Patient FIRST: Appendices

1. Introduction
2. Flow
3. Infection control
4. Reduced patients in emergency departments
5. Staffing
6. Treatment
7. Appendices

Appendix 1: ‘What does good look like in ED’ - Patient FIRST

Pressure resilience in EM 5 - PR5 plus​

1. Clinical care​

i. Initial assessment. There must be a safe, validated and reliable system in place at the front end to identify critically ill patients, whether arriving by ambulance or walk-in.This should include a robust infection control process, to identify patients with infectious diseases, or risk of, at attendance. ​

ii. Critically ill. Once identified, there needs to be a robust system in place to manage these patients, as directed by national guidelines. This should be audited regularly. ​

iii. Deteriorating patients in ED. There should be an easily reproducible and accessible system in place to identify deteriorating patients in any part of the department, as well as a process to ensure this is acted upon. ​

2. Infection prevention and control

Overall aims should be to prevent the spread of and control infectious diseases: ​

i. Between patients​.

ii. Patient acquiring infection from clinical staff​.

iii. Staff acquiring infection in their workplace.

iv. And manage patients with infectious diseases or risk of, according to recognised clinical guidelines in the right environment, for example, COVID-19​.

3. Patient flow

There should be a structured approach to patient flow to ensure that all components of the system are appreciated and managed appropriately, and always escalated when necessary. ​

4. Work force

There should be an appropriate staffing model in the Emergency Department, one which takes variation in demand into account, not just average demand. To include a flexible system to manage infection risk, for example COVID surge. ​

5. Leadership and culture

For the above initiatives to be successful, it is imperative that there is resilient leadership which encourages a positive and caring culture within the team, that has safety and patient care at the forefront.