Project reset in emergency medicine: Patient FIRST

Page last updated: 8 September 2023
Organisations we regulate
  1. Introduction
  2. Flow
  3. Infection prevention and control
  4. Reduced patients in emergency departments
  5. Staffing
  6. Treatment
  7. Appendices


The coronavirus (COVID-19) pandemic has changed many ways of working within urgent care settings.

These settings include emergency departments. The changes have affected all patient groups.

It’s important that we understand and harness the learning from this for emergency care at local, regional and national level. We need to appreciate and support the elements that have improved patient care and safety. We also need to adjust and realign some of the processes that may not have improved patient care or safety.

CQC brought together a team of senior emergency department clinicians to develop ‘Patient FIRST’. The team included expertise from paediatrics. All the clinicians work in emergency departments rated as good or outstanding. And they are CQC specialist professional advisors.

Patient FIRST is a support tool designed by clinicians, for clinicians. It includes practical solutions that all emergency departments could consider. Implementing these solutions supports good, efficient and safe patient care - for both adult and paediatric care. It also includes guidance for senior leaders at trust and system level.

FIRST stands for:

  • Flow
  • Infection control, including social distancing
  • Reduced patients in emergency departments
  • Staffing
  • Treatment in the emergency department

Patient FIRST is for people directly or indirectly involved in delivering urgent and emergency care:

  • trusts - to reflect and support that good urgent and emergency care is achieved through:
    • cultural shifts
    • complete buy-in within a hospital and across trust systems
      It’s not simply departments working in silos
  • leaders and managers - for how to improve the service and support the clinical staff - enabling delivery of good urgent care models
  • clinical staff - for what they should be aiming to achieve and ideas on how to do this

CQC makes sure health and social care services provide people with safe, effective, compassionate and high-quality care. Providers must make sure their services are safe, effective, caring, responsive and well-led. CQC supports the aims of the Royal College of Emergency Medicine (RCEM) position statement for emergency care.

Principles of Patient FIRST

Patient FIRST is based on five principles to support emergency care:

  1. Patients must come first and safety cannot be compromised.
  2. Emergency departments must focus on their core function of rapid assessment and emergency stabilisation of critically ill and injured patients.
  3. Staff in emergency departments must have the authority to move people from the department after their initial assessment to a more appropriate pathway of care outside the emergency department.
  4. Patients must have access to other services outside hospital to help ensure emergency departments are not the default pathway.
  5. Delivering good quality urgent and emergency care must have the support of all services inside and outside hospital.

When meeting these principles, local system working provides better care for patients. CQC found this through its assessment of services.

Our focused inspections during winter have been based on a structured framework. Trusts can use this to assess their own emergency department.

Read the framework


Our thanks to the National Emergency Medicine Specialty Advisor Forum for contributing to this guidance.


Download and print

Patient FIRST (September 2023) (pdf, 338.19kB, English)




Reduced demand, improved capacity

Infection prevention and control

See also

RCEM: Patients will die unless care in Emergency Departments is reset

RCEM Position Statement: COVID-19: Resetting Emergency Department Care (6 May 2020)

Improvement toolkit

Produced by front line clinicians in response to CQC’s Patient FIRST, this toolkit suggests a framework that NHS trusts can use to monitor and assess their progress in applying good practice principles.

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