King's College Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good.

The service planned and delivered people’s care and treatment in an evidence-based manner, with best practice guidelines in mind. Staff worked effectively together. The service monitored outcomes consistently. Staff understood consent and the Mental Capacity Act 2005. However, there were issues with venous thromboembolism (VTE) risk assessments and the prescription of VTE prophylaxis.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service did not always ensure that patients were provided with prophylaxis for venous thromboembolisms as per national guidelines. However, the service otherwise had systems in place for staff to deliver people’s care and treatment as per best practice and national guidelines.

Patients who are admitted to hospital should have a risk assessment for venous thromboembolisms (VTEs; a group of conditions involving blood clots in the veins, which can be caused by long stays in hospital). These risk assessments often lead to the prescription of VTE prophylaxis (preventative treatment to stop VTEs from developing). We reviewed the notes of 6 patients who had been in the Emergency Department (ED) for over 12 hours, all of whom had been referred to the medical team but had not yet been admitted to a ward. Of these, 0 had a VTE risk assessment completed and only 1 had VTE prophylaxis prescribed. This was contrary to National Institute for Health and Care Excellence (NICE) recommendations, which state that, for patients not yet admitted to wards, these risk assessments and the resulting treatment should take place within 12 hours. We discussed this with senior leaders who told us that these assessments and prescriptions were the responsibility of specialist teams, and that patients staying in the ED for long periods after they had been referred to specialist teams had made the oversight of tasks like this more difficult. However, we were not told about any work being undertaken with specialist teams to improve this metric. The lack of VTE risk assessments and prophylaxis presented a risk that ED patients would develop VTEs.

The service had high-quality guidelines available for clinical staff to use. We reviewed 10 such guidelines. These were generally easy to find, relevant to staff responsibilities, up-to-date, and developed in line with national guidance and best practice. For example, the ‘Management of Spontaneous Pneumothorax’ guideline was in-line with and referenced British Thoracic Society guidance. The service kept track of updated guidelines in its medication safety meetings, which were held on a two-monthly basis, and in its ED ‘Patient Outcome Group’ meetings, which were held monthly.

Initial reviews by ED doctors (known as ‘clerkings’) were generally of a high quality. We reviewed these in the notes of 10 patients. All 10 were easy to find and assigned to a named doctor. All 10 clerkings contained a clear plan and included documentation of current treatment, 9 had a clear impression/working diagnosis, and 8 contained a clearly documented past medical history.

Members of the psychiatric liaison team completed comprehensive bio-psychosocial assessments as per best practice. The psychiatric liaison service had received its Psychiatric Liaison Accreditation Network (PLAN) accreditation from the Royal College of Psychiatrists (RCP). The RCP judges a service against 111 quality standards to award this accreditation.

The service worked well across teams and services to support patients. There was effective multidisciplinary working within the department.

Emergency Department (ED) staff worked well together to deliver patient care. Doctors and nurses described a supportive environment in which they were viewed as being on the same team.

Security staff were responsive and compassionate. Clinical staff consistently gave very positive feedback about the help security staff provided when patients were violent or aggressive. We observed security staff actively checking in with clinical staff. Security attended quickly when required and attended code 10 acute behavioural disturbance calls.

ED staff and staff from the psychiatric liaison service worked well together to manage the risks posed by having high-risk mental health patients present within the department for long periods. Psychiatric liaison staff had a daily morning ward round to review patients who had remained in the department, and had morning safety huddles with ED staff to discuss risks. The Emergency Physician In Charge (EPIC) doctor carried a list of mental health patients in the department for quick reference. This included each patient’s legal status (for example, whether they were under a section of the Mental Health Act 1983) and was passed onto the next EPIC doctor on shift.

ED staff worked well with staff from other care groups. There were clear referral pathways to specialist services and staff told us that they were generally responsive to these referrals. ED staff and specialist staff worked well together during emergency calls. For example, we observed intensive care staff facilitating transfers to and from imaging departments when patients needed scans during some types of emergency calls. ED staff also worked well with staff from in-reach services, such as frailty nurses and the alcohol care team. Paediatric ED staff described having good working relationships with the inpatient paediatric team.

Patients requiring admission were not transferred to wards in a timely manner due to systemic pressures. The trust had a corridor care policy (previously the ‘Trust Boarding Policy’) which set out the circumstances in which patients from ED should be transferred to specialist wards to receive corridor care there, with the goal of decreasing ED overcrowding. However, some senior staff told us that they believed some care groups resisted receiving corridor care patients, and that this resulted in the ED remaining full. As we did not inspect any other adult services at the same time as this inspection, we did not review whether the corridor care policy was being used equitably in other areas of the hospital.

Medical and nursing handovers were well-structured and comprehensive. Staff were encouraged to hand over important information about their patients and were given time to ask questions.

We observed ED staff and ambulance staff working well together. ED staff took detailed handovers from ambulance staff and ambulance staff helped to take observations during these handovers. Staff from the local ambulance NSH trust provided positive feedback about working with ED staff.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people’s care and treatment to attempt to continuously improve it. There was a culture of trying to improve outcomes using data. Staff took the time to engage in quality improvement projects despite systemic pressures on the service.

The service participated in multiple Royal College of Emergency Medicine (RCEM) quality improvement projects (QIPs). These included projects for mental health patients, such as the 2026 ‘Adolescent Mental Health’ QIP. When involvement in these audits had spanned multiple years, improvements in some metrics were identifiable. For example, the RCEM ‘Care of Older People in the Emergency Department’ audit showed an improvement in the rates of delirium screening for at-risk patients from a mean of 19% in the first year to 39% in the second year.

The service ran internal monthly nursing audits into compliance with best practice and local policy. Subjects included in these monthly nursing audits included hand hygiene, infection prevention and control, intravenous lines, documentation, and medicines management. We saw evidence of action plans generated from these audits and some evidence of improvements following these action plans. For example, following an audit of falls risk assessments which identified low compliance, a digital prompt was introduced into the service’s computer system and learning was reinforced with staff – this led to compliance increasing from 43% in September 2025 to 80% in March 2026. However, these audits did not include compliance monitoring of sepsis risk assessments, which the service did not review in any other way.

In addition to these monthly nursing audits, doctors within the service had developed a robust system for managing internal QIPs. At the time of our inspection, there were 7 ongoing non-RCEM QIPs within the adult ED service, with more that had recently been completed. Subjects of ongoing QIPs included the service’s management of hypertension, and a review of the service’s pathway for patients presenting with Bell’s palsy. The service kept track of these QIPs through a spreadsheet and ensured that each had a named lead clinician. Action plans were developed following each QIP and progress for these actions was noted at monthly ED ‘Patient Outcome Group’ meetings. We were provided with evidence that QIP results were presented at relevant meetings and occasionally at external conferences. There was evidence of changes introduced following these QIPs (for example, creation of local guidelines that were uploaded onto the service’s intranet and alerts added to the service’s patient notes system).

The service also regularly collected other data which was not part of formal QIPs or audits. This data, including performance standards such as ambulance handover times, and outcomes such as reattendance rates, was reviewed and discussed by service leaders within their regular meeting schedule. For example, paediatric reattendance rates were discussed in a monthly multidisciplinary meeting delivered as part of the service’s ‘Needs Evaluation & Support Team for Emergency Department Attendances’ programme. However, the service’s performance for these standards did not always meet national targets. For example, in May 2026, 70.7% of patients who attended the ED were seen and discharged or transferred within 4 hours. This was below NHS England’s target of 78%. However, it should be noted that this data does not include patients who attended this ED and were subsequently streamed to the on-site urgent treatment centre (UTC), and that NHS England's target of 78% applies to all patients regardless of how they are streamed.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood what consent meant. Staff were also able to explain the concept of mental capacity to us and understood their responsibilities under the Mental Capacity Act if they believed a patient lacked capacity to make a decision about their care. Relevant members of staff were able to explain how they would perform a capacity assessment. There were clear processes and policies in place to guide staff through consent and capacity issues. Staff in the paediatric Emergency Department (ED) understood concepts specific to paediatric consent to treatment, such as Gillick competency and the Fraser guidelines.

Patients told us that staff gained consent verbally before performing care. Portable translation services (through an electronic tablet) were available for all clinical staff to use. This meant that consent could be gained when caring for patients who did not speak English.

Mental health staff had a good understanding of mental capacity and took this into consideration when reviewing patients with mental health conditions. Staff described using common law and the Mental Capacity Act 2005 to stop patients leaving the department if they felt that they would go on to harm themselves or others.

The service used restraint techniques when patients presented a risk to themselves or others and other de-escalation techniques had failed. The service recorded every instance of this as an incident. From February to April 2026, the service used restraint 185 times (all of these were chemical restraints, with some also including physical restraint). This reflects the high number of patients presenting with acute behavioural disturbances. We did not see any instances of inappropriate use of restraint while we were present. The service had policies and prescribing guidance for restraint.

Security staff, who often engaged with patients who lacked capacity, received training in restraint, supporting patients with mental health needs, and the Mental Capacity Act 2005.