Local Guidance
This page contains guidelines, proformas and discharge advice produced by Emergency Departments (EDs) that can be downloaded and adapted for local use by other EDs. These resources are not endorsed by RCEM and have not been reviewed for quality or clinical suitability. If you would like to recommend guidelines for publication here or have any other queries in regards to local clinical guidelines, please email Sarah.Morrissey@rcem.ac.uk.
Click on these links to jump to the section you require:
COVID-19 (Coronavirus)
Adult Guidelines / Protocols
Paediatric Guidelines / Protocols
Discharge Advice
Initial Assessment Tools
If your ED has completed local guidance, protocols, assessment tools or discharge advice and would like to share with others for local adaption please contact us. Please note that this information has not been checked or endorsed by RCEM.
- NEW: Infection Prevention and Control Guidance (Public Health England, August 2020)
- Adult ED clerking form for respiratory patients (London Northwest University Healthcare NHS Trust, April 2020)
- Adult ED covid guidance for families and friends in 16 different languages (London Northwest University Healthcare NHS Trust, April 2020)
- Adult ED covid guidance for patients in 16 different languages (London Northwest University Healthcare NHS Trust, April 2020)
- Adults ER Drill: Team Comms wearing AGP PPE (Leicester Royal Infirmary ED, May 2020)
- Adult ED guidance tool for respiratory patients (London Northwest University Healthcare NHS Trust, April 2020)
- Adult Escalation Plan for Patients with confirmed/suspected COVID19 (Guy's and St Thomas', March 2020)
- Adults MDT Sim Scenario: COVID-19 (Leicester Royal Infirmary ED, May 2020)
- Adult Streaming and Triage Tool (Guy's and St Thomas', March 2020)
- Antibody testing for staff - information pack (Guy's and St Thomas', May 2020)
- Assessment and Triage of Patients with Suspected COVID-19 (Mid Yorkshire Hospital NHS Trust, May 2020)
- Compilation of Letters to COVID19 Patients (CherryGodMother, April 2020)
- Conscious Proning during COVID-19 Outbreak (Worcestershire Royal Hospital, April 2020)
- Coronavirus ED pathway tool (Royal Free, April 2020)
- Coronavirus ED patient information leaflet (Addenbrookes, March 2020)
- COVID19 ED Care Record tool (Royal Free, April 2020)
- Dental Trauma First Aid (J Smallridge, 2020)
- Dental Trauma First Aid - quick guide leaflet(J Smallridge, 2020)
- Diabetic Ketoacidosis/Hyperosmolar Hyperglycaemic State (Guy's and St Thomas', April 2020)
- ED COVID-19 Optimiser (Whittington Health NHS Trust, April 2020)
- Emergency Department COVID-19 adult management (Walsall Healthcare Trust, April 2020)
- Emergency Department COVID19 plan (abbreviated (NHS Forth Valley, March 2020)
- Emergency Department Clinical Tool for COVID19 (Royal Surrey, March 2020)
- Excess Death Prevention, info for medical practitioners (NHS England, March 2020)
- Falling EtCO2 action plan (Guy's and St Thomas', March 2020)
- High airway pressure action plan (Guy's and St Thomas', March 2020)
- High EtCO2 action plan (Guy's and St Thomas', March 2020)
- Hospital Admission for Patients with Suspected COVID-19 (Mid Yorkshire Hospital NHS Trust, May 2020)
- Intubation SOP (NHS Forth Valley, March 2020)
- Isolation Emergency Response Team Plan (Blackpool Victoria ED, March 2020)
- Kit dump (NHS Forth Valley, March 2020)
- Lung ultrasound with COPD (Royal Cornwall Hospital & Intensive Care Society, March 2020)
- Lung ultrasound decision tree (no medical history) (Royal Cornwall Hospital & Intensive Care Society, March 2020)
- Lung ultrasound with LVF (Royal Cornwall Hospital & Intensive Care Society, March 2020)
- Lung ultrasound proforma (Royal Cornwall Hospital & Intensive Care Society, March 2020)
- Managing self care during COVID19 (St James's Hospital, March 2020)
- Medical Post Take Checklist (Royal Free, April 2020)
- Mobile Endotracheal Intubation Teams (Guy's and St Thomas', March 2020)
- Paediatric ED COVID-19 Care Record (RCEM April 2020)
- Paediatric ED Drill: Team Comms wearing AGP PPE (Leicester Royal Infirmary ED, May 2020)
- PE pathway (Addenbrookes, March 2020)
- Presentations and management of COVID-19 in older people in acute care (Health Improvement Scotland, May 2020)
- Resus SOP for COVID19 (Guy's and St Thomas', March 2020)
- Role cards for COVID SOP (NHS Forth Valley, March 2020)
- Royal Surrey COVID process (Royal Surrey, April 2020)
- RSI drugs prep (NHS Forth Valley, March 2020)
- RSI checklist for COVID (Guy's and St Thomas', March 2020)
- Talking to Relatives: Compassionate Phone Communication (Chelsea & Westminster, April 2020)
- Telephone communication (Newham University Hospital, April 2020)
- Unexplained Hypoxia / Acute oxygen desaturation action plan (Guy's and St Thomas', March 2020)
- AKI pathway (Nottingham University Hospitals, April 2015)
- Absconding - Guidance for contacting the Police Service for patients who have absconded from the Emergency Department (Worcestershire Royal Hospital)
- Acute Atrial Fibrillation (Barts Health, June 2014)
- Acute Coronary Syndrome (Barts Health, 2014)
- Acute pulmonary oedema (treatment with CPAP) (University Hospital of South Manchester, Dec 2011)
- Acute Upper GI Bleeding ED Management (Royal Blackburn Hospital, Nov 2015)
- Allergic Reaction (Barts Health, January 2013)
- Asthma (moderate severity) (Barts Health, 2011)
- Atrial Fibrillation (Russells Hall Hospital, Mar 2011)
- Bier's Block Checklist (NHS Lothian, Sep 2017)
- Bier's Block Summary of Complications Associated with Prilocaine for IVRA (NHS Lothian, Sep 2017)
- Bier's Block Patient Information Sheet (NHS Lothian, 2017)
- Burns Injury (Russells Hall Hospital, UPDATED Mar 2012)
- Cauda Equina Proforma (Royal Blackburn Hospital, Nov 2015)
- Cellulitis Pathway (Royal Blackburn Hospital, Nov 2015)
- Cervical Spine Flow Chart (Nottingham University Hospitals, April 2015)
- Cervical spine injury (Barts Health, Mar 2014)
- Chemical eye injury management (Royal Free, Jun 2019
- Colles fracture management in the ED by Emergency Nurse Practitioners (Mid Yorkshire Hospitals, Jan 2019)
- Concussion Advice Leaflet (Victoria Hospital Kirkaldy, 2019)
- Dental pain or loss pathway (Nottingham University Hospitals, April 2015)
- DKA Pathway (Royal Blackburn Hospital, Nov 2015)
- DPM Pathway (Nottingham University Hospitals, April 2015)
- DVT (Newham University Hospital, Nov 2011)
- DVT Referral Form (Royal Blackburn Hospital, Nov 2015)
- Early pregnancy bleeding pathway - nurse led (Mid Yorkshire Hospitals, July 2013)
- Ectopic Pregnancy: Management in the Emergency Department (Addenbrooke’s Hospital, 2009)
- Ebola (Barts Health, 2014)
- Ebola - personal protective equipment checklist (Barts Health, 2014)
- Elderly falls/collapse (University Hospital of South Manchester, Dec 2011)
- ENT foreign body (Nottingham University Hospitals, April 2015)
- Epistaxis management (Nottingham University Hospitals, April 2015)
- Falls in older patients (Russells Hall Hospital, 2012)
- Fascia Iliaca Compartment Block (Morriston Hospital, 2016)
- First Seizure (Barts Health, 2014)
- First seizure in adults (Addenbrooke’s Hospital, 2009)
- Fitness to drive in common medical presentations (St George's University Hospitals, June 2018)
- Fragility Fracture (Russells Hall Hospital, Mar 2013)
- Fractured Neck of Femur (Leicester Royal Infirmary, 2014)
- Full capacity escalation (Prince of Wales Hospital, 2014)
- Gastrostomy PEG feeding issues(Nottingham University Hospitals, April 2015)
- GI bleed - Low risk UGIB pathway (Nottingham University Hospitals, April 2015)
- Homeless Team booklet (Kings Health Partners, Feb 2016)
- Head Injury (Barts Health, 2014) NOTE: NICE Head Injury guidance was updated Jan 2014 (CG176)
- Headache (Barts Heath, 2015)
- Headache - Acute (University Hospitals of Leicester, Oct 2015)
- Headache - Emergency Decision Unit Pathway (University Hospitals of Leicester, Oct 2015)
- Hot joint pathway (Nottingham University Hospitals, April 2015)
- Hyperkalaemia treatment proforma (Mid Yorkshire Hospitals NHS Trust, April 2020)
- Hyponatraemia (Wirral University Teaching Hospital NHSFT, 2012)
- Infectious Diseases (Nottingham University Hospitals, April 2015)
- Major incident - guide to the first hour (University Hospitals Bristol, June 2016)
- Mental health assessment form - adults (Addenbrooke's Hospital, 2013)
- Mental health risk assessment matrix (Bristol Royal Infirmary, 2013)
- Mental health: VISA Assessment tool and case studies (University Hospitals of Derby and Burton, July 2019)
- Mental health: VISA Assessment tool (University Hospitals of Derby and Burton, July 2019)
- Migraine (Barts Health, 2011)
- Needle stick injuries - Blood borne virus exposure in non-occupational patients (Nottingham University Hospitals, April 2015)
- Non-invasive ventilation (BiPAP) for COPD (University Hospital of South Manchester, Dec 2011)
- Open tibia / fibular fractures (The Mid Yorkshire Hospitals NHS Trust, Dec 2018)
- Paracetamol overdose (Barts Health, 2012)
- Paracetamol Overdose Bundle (Royal Blackburn Hospital, Nov 2015)
- NEW: Paracetamol poisoning - management proforma for adults (Leicester Royal Infirmary, June 2020)
- Penthrox Guidelines for Trauma & Burns (North Bristol, May 2020)
- Pneumothorax (Barts Health, 2011)
- Pregnancy Pathway (Nottingham University Hospitals, April 2015)
- Propofol Sedation Chart (Royal Devon and Exeter Foundation Trust, July 2017)
- Police custody- Discharge of patient from the Emergency Department to police custody (Worcestershire Royal Hospital)
- Post-seizure (Barts Health, 2011)
- Procedural sedation proforma for adults (Queen Elizabeth Hospital Birmingham, Feb 2012)
- Pulmonary embolism (Barts Health, 2014)
- Radial head fracture management pathway (Mid Yorkshire NHS Trust, Aug 2019)
- Rapid sequence induction (Addenbrooke’s Hospital, 2009)
- Red Eye Algorithm (Mark Wright. This diagnostic algorithm is taken from chapter 3 of Pocket Tutor Ophthalmology and reproduced with the kind permission of JP Medical Ltd)
- Referral of Patients from Emergency Department (ED) to Inpatient Teams (Salisbury District Hospital, 2012)
- Renal colic (Barts Health, 2011)
- Return to training in EM (Thames Valley School of Emergency Medicine, 2019)
- Sedation of adult patients (Addenbrooke’s Hospital, 2009)
- Sedation (Barts Health, 2010)
- Sedation Pack (Plymouth Hospitals, July 2016)
- Sepsis (Barts Health, 2014)
- Sepsis pathway (St George's Hospital, September 2016)
- Severe Sepsis: recognition and management proforma (Leicester Royal Infirmary, 2014)
- Sore throat (Barts Health, 2015)
- Subarachnoid haemorrhage (Barts Health, 2014)
- SVT (Barts Health, 2015)
- Syncope (Barts Health, October 2012)
- Syncope Flowchart (The Royal London Hospital)
- Tuberculosis TB (Barts Health, 2015)
- Thromboprophylaxis (Bristol Royal Infirmary 2013)
- Triage (Hinchingbrooke, June 2012)
- Ultrasound guided nerve block for hip and femoral fractures (Barts Health, 2014)
- Vertigo flow chart (Barts Health 2015)
- Vertigo guidelines (Barts Health 2015)
- VKA - Emergency reversal of Oral Vitamin K antagonists for life threatening emergencies (West Suffolk, May 2013)
- Acute gastroenteritis in childhood (Central Manchester University Hospitals, 2009)
- Acute paracetamol overdose (Central Manchester University Hospitals, 2009)
- Afebrile fits (Central Manchester University Hospitals, 2009)
- Apparently drunk child (Central Manchester University Hospitals, 2009)
- Asthma in childhood (Central Manchester University Hospitals, 2009)
- Bronchiolitis (Central Manchester University Hospitals, 2009)
- Button battery ingestion (Birmingham Children's Hospital 2013)
- Cervical spine injury - children (Barts Health, Mar 2014)
- Clavicle Fracture Management in Children aged 2 to 12 years (The Mid Yorkshire Hospitals NHST, Sep 2016)
- Constipation in childhood (Central Manchester University Hospitals, 2009)
- Croup (Central Manchester University Hospitals, 2009)
- Distal Forearm Buckle Fractures in Children (Addenbrooke’s Hospital, 2009)
- Febrile convulsions (Central Manchester University Hospitals, 2009)
- Fever in young children (Central Manchester University Hospitals, 2009)
- FGM - Guidance for the Reporting of Genital Mutilation (University Hospitals of North Midlands, 2016)
- Gastroenteritis in children (Addenbrooke’s Hospital, 2009)
- Gastrointestinal bleeding (Sheffield Children's Hospital, 2013)
- Head injury in childhood (Central Manchester University Hospitals, 2009) NOTE: NICE Head Injury guidance was updated Jan 2014 (CG176)
- Head injury in children (Barts Health, Mar 2014)
- Ketamine Sedation - paediatric (Royal Devon & Exeter, Oct 2016)
- Limping child without trauma (Central Manchester University Hospitals, 2009)
- Nasal diamorphine for children (Addenbrooke’s Hospital, 2009)
- NEW: Paracetamol poisoning - management proforma for children (Leicester Royal Infirmary, June 2020)
- Procedural sedation for paediatric patients using Ketamine (Dudley Group of Hospitals 2012)
- Spinal cord injuries - advice for development of joint protocols (London Spinal Cord Injury Centre and National Spinal Cord Injury Board, 2014)
- Spinal Cord Injuries - London Spinal Cord Injury Centre Referral Pathway for Children (Royal National Orthopaedic Hospital NHS Trust, 2014)
- Staggered paracetamol overdose (Central Manchester University Hospitals, 2009)
- Swallowed foreign bodies (Sheffield Children's Hospital, 2013)
- The limping child (Addenbrooke’s Hospital, 2009)
- UTI in childhood (Central Manchester University Hospitals, 2009)
- Triage (Hinchingbrooke, June 2012)
Discharge Advice
- Abdominal pain (men) - discharge advice (Addenbrooke’s Hospital, 2011)
- Abdominal pain (women) - discharge advice (Addenbrooke’s Hospital, 2011)
- Alcohol, drugs and accidents (Oxford University Hospitals, 2014)
- Allergic reactions (Oxford University Hospitals, 2011)
- Ankle sprain (acute) - discharge advice (Sunderland Royal Hospital, June 2012)
- Arm slings (Oxford University Hospitals, 2012)
- Asthma attack (The QE Hospital (Glasgow), Mar 2017)
- Asthma in children - advice sheet (Royal Devon and Exeter Hospital, 2015)
- Bier's Block Patient Information Sheet (NHS Lothian, 2017)
- Buddy strapping (Oxford University Hospitals, 2013)
- Cellulitis - discharge advice (Sunderland Royal Hospital, June 2012)
- Chest drain - leaving hospital discharge advice (Sunderland Royal Hospital, June 2012)
- Chest drain after chest injury - discharge advice (Sunderland Royal Hospital, June 2012)
- Collar Bone Fracture in Children - discharge advice (The Mid Yorkshire Hospitals, Jan 2017)
- Deep Vein Thrombosis (DVT) - discharge advice (Glasgow Royal Infirmary, 2011)
- Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) (Oxford University Hospitals, 2014)
- Digital nerve block - discharge advice (Sunderland Royal Hospital, June 2012)
- Dislocated shoulder - discharge advice (Sunderland Royal Hospital, June 2012)
- Early Pregnancy Problem - discharge advice (Glasgow Royal Infirmary, 2011)
- Elbow crutches (Oxford University Hospitals, 2015)
- First afebrile seizure in children (University Hospitals of Leicester, 2017)
- Fit, faint or funny turn? Information for people who may have had a first seizure (Oxford University Hospitals, 2012)
- Following your visit to the ED (Oxford University Hospitals, 2014)
- Hand (5th Metacarpal) Fracture - discharge advice (Glasgow Royal Infirmary, 2011)
- Head Injury - discharge advice for adult carers (Sunderland Royal Hospital, June 2012) NOTE: NICE Head Injury guidance was updated Jan 2014 (CG176)
- Head Injury - discharge advice for patients over 12 years (Sunderland Royal Hospital, June 2012) NOTE: NICE Head Injury guidance was updated Jan 2014 (CG176)
- Head Injury - gradual return to sport discharge advice (Glasgow Royal Infirmary, 2011) NOTE: NICE Head Injury guidance was updated Jan 2014 (CG176)
- Head injury in adults with bleeding disorders (Oxford University Hospitals, 2015)
- Ketamine sedation (children) - discharge advice (Addenbrooke’s Hospital, 2011)
- Ketamine sedation (Children) - discharge advice (Dudley Group of Hospitals 2012)
- Knee exercises (Oxford University Hospitals, 2014)
- Mallet Finger Injury - discharge advice (Glasgow Royal Infirmary, 2011)
- Mallet Finger - discharge advice (Sunderland Royal Hospital, June 2012)
- Minor burns (Oxford University Hospitals, 2015)
- Pain relief (Oxford University Hospitals, 2014)
- Plaster casts (Oxford University Hospitals, 2014)
- Post-Exposure Prophylaxis following Sexual Exposure (PEPSE) (Oxford University Hospitals, 2010)
- Pneumothorax - discharge advice (Addenbrooke’s Hospital, 2011)
- Pretibial laceration (Lower Leg Wounds) - discharge advice (Sunderland Royal Hospital, June 2012)
- Procedural Sedation - discharge advice for adults (Glasgow Royal Infirmary, 2011)
- Procedural Sedation - discharge advice (Addenbrooke's Hospital, 2011)
- Radial Head/Neck Fracture - discharge advice (Glasgow Royal Infirmary, 2011)
- Radial head fracture (Mid Yorkshire NHS Trust, Aug 2019)
- Sedation - discharge advice (Sunderland Royal Hospital, June 2012)
- Self discharge against advice (Refusal of treatment)(Glasgow Royal Infirmary, 2011)
- Shoulder - pendular exercises (Oxford University Hospitals, 2014)
- Soft tissue injuries (Oxford University Hospitals, 2014)
- Supra-ventricular tachycardia (SVT) - discharge advice (Addenbrooke's Hospital, 2011)
- Syncope - discharge advice (Sunderland Royal Hospital, June 2012)
- Torus “Buckle” Fractures - discharge advice (Glasgow Royal Infirmary, 2011)
- Welcome to the ED (Oxford University Hospitals, 2014)
- Whiplash (Oxford University Hospitals, 2011)
- Wound care (Oxford University Hospitals, 2014)
IMPORTANT: The following tools have been designed for use by nurses at the point of initial assessment
- Abdominal pain (QMC Nottingham, Jan 2013)
- Alcohol withdrawal (QMC Nottingham, Jan 2013)
- Asthma ED clerking proforma (The QE Hospital (Glasgow), Mar 2017)
- Cardiac chest pain (QMC Nottingham, Jan 2013)
- Cellulitis (QMC Nottingham, Jan 2013)
- Collapse (QMC Nottingham, Jan 2013)
- Confusion (QMC Nottingham, Jan 2013)
- Diarrhoea and vomiting (QMC Nottingham, Jan 2013)
- Fractured neck of femur (QMC Nottingham, Jan 2013)
- GI bleed (QMC Nottingham, Jan 2013)
- Head Injury (QMC Nottingham, Jan 2013) NOTE: NICE Head Injury guidance was updated Jan 2014 (CG176)
- Pain (QMC Nottingham, Jan 2013)
- Pleuritic chest pain (QMC Nottingham, Jan 2013)
- Paracetamol overdose (QMC Nottingham, Jan 2013)
- PV bleed (QMC Nottingham, Jan 2013)
- Seizure (QMC Nottingham, Jan 2013)
- Septic athritis (QMC Nottingham, Jan 2013)
- Shortness of breath (QMC Nottingham, Jan 2013)
- Stroke (QMC Nottingham, Jan 2013)
- UTI (QMC Nottingham, Jan 2013)
The College wishes to thank all the authors who have kindly agreed to share their guidelines here. If your Emergency Department has guidelines that you are willing to make available to others via this page please contact sam.mcintyre@rcem.ac.uk.