A solid foundation is a must! Quality at a basic Accident and Emergency Department within a regional network

The Minister of Health, Welfare and Sport has asked the Health Council of the Netherlands for advice on one particular element that requires special attention: support facilities in hospitals with basic A&E departments. Given that the full range of specialist care and specialist facilities is not available in such hospitals, it is important to identify what is needed for the provision of proper emergency care. This topic has been addressed by a Health Council committee specially appointed for the purpose.

There are two central issues. Firstly, acute care must be accessible to patients. Secondly, patients must be taken to the right place, one where appropriate acute care is available to them.

These goals can only be achieved if all links in the chain of acute care, in each region, cooperate more closely with one another. Each region must focus on achieving the most effective division of labour between basic A&E departments, profile A&E departments, and the A&E departments at university medical centres. Binding regional agreements are the key. What is the minimum requirement in terms of available specialisms and facilities? Firstly, it is important that, where necessary, emergency room physicians can have rapid access to the following specialisms: gynaecology/obstetrics, surgery, internal medicine, cardiology, paediatrics, ENT surgery, neurology, anaesthesiology and radiology.

Supporting specialisms such as pharmacy, clinical chemistry, medical microbiology, and pathology must also be readily available. There must be a capability for rapid surgical intervention, so it is essential that an operating theatre team and an anaesthetist be available. Laboratory and X-ray facilities should also be readily accessible. There should also be a 24-hour postoperative care and observation unit for acute problems. This does not apply to intensive care. Patients requiring intensive care will have to be transferred to a profile hospital or university hospital.

Committee

• Prof. J.J. Heimans, Professor of Neurology, VU University Medical Center, Amsterdam, chairman
• Prof. H.J.J.M. Berden, Professor of Hospital Organisation and Development, Management Board, Elisabeth Hospital, Tilburg
• Prof. R.O.B. Gans, Professor of Internal Medicine, University Medical Centre, Groningen
• Prof. J.G. van der Hoeven, Professor of Intensive Care, St. Radboud University Medical Centre, Nijmegen
• Dr. A. de Jonge, Primary-care Obstetrician, VU University Medical Center, Amsterdam
• Prof. C.J. Kalkman, Professor of Anaesthesiology, University Medical Centre, Utrecht
• Prof. J.J. Krabbendam, Emeritus Professor of Technical Management and Organisational Science, University of Twente, Enschede
• Prof. D.A. Legemate, Professor of Vascular Surgery, Academic Medical Centre, Amsterdam
• Dr. E.P. Moll van Charante, GP, Academic Medical Centre, Amsterdam
• Prof. H.A. Moll, Professor of Paediatrics, Erasmus Medical Centre, Rotterdam
• Prof. J.G. Nijhuis, Professor of Obstetrics and Gynaecology, University Medical Centre, Maastricht
• Prof. I. Schipper, Professor of Traumatology, Leiden University Medical Centre
• P. van der Torn, Physician, Stichting Werkgemeenschap tussen Techniek en Zorg, Rotterdam
• Dr. M.C. Visser, Neurologist, VU University Medical Center, Amsterdam
• Prof. F. Zijlstra, Professor of Cardiology, Erasmus Medical Centre, Rotterdam
• F. Bandhoe, Ministry of Health, Welfare and Sport, The Hague, observer
• J. Boer, Ministry of Health, Welfare and Sport, The Hague, observer
• Dr. S. Kunst, Health Council of the Netherlands, The Hague, scientific secretary
• Dr. C.A. Postema, Health Council of the Netherlands, The Hague, scientific secretary