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RCEM Guidance

RCEM Guidance

The Royal College of Emergency Medicine (RCEM) has clinical guidelines available for professionals working in emergency medicine.

RCEM Guidance – College Guidelines

This section includes guidance on the following: RCEM Guidance, Toolkits and Best Practice. You will find information and college guidance below regarding the following: paracetamol overdose, mental health, drugs and alcohol and guidance implementation.

This page contains guidelines and statements produced by the College’s Quality in Emergency Care (QEC) committee. For clinical guidelines relevant to EM published by other organisations please go the External Guidelines page. For clinical guidelines written by Emergency Departments (EDs) and shared for use/adaptation by other EDs please go to the Local Guidelines page. We’d love to hear your feedback on our guidance documents.

COVID-19
Coronavirus information page (updated regularly)

NEW: Management of patients presenting to the Emergency Department / Acute Medicine with symptoms of Covid-19 Vaccine induced Thrombosis and Thrombocytopenia (VITT) (April 2021)

NEW: Emergency Department Infection Prevention and Control (IPC) during the Coronavirus Pandemic (revised February 2021)

College Guidelines

+ Position Statements
+ Resource Toolkits + Best Practice Guidelines

Best Practice Guidelines

+ GEMNet Guidelines

The following evidence-based guidelines have been published by GEMNet:

+ Toxicology + External Guidelines

For clinical guidelines relevant to Emergency Medicine produced by external organisations please click here.

+ COVID-19 coronavirus

COVID-19 coronavirus

+ Ebola Guidance

Ebola Guidance

+ Selected further guidance & resources

Selected further guidance and resources

+ Committee templates

Committee templates

Guideline Implementation

To ensure the highest quality of clinical care for patients attending Emergency Departments in the UK, the Quality in Emergency Care Committee (QEC) of the Royal College of Emergency Medicine (CEM) needs to adopt an implementation framework that not only reflects the QEC’s role in promoting clinical effectiveness, but also the CEM’s role as an effective partner in the collaborative leadership of academic medical royal colleges to support and promote integrated evidence-based care with its stakeholders and partner organisations.

For the purposes of ensuring clinical effectiveness at every level, ranging from national policy-making to local implementation, the following framework is proposed.

This draws upon relevant national policies and the international literature regarding knowledge translation and clinical effectiveness. The aim is to develop and establish an emergency care system that benefits from active participation of the QEC. Crucial to this is the development of social and collaborative networks to facilitate the formulation and uptake of policies and strategies. Many of these activities are already underway.

As part of the College’s work on implementation, a strategy for disseminating information to Fellows and Members has been published (Nov 2010).

Ambulatory Emergency Care

The Royal College of Emergency Medicine has resources available for Emergency Departments on ambulatory care.

This toolkit has been written primarily for the Emergency Physician aiming to develop ambulatory care from the ED. It requires strong clinical leadership, regular access to senior decision makers, a clear focus on multidisciplinary team development and close collaborative working with all relevant specialty colleagues.

Mental Health

RCEM has an active Mental Health Committee whose role is to produce guidelines and resources to equip RCEM members and fellows, with the aim of improving care, safety and patient experience for patients with mental health problems. We also do advocacy and liaison work with other National bodies including other royal colleges, the college of policing, and the CQC.

For queries or more information email mhchair@rcem.ac.uk

RCEM learning. There are some great podcasts and learning modules here.

RCEM Advocacy

RCEM conducted an online survey to find out more about the services provided by EDs to children and young people presenting with mental health problems. This will be repeated in 2021.

National Reports

Useful Organisations and web resources

Faculty of Liaison Psychiatry

RCEM Wellbeing App

The Royal College of Emergency Medicine recently launched the RCEM Wellbeing App to provide Fellows and Members with the tools they need to measure, understand and improve their mental wellbeing. It can be found here.

Updates in Mental Health Newsletter

An update to mental health leads about what is happening in Emergency Mental Health Nationally and at RCEM.

How is your ED doing on mental health?

This quiz will take you 2-3 minutes, just to get you thinking.

Do you have a system for mental health triage in your ED?
This is the probably the most important intervention to improve safety for mental health patients. Who trains your nurses to do this? (Hopefully your liaison team are fully engaged with this!) See toolkit for ideas.

Do you have a process for observing those patients that you are most concerned about leaving the ED or self-harming?
Often health care assistants take this role, do you ever speak to them about patients to ask what they have observed? Can you work together to help the patient feel safe and well cared for? HCAs often report not knowing what to say or look for with some patients. Do you have any resources for patients to reduce anxiety? E.g. mindfulness exercises, colouring, soduku, etc?

Do you know your local 24/7 mental health crisis phone number (most introduced since Covid) to give to patients that may need help?
NHS urgent mental health helpline (England only)

Can you name any or all of the Liaison Psychiatry / Crisis team nurses and doctors that see patients in your department?
Try a charm offensive, get to know them, learn from them, get feedback from them.

Are you ever aware of poor staff attitudes towards patients with mental health problems who attend frequently?
Could you challenge these attitudes and be the patient’s advocate?

Have you ever had these attitudes yourself?
Ask yourself why? Were you tired? Annoyed at the system? or perhaps not had / taken the time to find out why this patient landed in the ED and how they feel?

If you think you could be an advocate for better services and care in your department, why not contact (or become?!) your ED mental health lead.

For more information, see our Clinical Guidelines pages.

Older People

Welcome to the webpage of the Special Interest Group (SIG) for older people at the Royal College of Emergency Medicine.

We are very interested to hear from you about projects and ideas you may have to improve the care of older people in our emergency departments.

Older people are increasingly important attendees to UK’s emergency departments. They are a heterogeneous group and many are active and well although a small proportion are frail.

The fact that older people comprise a special group of ED attendees was described some time ago and many of the conclusions are ever more important. The report from QualityWatch described the complexity in presentation associated with age and its impact on ED attendances.

RCEM was instrumental in supporting the Silver Book project and this SIG is a concerted effort to bring together like-minded people keen on improving quality care for older people in UK EDs through leadership, service improvement, research and education.

The Silver Book II

Resources

Here are links to some websites on Geriatric Emergency Medicine from around the world that demonstrate the excellent work being undertaken on improving older peoples care.

Link to useful academic publications and books:

Contact

  • You can follow us on Twitter using #geriatricEM or following @RCollEM
  • You can get in touch with the Chair of the Frailty Special Interest Group at FrailtyChair@rcem.ac.uk, or Alison.Ives@rcem.ac.uk

Public Health – RCEM Special Interest group

We all recognise how the Coronavirus pandemic has exposed health inequalities and how more so now than ever the relevance of public health and the role we play as emergency physicians in improving the nation’s health, as well as our response to infectious disease control in the emergency department and the wider urgent and emergency care system.

Public health underpins everything we do, even if you do not know it. For example, do you ever get frustrated by seeing the same sort of preventable injuries and illnesses coming through the front door of your Emergency Department (ED)? What about the injured child cyclist? The adult with recurrent alcohol, tobacco, or drug-related illness? Presentations due to failures in under-resourced community and social care systems? People struggling with mental health problems because they have nowhere else to turn? Social deprivation, alcohol, drugs and adverse mental health are inextricably linked and widen health inequalities with higher levels of preventable illness such as injury related to road traffic accidents, cardiovascular disease and infectious disease with lower socioeconomic status. The ED has annual patient-doctor interactions in the tens of millions, but how often do we take the opportunity to think about the “bigger picture”, let alone have a positive impact on it?

The RCEM Public Health Special Interest Group was established in January 2017 with the vision to provide an integrated approach to strengthening the interface between public health and emergency care in order to improve health outcomes for communities. We are currently made up of 6 clinicians and 1 lay member (names below) who hope to achieve this vision through:

  • sharing the vision with health care workers nationally and internationally
  • working with partners in the development of policies, research, training, and clinical practice related to EM and PH
  • fostering an environment that encourages health care workers to pursue their professional interests in this field.

As a Special Interest Group, we have developed partnerships with key stakeholders and been active in education and curriculum development, research and policy and media engagement. Our initial priority area was injury prevention. Our priority for the next three years is health inequalities and preventative approaches in emergency departments. For trainees this is a particularly exciting time as public health is incorporated into the 2021 emergency medicine curriculum and we plan to support you with resources.

Below is a summary of our work in these areas and future plans.

Guidance

  • We are currently developing a ‘how to guide,’ for implementing public health interventions in emergency departments.
  • Because of the key role that public health has in the emergency department, RCEM has recognised the need for there to be a lead in public health within each emergency department. You don’t need to be an expert, just have an interest in improving people’s lives with a public health approach. The job description for this role is here. Please get in touch if you are interested so we can form a network of emergency department public health leads across the UK.

Education and curriculum

  • We have provided expert advice on ‘health prevention and illness prevention,’ as part of the RCEM 2021 curriculum for trainees.
  • We held a session at the Annual RCEM Scientific Conference in 2018 on the importance of public health in emergency care.
  • In 2018, we also brought together a cross specialty group from public health and emergency medicine for a successful study day: ‘A case of opposites attract or more in common?’
  • We are developing an RCEM learning module on public health.
  • We are going to set up a buddying scheme for public health and emergency medicine trainees to work together on quality improvement projects.

Policy and partnership

The following resource has been released by NHS England highlighting 8 urgent points that need to be addressed in order to tackle health inequalities.

  • We collaborated with injury prevention groups and contributed to the National Accident Strategy ‘Safe and Active at all ages’
  • We have worked with Doctors of the World, Faculty of Public Health (FPH), and Lancet Commission on migration, to advocate for the removal of healthcare charging for migrants.
  • Member of the SIG revised RCEM guidance on homelessness and HIV in 2020.
  • We have an agreement in principle to develop a joint RCEM and FPH public health group (delayed due to COVID-19 pandemic).
  • The SIG have developed a set of recommendations for emergency departments on the need to consider public health.

Research and media engagement

Health Inequalities

The Kings Fund summarises what are health inequalities, inequalities in life expectancy, healthy life expectancy, avoidable mortality, long-term conditions, mental ill-health, access and experience of health services, plus pathways to health inequalities, interactions between the factors driving health inequalities.

The Kings Fund regularly update their health inequalities page with topical and interesting articles

Further health inequalities resources can be found on the Health Foundation Page

The NHS Long Term plan outlined aims and objectives for the NHS over a ten year period. Chapter 2 involved new funded action the NHS will take to strengthen its contribution to prevention and health inequalities.

The Health Foundation commissioned the Institute of Health Equity to examine progress in addressing health inequalities in the UK, 10 years on from the landmark study Fair Society, Healthy Lives (The Marmot Review). The following resource explores the changes since 2010 in 5 key objectives, outlining areas of progress and decline of each as well as recommendations for future actions.

Covid-19 and health inequalities

Research showing the association between the current pandemic and health inequalities has been definitive. The following links highlight just a small selection of key resources describing this association.

The following videos are a great resource for preventing vaccine hesitancy within ethnic minorities:

Notifiable Diseases

Upcoming events

Contact

You can email the Public Health chair: PHChair@rcem.ac.uk, Public Health administrator Alison.Ives@rcem.ac.uk, or tweet us at @RCollEM and use#RCEMPH.

The group have set up a WhatsApp group to coordinate engagement with public health and emergency medicine colleagues.

Members

Dr Ling Harrison (chair), Dr Kirsty Challen, Dr Najeeb Rahman, Mr Martin Rolph (Lay), Dr Thomas Shanahan, Dr Andy Snell and Dr Olivia Villegas

Staff/self care during COVID19

Help for doctors with more severe current anxiety or depression symptoms now

BMA – 24/7 counselling service (0330 123 1245)

BMA – counselling and peer support

Papyrus – Hopeline

Resilience and wellbeing

RCEM has put together 2 posters to display in our staff areas with advice about individual and team (herd) wellbeing:

Other resources

Podcasts

Top tips from the podcast:

  • Limit exposure to information on social media, e.g. check it twice per day only
  • Connect with your usual network of friends and family people by phone or social media, check in with people, start using support
  • Maintain normal day to day activity as much as possible, exercise, eat well, sleep etc
  • Anxious thoughts are normal and we cannot stop them coming, but we can either follow them down into a worse place or we can practice taking small breaks, controlled breathing and focussing on a small absorbing task.

Mindfulness apps

  • Headspace
  • Headspace – main website
  • Calm
  • Sleepio– free access for all NHS staff throughout the COVID-19 response
  • Daylight– free access for all NHS staff throughout the COVID-19 response

Advice

Back to the main COVID19 page

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