Improving safety in the Emergency Department this winter



Our emergency departments are under ever increasing pressure, with performance in winter reaching new lows every year; putting both patient safety and staff morale at risk.

While a significant increase in resources, for both the NHS and social care, is clearly needed there are actions that health service leaders and boards can take to help their systems maintain safety and improve performance over winter. 

Here we outline those actions and call on health service leaders to encourage whole system ownership of ED performance, with every part of the hospital understanding the importance. 

The guide below describes what systems should do, appropriate to the performance ‘zones’ EDs find themselves in; Green (4hr performance >95%), Amber (85-95%), or Red (<85%). 

The scale of the challenge across the UK

All year round pressure

  1. Emergency Department patient demand has risen by at least the equivalent of 13 new emergency departments in the UK
  2. Patients are stranded in hospitals awaiting discharge
  3. The number of patients waiting more than 12 hours before admission into a hospital ward bed has increased substantially

Escalating demand over a number of years


In England

  • From Quarter 1 2011-12 to Quarter 4 2017-18, the number of people waiting more than 12 hours from decision to admit to admission increased by 2,248 (11,831%)
  • From Quarter 1 2010-11 to Quarter 4 2017-18, the number of people waiting more than four hours from decision to admit to admission increased by 211,367 (1,468%)
In Scotland

  • From 2011-12 to 2017-18, the number of people who spent more than 12 hours in an Emergency Department increased by 2,282 (300%)
  • From 2011-12 to 2017-18, the number of people waiting more than eight hours in an Emergency Department rose by 9,159 (184%) 
In Wales

  • From 2013-14 to 2017-18, the number of people who spent more than 12 hours in an Emergency Department increased by 27,421 (238%)
  • From 2011-12 to 2017-18, the number of people who spent more than eight hours in an Emergency Department rose by 52,878 (205%)

In Northern Ireland

  • From 2013-14 to 2017-18, the number of patients waiting longer than 12 hours rose by 14,238 (458%)
  • From 2013-14 to 2017-18, average four-hour performance at all Emergency Departments fell by 4.6 percentage points to 73.5%
  • High quality patient experience
  • Adequate staffing
  • Wider system engagement
  • Excellent system leadership
  1. Maintaining safety, time-critical care (based on clinical acuity) and dignity for all patients
  2. Supporting system performance (adequate staffing and acute bed capacity for system flow)
  3. Ensuring training is always supported

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The data presented here reflects the different reporting periods and practices of the English NHS and those of the NHS in each of the Devolved UK nations. The data the NHS in England can be found here; Scotland; Wales; and Northern Ireland.