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 
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         (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.
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