Royal College of Emergency Medicine

“RCEM is involved in the design and piloting of a revised paediatric early warning score specifically intended for Emergency Departments”

“We will ask the trust for the action they intend to take because of this Prevention of Future Deaths Report and monitor those actions as part of our ongoing monitoring and engagement with them.”

“NHS England has published a summary of existing guidance on the deployment of medical associate professions for NHS organisations. This guidance makes it clear that all staff should introduce themselves and their role clearly and be supported by their employer to do so.”

“RCEM issued a position statement in October 2024 regarding patients who may require a laparotomy [7]; this statement highlights that some patients are at greater risk of requiring surgery and part of this group includes the older person and those with cognitive impairment.”

“the Department notes that the report has been sent to a number of medical Royal Colleges and professional bodies relating to anaesthesia. We think these organisations are best placed to respond to points 6, 7 and 8 of your report which relate specifically to guidelines around anaesthesia therefore our response focuses on points 1 - 5 only.”

“We note the initial assessment took place in an Urgent Treatment Centre (UTC) rather than Emergency Department (ED); from the described circumstances of Ms [name redacted] death, it is not clear whether the UTC was effectively 'gatekeeping' access to an emergency department or not.”

“I intend to make a prevention of future deaths report”

“We will continue to be strongly supportive of this initiative and support the need for early escalation of care for those patients in whom it is not possible to undertake vital signs.”

“We have been collaborating with NHS England and the Royal College of Nursing to develop a single national PEWS for England since 2018 and are supportive of equivalent processes across the UK”

“Emergency clinicians with responsibility for the care of children receive training in how to assess risk and immediately manage children's mental health needs and support their family/carers”

“The trust emergency department electronic patient records do not show how many times a patient has presented to hospital with the same signs and symptoms during their current illness”

“we will continue to work closely with the Faculty of Intensive Care Medicine and seek to improve upon our existing guidance to highlight the importance of waveform capnography in the early recognition of oesophageal intubation.”

“We are aware that increased body temperature can be a trigger for seizures in Dravet's syndrome and that these seizures may be of a complex nature (lasting longer than 15 minutes or occurring again within 24hr”

“We have taken an action to make all the medical directors and lead paramedics of UK ambulance services aware of the circumstances of [the deceased]' death and have asked them to review the JRCALC guidance and any local pathways or guidance in relation to decisions around conveying children after seizures.”

“We believe that our guideline on epilepsies: diagnosis and management [CG137], which was in place at the time of [the deceased]' death, is directly relevant to this case. The guideline covered diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care and made recommendations on what should happen following a first seizure (section 1.4), diagnosis (section 1.5) and investigations (sections 1.6). CG137 has since been replaced by our guideline”

“The guidance was reviewed on 18" May 2021 by Clinical and Operational leads in NELFT and Barts Health. It has now been submitted to the joint governance and operational group for consideration and sign off at the next session on gh June 2021.”

“The Royal College of Emergency Medicine is in the process of finalising a Guideline, based on the limited evidence that is available on the selection of patients for CT scanning. This will be circulated to our 10,000+ members and published on our website for public viewing. It is planned that this will be endorsed by the Royal College of Radiologists, to raise awareness amongst Radiologists.”

“covers the management of hip fractures will be updated to reflect and emphasise the need for appropriate monitoring of all patients particularly those in pain pre or post procedure. This document is due for renewal within the next 12months.”