Emergency department capacity management: guidance

Foreword by the Cabinet Secretary for Health, Wellbeing and Sport

I am delighted to be able to endorse this emergency department ( ED) capacity management guidance in partnership with the Royal College of Emergency Medicine. The guidance, which sets out the risks of ED crowding and the effect on safety and patient care, offers a framework of escalation to proactively manage and prevent crowding in ED and/or assessment areas, along with implementation tips for NHS boards to consider.

The delivery of the four-hour emergency access target is a key ministerial priority and is about improving outcomes for people who are using services. The people of Scotland have told us what they want from health and social care services - care that is person-centred, safe and effective - and I am committed to ensuring that we do all we can to put in place sustainable measures, processes and practices to achieve better care in every part of the health and social care system in Scotland.

While the most visible and widely publicised example of pressure and patient care delays are patients on trolleys in EDs, this is not just an ED problem; crowding in the ED affects various parts of the hospital in different but interrelated ways. We recognise the multi-disciplinary issues and we must do more to minimise the risk to patients on a whole-system, integrated basis. This guidance, while offering a significant opportunity for NHS boards to ensure that front-door services operate effectively to avoid crowding in the ED, also supports a whole-system approach to eliminating crowding and sits within the context of a wider programme of work focused on improving unscheduled care.

I would strongly encourage all boards to embrace this guidance and develop standardised processes for managing ED capacity that will help to reduce variation and embed a culture of early referral and proactive capacity management, ensuring that patient flow is high-quality, safe and effective.

This guidance complements the work on the 6 Essential Actions to Improving Unscheduled Care, which has been created with our partners, including the Royal College of Emergency Medicine, to improve unscheduled care nationally.

The 6 Essential Actions national programme has accepted an ambition to support implementation of an escalation policy in every acute site across Scotland. We look forward to working together with you to eliminate crowding and in turn, improve the safe, high-quality and effective person-centred care delivered to people in Scotland.

Shona Robison, MSP
Cabinet Secretary for Health, Wellbeing and Sport