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  • Led by University Hospitals Bristol NHS Foundation Trust.
  • Implemented in the emergency department at the trust.
  • Aimed to address overcrowding in A&E and the increase in mortality rates this causes.
  • Implemented a checklist designed to improve patient safety in emergency care departments.




This project by University Hospitals Bristol NHS Foundation Trust involved introducing a safety checklist to help reduce incidents relating to failure to recognise deteriorating patients or delays in delivery of care in the emergency department.

Increasing demand and an ageing population has led to overcrowding in most UK emergency departments. This is exacerbated by winter pressures, when acute trusts are pushed beyond their operational capacity. Overcrowding contributes to clinically significant delays to diagnosis, recognition of acute deterioration and in instigating the correct treatment. Patients suffering from time critical conditions such as stroke, sepsis or heart attack are particularly vulnerable.

Human factors play a central role in the delivery of sub-standard care during overcrowding, as staff become overwhelmed by the volume of tasks and relentless interruptions. Checklists, when introduced appropriately, can improve standardisation and reliability in the delivery of care. This project involved the design and introduction of an emergency department checklist: a time-based framework of tasks to be completed for every patient presenting with a major illness.

The checklist can be completed by any member of clinical staff in any area and contains all the basic elements of care, as well as early triggers to specific care pathways such as sepsis.

Since the innovation was implemented at University Hospitals Bristol, key clinical performance indicators have shown significant improvements, including the monitoring of vital signs, calculation of early warning scores, pain scoring and administration of medication. Since its introduction there have been no clinical incidents related to failing to recognise a deteriorating patient or delay in care delivery.

Challenges faced by the project team included maintaining enthusiasm for the intervention during winter 2014 when overcrowding became ‘the norm’ for the emergency department.

Contact details

For further information about the project, please email Dr Emma Redfern at University Hospitals Bristol NHS Foundation Trust.

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