Policy briefing

Emergency department standards

The latest policy and what it means for healthcare professionals.

The latest policy and what it means for healthcare professionals.

Picture: iStock

Essential facts

Sufficient numbers of nurses, patient access to WiFi and regular comfort rounds are on a list of 50 standards for emergency departments (EDs) to improve care.

The Royal College of Emergency Medicine (RCEM) has asked staff to consider how well their department does in meeting the newly published standards.

The standards cover the patient environment and pathway through the ED, treatment of elderly patients and children, and care of people with complex needs, as well as education about care, teamwork and leadership.

The RCEM says the list is needed to counter a culture of national targets and financial balance to the detriment of care quality. This was exposed in the Mid Staffordshire NHS Foundation Trust public inquiry, the college says.

The new standards are intended to help ensure that staff focus on safe, compassionate care. They are graded either as fundamental, which means every ED should achieve them routinely, or as developmental, which means every ED should work towards achieving them.

What’s new?

Among the fundamental standards are a television in every waiting room, ensuring patients know they can use their phones and providing them with phone chargers, and giving them updates on their care. Making staff feel valued is also regarded as essential.

In addition, EDs should be well maintained, ceiling tiles should not be damaged or stained, and toilets should be cleaned a minimum of twice a day.

Every ED should have a quiet and private clinical area for dying or recently deceased patients and their families. RCEM suggests hanging laminated butterflies in these areas to indicate to staff that they should keep the noise level low and use the appropriate language.

Verbal and written information should be provided during discharge planning and social and welfare concerns checked.

Developmental standards include providing reading material and updated waiting times in waiting rooms, and messages on resuscitation room ceilings for recumbent patients. EDs should also aim to achieve a high standard of dementia care.

Implications for nurses

Nurses should work in EDs that meet RCN safe staffing ratios, and all nurses should feel valued and able to raise concerns.

Among the fundamental standards, one states that staff should carry out frequent comfort rounds to see if patients need assistance.

Nursing staff at entrances should have easy and timely access to a senior doctor for treating sick patients and prescribing analgesia for severe pain.

The document states that nurses should take regular breaks because tired staff are less likely to appear caring and more likely to make mistakes.

EDs should work towards scheduled combined medical and nursing handovers. Senior doctors and nurses should remember to thank staff should for their efforts.

Expert comment


Jim Bethel is a senior lecturer in emergency care at the University of Wolverhampton

‘These standards provide a useful benchmark for care and set a baseline below which standards should not fall. 

‘The document seems to imply that the four-hour standard has driven down care in emergency departments.

‘I am a big fan of the standard. We need the ability and resources to provide excellent care, but in a timely manner.

‘I would have liked to see the Royal College of Emergency Medicine work in a more multidisciplinary manner by including nurses and other professions in drawing up the standards.

‘Otherwise, I am not sure the standards will carry enough weight to force change and improve care.’

This article is for subscribers only