NHS England has issued new guidance for model emergency departments to cut wait times, improve patient flow, and raise standards in urgent and emergency care
NHS England has published new guidance for model emergency departments, offering a blueprint to make urgent and emergency care faster, safer, and more reliable. The guidance aims to reduce waiting times, improve patient flow, and set standards for high-performing care pathways. As hospitals face increasing pressure, this model ensures patients receive the right care at the right time.
The current state of NHS emergency care
Emergency departments play a key role in the urgent and emergency care system, often treating patients when they need it most. The current state of emergency departments shapes public perception of the NHS.
However, emergency departments have reached a crisis point. Long waiting times, unsafe capacity levels, and overcrowded departments burden the health service. Poor hospital flow increases corridor care and ambulance delays, which may occasionally cause harm and strain staff working conditions.
High-performing urgent and emergency care pathways depend on the whole system working effectively around the clock, 24 hours a day, 7 days a week. This means that when part of the flow lags, the whole system suffers.
How will it change emergency departments?
The five key principles of clinical care within an emergency department are:
- ED care must prioritise patients with the most urgent medical needs.
- Overcrowding increases risk and makes it harder to identify and treat the sickest or most vulnerable (frail, newborns, learning difficulties, mental health)
- Overcrowding creates inefficiency in urgent and emergency care, adding staffing pressure and delays.
- Patients should receive care in the right setting without unnecessary delays for tests, treatment, or admission.
- Effective ED care requires whole-hospital engagement, leadership, and smooth patient flow from all specialties.
The four key priorities from a patient’s perspective are:
- Patients want to feel safe and reassured that they will receive prompt care. Clear, compassionate communication is essential for building this trust.
- Patients prefer extended treatment because it allows them to avoid the stress of the ED and prioritise comfort, and to maximise use of SDEC and EEMAC areas.
- Patients expect timely updates about what will happen before, during, and after care. Sharing information about wait times and next steps addresses this need.
- Patients don’t want to wait long in the ED for a bed; focus on improving flow and reducing bed occupancy.
How can these priorities be met?
Healthcare leaders describe how the five key principles of clinical care in emergency departments work together to meet patient needs.
- Streamlining and redirecting urgent care
The model states that senior nurses or clinicians, conducting streaming and initial assessments at the ED front door, should use digital tools to support streaming and redirection. They will rapidly direct patients requiring urgent care and treatment to urgent care pathways or to the ED if emergency medicine oversight is required.
2. Emergency department pathways for those patients who need to be admitted, treated or discharged
The model directs emergency department assessment teams to support rapid decision-making. Senior clinicians should lead, with specialist and diagnostic support. Teams should manage patients likely to be treated or discharged quickly in suitable ambulatory or clinical areas. Patients with clear needs, such as a stroke or a heart attack, should bypass the ED and go directly to specialist care.
Staff must prioritise the resuscitation area for emergency patients. These patients typically arrive by ambulance or helicopter, or are transferred from within the ED or elsewhere. Depending on the severity of need, they may or may not bypass RAT.
3. An extended emergency medicine ambulatory care area
Staff care for patients who need further observation, tests, or treatment after the initial ED assessment but are expected to be discharged the same day in EEMAC areas. These facilities, operating alongside the ED, usually complete care within 8 hours and focus on discharge rather than admission. Staff first assess patients in the ED before transferring them to EEMAC, ensuring they receive the right care away from the busy emergency department.
Priority cohorts
The model specifies how emergency departments should care for priority cohorts, including children, older adults with frailty, end-of-life patients, and people with mental health conditions.
Infants, children and young people: Care should be in safe, age-appropriate environments with parents or carers involved, fast assessment within 0–4 hours, and extended observation if needed, with 24/7 mental health support.
Frail or palliative/end-of-life patients: Patients should be identified early, receive timely specialist palliative care, be discharged to their preferred place when possible, and avoid unnecessary ED visits or hospital stays.
Patients with mental health conditions: Provide rapid community crisis support, 24/7 mental health liaison with 1-hour response, joint mental and physical health assessment when needed, and mental health EDs for crisis cases not requiring physical treatment.
