM). Available from:
https://www.acrrm.org.au/docs/default-source/all-files/college-standards-for-small-rural-
hospital-emergency-departments.pdf?sfvrsn=7b50f7b_6
3. EMTALA Fact Sheet [Internet]. [cited 2020 Dec 22]. Available from: https://www.acep.org/life-
as-a-physician/ethics--legal/emtala/emtala-fact-sheet/
4. Definition of Emergency Medicine [Internet]. [cited 2020 Dec 22]. Available from:
https://www.acep.org/patient-care/policy-statements/definition-of-emergency-medicine/
5. Best Practices – Medical Screening Exam [Internet]. [cited 2020 Dec 22]. Available from:
https://www.acep.org/how-we-serve/sections/freestanding-emergency-centers/news/june-
2015/best-practices--medical-screening-exam/
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