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Reports & Toolkits

Reports & Toolkits

The Royal College of Emergency Medicine's Safety Reports and Toolkits section of the website.

Essential Reading

Francis Report

The Francis Report is essential reading for all clinicians working in Emergency Departments and has important recommendations for patient safety. The Safer Care team have developed the following resources to support safety in the wake of the Francis review.

Francis report: a call to arms

The Francis Report is mandatory reading for all clinicians working in Emergency Departments. Drs Ruth Brown and Sue Robinson have written ‘The Francis Report: a call to arms,’ published within the Emergency Medicine Journal. In this article they advocate that the Francis report serves as a call to arms for ED staff to stop normalising the abnormal and tolerating substandard care, to respect and protect our patients and hold our leaders, and ourselves, to account.

You can view this document here.

Francis Report Recommendations – a Checklist for Senior Teams in Emergency Departments

The Francis report has many recommendations for organisations as a result of the enquiry. The College has developed this checklist for Clinical Directors of the Emergency Department – taking the most relevant recommendations and identifying key actions for clinical leaders of emergency departments. While the list is not exhaustive it is meant as a handy guide to action that might usefully be taken in the first instance. Download this document here.

Francis Report – Statement for Fellows and Members

The College has prepared a statement for Fellows and Members on the Francis Inquiry Report outlining what the report is and why it is important for Emergency Medicine. This document also acts a guide to challenging occurrences of poor care. This document can be found here.

Berwick Report

The Berwick report is essential reading for emergency medicine practitioners. It identifies changes that could help the English NHS become safer and more patient-centered whilst making numerous recommendations to help protect patients. Read the recommendations from Professor Don Berwick and the National Advisory Group on the Safety of Patients in England here.

Non-technical Skills

Non-technical skills (NTS) have a vital role to play in Emergency Medicine practice. There is increasing awareness that a clinician must not only possess good technical skills but should also be proficient in a variety of interpersonal and cognitive skills in order to optimise patient care. Non-technical skills reduce the opportunity for human error and enhance risk management both of which are known to improve patient care. The College has prepared a Non-technical Skills-Top 10 Tips as a guide on how to maximise emergency physician’s non-technical skills for the benefit of patients and staff. Download this document here.

Integrating Safety Checklist

The Safer Care Committee has developed a new checklist for integrating safety into your Emergency Department. This allows you to assess how well you integrate and consider safety in your departmental activities and makes suggestions for which staff need to be involved.

Download the checklist as a pdf here.

Radiology Processes

There have been cases that were the subject of a Coroner’s rule 43 report to the Secretary of State. Both of these involved the system for reporting serious and potentially fatal unexpected findings on radiological imaging.

The Safer Care team have prepared guidance for Emergency Teams on reviewing radiological imaging, which can be downloaded here.

The Safety Toolkit

Emergency Medicine in the UK is currently in a state of crisis. Many Emergency Departments are understaffed and facing an unprecedented increase in attendances whilst under intense pressure to achieve quantitative targets. These demands in conjunction with the findings of the Francis and Berwick Reports (see Essential Reading) means that the absolute requirement to deliver high quality and safe care in Emergency Departments has never been greater.

To help support our membership in this the Royal College of Emergency Medicine has developed The Safety Toolkit which aims to describe the structures, processes and skills required for a ‘safe’ department. There are resources identified within each section to stimulate, provoke and challenge, as well as guide personal development. There are overlapping references and differing perspectives but the vision is of a resource for change and development.

  • Download The Safety Toolkit (full document) here

Download separate sections of the toolkit using the links below:

  • Download ‘Designing a risk register’ here
  • Download ‘Learning from practice’ here
  • Download ‘Safe leadership’ here
  • Download ‘Supporting the Second Victim’ here
  • Download ‘Education’ here
  • Download ‘Safety scorecard’ here
  • Download ‘Safety culture’ here
  • Download ‘Team working’ here
  • Download ‘Departmental activity resources’ here
  • Download ‘Integrating safety checklist’ here
  • See Nitrous Oxide & Pre-Hospital Emergency Medicine (Information Sheet)

Tools Resources and Systems

The Safer Care Team recommend that Emergency Medicine doctors utilise the below tools, resources and systems when considering patient safety.

Crisis Resource Management (CRM)

CRM can be defined as a management system which makes optimum use of all available resources – equipment, procedures and people – to promote safety and enhance efficiency. Originally used in aviation but increasingly utilised in healthcare.

Clinical Negligence Scheme for Trusts (CNST)

The Clinical Negligence Scheme for Trusts handles all clinical negligence claims against member NHS bodies where the incident in question took place on or after 1 April 1995 (or when the body joined the scheme, if that is later). Membership of the scheme is voluntary.

Essentials of Patient Safety

Written by Prof Charles Vincent, a short version is available to download for free. The topics addressed include the evolution of patient safety; the research that underpins the area, understanding how things go wrong, and the practical action needed to reduce error and harm and, when harm does occur, to help those involved. The main book covers these topics in more depth and a number of additional topics such as measurement, safety culture, design, safety campaigns and safe organisations. See more here.

Failure Mode and Effects Analysis (FMEA) – a methodology for analysing potential reliability problems. See:

FMEA: A model for reducing medical errors

M Chiozza, C Ponzetti

Clinica Chimica Acta

Volume 404, Issue 1, 6 June 2009, Pages 75-78

Global Trigger Tool (GTT)

An easy to use tool that supports a structured case note review to identify harm events. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes. The Trigger Tool methodology includes a retrospective review of a random sample of patient records using triggers to identify possible adverse events. It is important to note, however, that the IHI Global Trigger Tool is not meant to identify every single adverse event in a patient record. See:
Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2009 (Available on

NHS Evidence

Provided by NICE, NHS Evidence is a new service which will develop, enhance and expand the services that were previously provided by the National Library for Health (NLH).

National Service Frameworks (NSF)

The National Service Frameworks cover some of the high priority conditions and key patient groups. They work to:

  • set clear quality requirements for care based on the best available evidence of what treatments and services work most effectively for patients, and
  • offer strategies and support to help organisations achieve these

See more in the National Archives.

Patient Safety – 10 things NHS Trusts should already be doing

This document from the Centre for Reviews and Dissemination of the NIHR and University of York highlights 10 key things which should be undertaken by Trusts to promote patient safety.

Patient Safety First

Patient Safety First is a national campaign that aims:

  • to ensure the safety of patients is everyone’s highest priority
  • to reduce harm by changing in specific areas.

It is sponsored by the NHS Institute for Innovation and Improvement, the NPSA and the Health Foundation.

Plan, Do, Study, Act (PDSA)

The PDSA cycle tests a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).

Patient Safety Alert (PSA)

Through analysis of reports of patient safety incidents, and safety information from other sources, the National Reporting and Learning Service (NRLS) develops advice for the NHS that can help to ensure the safety of patients.

Advice is issued to the NHS as and when issues arise, via the Central Alerting System in England and directly to NHS organisations in Wales. Alerts cover a wide range of topics. Types of alerts include Rapid Response Reports, Patient Safety Alerts, and Safer Practice Notices. See more here

Reporting incidents

From 1 April 2010 it became mandatory for NHS trusts in England to report all serious patient safety incidents to the Care Quality Commission as part of the Care Quality Commission registration process. To avoid duplication of reporting, all incidents resulting in death or severe harm should be reported to the National Reporting and Learning Service (NRLS), who will then report them to the Care Quality Commission. Report a patient safety incident here.

Staff Care, How to engage staff in NHS and why it matters

This report from the Point of Care Foundation shows that the way healthcare staff feel about their work has a direct impact on the quality of patient care as well as on an organisation’s efficiency and financial performance. This report is available here.

Royal College of Emergency Medicine – Top tips for patient safety

The RCEM Safer Care committee had produced a poster that lists simple steps that everyone can take to improve patient safety and raise awareness of patient safety. Please download and display in your ED. See here.

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