LO1

Care for physiologically stable adult patients presenting to acute care across the full range of complexity

At completion of LO1 a trainee will be able to: 

  • Gather appropriate information, perform a relevant clinical examination and be able to formulate and communicate a management plan that prioritises patient’s choices and is in their best interests, knowing when to seek help .

  • Assess and formulate a management plan for patients who present with complex medical and social needs.

These capabilities will apply to patients attending with physical and psychological ill health.

Key LO1 Descriptors

At completion of Intermediate training a trainee will be able to:

  • Assess and manage all adult patients attending the ED. These capabilities will apply to patients attending with both physical and psychological ill health.

  • Assess and formulate a management plan for patients who present with complex medical and social needs or who manifest as one of the frailty syndromes with Supervisor ‘on call’ from home for queries, able to provide directions via phone and able to attend the bedside if required to provide direct supervision.

These capabilities will apply to patients attending with physical and psychological ill health.

At completion of higher training a trainee will: 

  • Be an expert in assessing and managing all adult patients attending the ED. These capabilities will apply to patients attending with both physical and psychological ill health.

  • Be able to manage with no supervisor involvement.

All following ACCS descriptors apply in Intermediate and Higher training

General Guidance

  • Recognise when care would be more appropriately delivered by other healthcare professionals.

Mental Health 

  • Assess and initially manage patients of all ages presenting with features consistent with mental illness by taking account of their psychiatric and medical history, mental state examination, vital signs and available investigations.

  • Make a competent assessment of a patient’s suicide risk, taking into account circumstances and known risk factors.

  • Professionally and compassionately assesses a patient in crisis.

  • Safely manage acutely disturbed behaviour.

  • Manage the patient threatening to abscond.

  • Work collaboratively with Psychiatry Liaison staff and other agencies (including the Police) where necessary when caring for patients with mental health problems.

  • Contribute effectively to multidisciplinary care for frequently attending patients with mental illness.

  • Identify risk factors for suicide and/or absconsion and mitigates these by appropriate nursing/security observation.

  • Competently manages the physical/wound care and toxicological consequences of self-harm.

  • Understand safeguarding responsibilities.

  • Safely manages aggressive or disturbed behaviour via de-escalation techniques as well as assisting with physical and chemical restraint (rapid tranquilisation) by providing clinical oversight.

  • Communicate effectively with psychiatry liaison colleagues, nursing staff, security and the police when necessary.

  • Understand the legal frameworks underpinning the care of the psychiatric patient, as relevant to the ED and ED observation areas.

  • Respect patient autonomy but understand when a patient lacking capacity should have investigations or treatment made in their best interests.

Key Mental Health resources:

  • Mental Health in Emergency Departments – Toolkit (April 2023)

    • This comprehensive toolkit provides guidance on assessing and managing patients with mental health issues in emergency settings. It includes protocols for mental health triage, risk assessment, and collaboration with mental health services.

  • Best Practice Guideline: The Patient Who Absconds

    • This guideline assists emergency physicians in managing patients who leave the emergency department unexpectedly, focusing on legal considerations and patient safety. 

  • A Brief Guide to Section 136 for Emergency Departments

    • This document outlines the process for managing patients brought to the emergency department under Section 136 of the Mental Health Act, including assessment and legal considerations. 

  • RCEMLearning

    • RCEMLearning is the college's e-learning platform, offering modules on various topics, including mental health assessments and management. These modules are designed to enhance knowledge and skills in emergency medicine. 

When working with older patients with complex co-morbidity in the ED you should be …

Key resources:

Observational medicine 

  • Should be able to evaluate patients in a CDU/ observational medicine setting, be able to estimate risk and utilise diagnostic tests appropriately and make safe discharge plans, liaising with other services effectively when needed.

  • Communicate effectively with patients in the CDU/observational medicine setting.

Key Resources

  • RCEM Ambulatory Emergency Care Toolkit

    • This toolkit by the Royal College of Emergency Medicine (RCEM) provides guidance on managing patients in ambulatory and CDU settings. It covers patient selection criteria, risk assessment, and the development of clear pathways to prevent unnecessary admissions.

  • ACCS Curriculum 2021

    • The "Silver Book" offers standards and recommendations for the care of older people with urgent and emergency care needs, emphasizing the importance of comprehensive geriatric assessment and multidisciplinary collaboration.

  • NICE Guidelines on Acute Medical Emergencies

    • The National Institute for Health and Care Excellence (NICE) provides evidence-based guidelines on the assessment and management of acute medical emergencies, offering insights into appropriate diagnostic testing and patient management strategies.

  • GIRFT Principles for Urgent and Emergency Care

    • The "Getting It Right First Time" (GIRFT) programme offers principles to improve patient flow and experience in urgent and emergency care settings, including CDUs.

  • Communication Skills Training

    • Health Education and Improvement Wales (HEIW) provides a teaching programme that includes communication skills essential for effectively interacting with patients in acute care settings.

Page Contributors

Dr Sunny Jutla
Consultant in Emergency Medicine, Lead for EM3

Tom Brown
Website Designer

Jess Speller

Clinical Research FY2, Leicester Royal Infirmary