Welcome to the Royal College of Emergency Medicine Standards page. Here you will find resources including clinical sign off and information on sepsis.
The clinical standards for Emergency Departments (EDs) below have been produced by the Quality in Emergency Care Committee of the Royal College of Emergency Medicine (CEM). The standards are developed by consensus from emergency physicians with relevant expertise and with input from other relevant stakeholders. The standards are regularly reviewed and provide the criteria for RCEM audits.
RCEM had in the past set clinical standards but now recommends that you refer to national standards organisations such as NICE, SIGN, BTS, or other as relevant in your area.
Additional reference documents regarding clinical standards are available to download below:
RCEM standard for senior review prior to discharge (Consultant Sign-Off)
In December 2010 the Royal College of Emergency Medicine published a new standard for Consultant “sign off” of selected high risk patients being discharged from the Emergency Department.
This standard was updated in June 2016, introducing adults aged 70 years and over with abdominal pain as a new high-risk patient group. The age range for adults with atraumatic chest pain has been revised from 17 years and over to 30 years and over.
We welcome comment and feedback on the revised standard.
Staff working in Emergency Departments (ED) should be familiar with the significant morbidity and mortality associated with sepsis and possess the knowledge and skills to recognize it early and initiate resuscitation and treatment. The ED provides a key role in identifying patients with sepsis, followed by risk stratification for severe sepsis and septic shock, initiating resuscitation and treatment, and ensuring the correct onward management of patients identified with sepsis. EDs are vital to the success of collaborative care pathways for the seamless management of patients with sepsis from the prehospital environment, through the ED, and to admission in either a ward bed or the Critical Care Unit. Sepsis responds well to early treatment and, if required, rapid escalation of therapy.
The UK Sepsis Trust has led the development of a series of clinical toolkits which map the path to success in sepsis management. Developed with the Royal Colleges and specialist Societies, these toolkits provide pragmatic solutions to improving sepsis care across the healthcare system. They are supported by robust education and are designed for immediate implementation. Exemplar standards will help identify those units excelling at sepsis care.
The clinical toolkit for Emergency Medicine has been developed jointly by the Royal College of Emergency Medicine and the UK Sepsis Trust. It is designed to provide operational solutions to the complexities challenging the reliable identification and management of sepsis, and complements clinical toolkits designed for other clinical areas. We acknowledge use of some content from the Acute Medicine Toolkit developed by the UK Sepsis Trust & Royal College of Physicians.
RCEM re-audited the management of severe sepsis and septic shock in UK Emergency Departments in 2016/17. There has been a steady improvement in the giving of antibiotics over the years and now 44% of patients receive them within an hour of arrival. There has been a slight improvement in the giving of IV fluids from 40% to 43%. The taking of blood cultures and the measurement of lactate in the first hour have both improved, up from 40% to 45% and 49% to 60% respectively. Documentation of urine output measurement is poor at only 18%.