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:
- Infection control, including social distancing
- Reduced patients in emergency departments
- 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:
- Patients must come first and safety cannot be compromised.
- Emergency departments must focus on their core function of rapid assessment and emergency stabilisation of critically ill and injured patients.
- 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.
- Patients must have access to other services outside hospital to help ensure emergency departments are not the default pathway.
- 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.
Clinical and executive feedback from the workshops we held in 2021
We held two workshops in 2021, where clinical leads and executives from across the country discussed their experiences of improving patient safety within urgent care. They shared examples of how they had trialled and implemented change in their EDs, trusts, and in some cases, the wider urgent care system.
Following this, we have updated Patient FIRST to share these insights with the wider Urgent and Emergency Care (UEC) community. These signpost examples of good practice and processes that can help improve patient safety in emergency departments (EDs).
Suggested clinical drivers for change include collection and review of the following:
- Suggested processes and ideas
- Examples of good practice
- Examples of data to drive improvements in patient safety.
These suggestions are not exhaustive, but will permit departments, divisions, and trusts to:
- Have a barometer of the current pressures on their urgent care pathway
- Have drivers to support change when and where required
- Monitor some elements that may influence safety within the urgent care pathway.
Promoting safety culture in emergency departments
Attendees from both workshops emphasised the importance of promoting a culture of safety at emergency department (ED) and wider trust level. They also recognised the need to motivate and empower staff by listening to their feedback. Both were deemed critical factors in improving performance, patient outcomes and overall safety.
Understanding all systems involved in service delivery is crucial. Especially when developing interventions to prevent errors and harm to patients. By listening to attitudes of individuals in your organisation, you can assess into how systems are functioning. It also helps you identify problems early and be more responsive to legitimate concerns.
Regular assessment of your organisation's safety culture can highlight areas for improvement. It also helps you monitor change over time. A strong safety culture can influence how patient safety is considered and implemented in your organisation.
Our thanks to the National Emergency Medicine Specialty Advisor Forum for contributing to this guidance.