Emergency department capacity management: guidance

5. Summary

NHS boards are expected to develop improvement plans and standard processes for proactively managing capacity and avoiding crowding. Sites should prioritise the requirements of emergency/acutely unwell patients to ensure capacity always exists for them to be assessed in clinical spaces. It is also expected that patients will not have their progress through the system delayed at any point, and that the four-hour emergency access standard of 98 per cent will be achieved in all board areas to prevent crowding in EDs and acute receiving areas.

It is vital that each site does this in the context of the 6 Essential Actions to Improving Unscheduled Care. They should engage in advance with the adjoining streams for each Essential Action to ensure they are capable of managing demand, have flow from in-patient wards to discharge in place, and have secured the engagement of all acute care specialties.

Standard operating processes and clearly defined escalation procedures must be in place, supported by a mutually agreed communication plan across directorates, patient flows, the hospital site and the NHS board to ensure standard actions for ED crowding have been agreed. This will ensure that crowding is eliminated in the safest and most effective way and without delay. A clear line of daily responsibility for site management must be defined.