RCEM: Patients will die unless care in Emergency Departments is reset

6 May 2020

The Royal College of Emergency Medicine (RCEM) today warns that returning to the old model of Emergency Care will put lives at risk and calls for a reset in how care is delivered.

In its position statement ‘COVID-19: Resetting Emergency Department Care’, RCEM sets out recommendations on how to prevent further transmission of coronavirus in Emergency Departments (EDs), streamline emergency care and build on the current temporary practices to save lives.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “Going back to how we used to operate is not an option – patients will die if we do.

“It was just four months ago when we were seeing overcrowding on a record scale in Emergency Departments. It was unacceptable then and put lives at risk; to go back to that now will lead to avoidable patient and staff illness or death.

“If departments are crowded, we cannot protect patients and staff. Crowding has long been associated with avoidable mortality, and COVID-19 reinforces and multiplies this risk.

“We must have a way to enforce social distancing in Emergency Departments to ensure that patients do not become infected while seeking healthcare. If supermarkets can get this right, then the very institution that people entrust with their health must do so too. 

“There is a need for wholesale change while embracing the new practices we’ve seen during this crisis, with patient and staff safety at the forefront of thinking. Our position statement outlines what we must achieve and the areas to focus on to get us there.”

The five fundamental aims outlined in ‘COVID-19: Resetting Emergency Department Care’ are:

  1. Emergency Departments must not become reservoirs of nosocomial infection for patients
  2. Emergency Departments must not become crowded ever again
  3. Hospitals must not become crowded again
  4. Emergency care must be designed to look after vulnerable patients safely
  5. Emergency Departments must be safe workplaces for staff.

Dr Henderson said: “As we move beyond the peak of this outbreak, now is the time to act to ensure patient safety is never jeopardised again through poor infection control, design, physical crowding, inadequate staff protection, and corridor care.

“The NHS has coped magnificently so far despite facing many challenges, not least the supply of PPE, but has demonstrated an ability to optimise the delivery of care that puts patient safety first. We must learn from this response.

“We have seen a rapid expansion of bed capacity, appropriate levels of staffing, a breaking down of barriers with less siloed working – different parts of the hospital working better together than ever before, changed discharge practices for medically fit patients, better use of Same Day Emergency Care, and better utilisation of NHS 111. All of this has resulted in a much more responsive emergency care system.

“While COVID-19 remains with us we need to continue to do things differently. Emergency Departments must return to their original core purpose: the rapid assessment and emergency stabilisation of seriously ill and injured patients. They can no longer be used to  cover where community, ‘out of hours’, or specialist care has struggled to cope. The challenge that this presents to Emergency Departments is going to have parallels across the health system and we recognise this. This will need leadership and active support at national, regional and local level, together with changes in behaviour from both the public, and the wider health system.

“We have already begun to see this behaviour change in the drop off in attendances of those with lower risk issues and the increase in numbers of people calling NHS 111 or national equivalents. Those with serious concerns should continue to use their ED, but if they get advice that the situation isn’t an emergency, we do need those patients to use alternative services - for their own sake and that of others. We must ensure these pathways are there and viable for all.

“Infection prevention and control measures will need rapid implementation if we are to avoid the horror of a patient who has been safely isolating for weeks but then needs emergency care, has to come to the Emergency Department and by doing so, catches Covid-19 and comes to harm. That is a scenario that we must not allow to happen.

“We will need levels of PPE appropriate to the risks of working with undifferentiated patients and an understanding that work will take longer due segregation of departments and the donning, doffing and disposal of PPE.

“There are many actions we need to see happen while COVID-19 is endemic, and action must be fast. We know it can be done.

“For years, the College has called for an increase in bed capacity; the effort to increase it at pace during this crisis has been unprecedented but has shown that it can be done quickly. This has been possible because the Community and social care has been able to get patients out of hospital beds. This is only sustainable if there is a proper plan for investing in Primary and Social care going forward.

“In many areas this crisis has shown that where there is a will there is a way. By taking on board and acting on our recommendations policy makers will continue to show their will to save lives; together as the NHS we can find the way.”

-ENDS-

Notes to Editors
The five fundamental aims outlined in ‘COVID-19: Resetting Emergency Department Care’ are:

  1. Emergency Departments must not become reservoirs of nosocomial infection for patients
  2. Emergency Departments must not become crowded ever again
  3. Hospitals must not become crowded again
  4. Emergency care must be designed to look after vulnerable patients safely
  5. Emergency Departments must be safe workplaces for staff.

There are six key areas to ensure safety:

  1. Improved infection control
  2. Reducing crowding and improving safety
  3. Patients already under the care of specialist teams
  4. Physical Emergency Department redesign
  5. Using COVID-19 testing for best care
  6. Metrics to support reduced crowding.

Each key area has several recommendations which can be read in full in the position statement.