26 September, London

1. Emergency Departments
Patient Flow Guidance
2017

2. Outcome
2
All patients to receive timely assessment
and clinically appropriate, high quality
care in the ED

3. Core Principles
• All patients streamed at front door by ED clinician
(nurse) to most appropriate area and clinician
• Streaming involves brief history and basic observations
if appropriate to support triage prioritisation in streams if
required. Should include NEWS and PEWS
• Streams include Resus, Majors, Minors, co-located
Primary Care, AEC, Fast Track pathways etc.
• ED should prioritise:
① Time critical / life threatening presentations
② Frail older people at risk of admission
③ Vulnerable people e.g. mental health patients

4. Staffing
• ED staffing should be planned to meet capacity
• Senior Dr ST4+ or equivalent should be present
24/7
• Deployment of ACPs / Allied Healthcare
Professionals in Emergency Departments is
strongly encouraged
• Internal Professional Standards should be made
with Specialties and wider hospital
• Close liaison / direct support to the ED from in-
taking specialties is essential (particularly in
periods of escalation)
4

5. Flow
• ED layout reviewed regularly to support flow
• GP referred patients should go direct to
relevant assessment service unless clinically
unstable
• Acutely unwell people with Frailty should be
identified at front door and managed by
appropriate clinician on most appropriate
pathway
• Patients should only be admitted if their
needs cannot be met elsewhere e.g. AEC
5

6. To Learn More
Patient Flow Guide
Patient Flow Case Studies
• Safer, faster, better: good practice in
delivering urgent and emergency care
Section 14
• Guidance on Initial Assessment in ED: RCEM
• Guidance to Internal Professional Standards
• Using safety checklists in Emergency
Departments
• Fast Track pathways: Laparotomy bundle