First reported 18 Apr 2017•Latest report 28 Oct 2024
Definition
What this concern includes
Includes failures in emergency-department streaming and initial front-door assessment arrangements, including information gathering, clinical assessment, physiological checks, integration between primary and secondary care, pathway selection, risk-based escalation and maintenance of streaming guidance.
Not included
Excludes general emergency-department triage, treatment, waiting-time, crowding or patient-flow failures when streaming or front-door pathway selection is not the deficient control.
Excludes failures occurring after a patient has been safely streamed and accepted into the appropriate assessment pathway.
Excludes generic documentation, staffing or communication deficiencies unless they directly impair emergency-department streaming or initial front-door assessment.
Excludes condition-specific diagnostic or referral pathways where the named condition or pathway provides a more specific supported boundary.
Reports
5
Distinct published reports
Individual concerns
6
A report can raise multiple concerns
Date range
2017–2024
First to latest report issue date
Stated actions
11
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Royal College of Emergency Medicine2
Atrumed Ltd1
Barts Health NHS Trust1
Bedfordshire Hospitals NHS Foundation Trust1
BrisDoc Healthcare Services Limited1
Bristol NHS Foundation Trust1
National Institute for Health and Care Excellence1
NHS England1
North East London NHS Foundation Trust1
Yorkshire Ambulance Service NHS Trust1
NHS trust4
Health professional body2
Private limited company2
Executive non-departmental public body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
North Yorkshire and York
Concerns raised1
Failure to make appropriate ‘fit to sit’ determinations for patients unable to weight bear
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Draft and progress a dedicated fit-to-sit policy through internal review and final clinical governance approval.
Stated by Yorkshire Ambulance Service NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 1 November 2024.
Action
Disseminate the approved fit-to-sit policy across YAS for use by all clinical staff.
Stated by Yorkshire Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 1 November 2024.
Action
Conduct a Patient Safety Incident Investigation into the moving-and-handling care, including fit-to-sit decisions, handover, diversion, HALO involvement and specialist-hospital transport.
Stated by Yorkshire Ambulance Service NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 1 November 2024.
Inner South London
Concerns raised1
Streaming patients without current chest pain to a MedOCC or equivalent service despite risk of sudden deterioration
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.7
Action
Issue guidance on emergency-department initial assessment and triage.
Stated by Royal College of Emergency MedicineStated completedThe respondent said that this action was complete when they made their response on 2 September 2024.
Action
Collaborate with NHS England to standardise initial-assessment definitions and processes.
Stated by Royal College of Emergency MedicineStated completedThe respondent said that this action was complete when they made their response on 2 September 2024.
Action
Continue working with NHS England to promote standardised initial assessment for emergency-department patients.
Stated by Royal College of Emergency MedicineStated in progressThe respondent said that this action was in progress when they made their response on 2 September 2024.
Action
Review the effectiveness of current triage systems using evidence.
Stated by Royal College of Emergency MedicineStated completedThe respondent said that this action was complete when they made their response on 2 September 2024.
Action
Help design a new initial-assessment process for implementation across emergency departments in England.
Stated by Royal College of Emergency MedicineStated in progressThe respondent said that this action was in progress when they made their response on 2 September 2024.
Action
Develop a new initial assessment model collaboratively with emergency care, nursing and patient representatives to improve patient safety.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 2 September 2024.
Action
Introduce the new initial assessment model at sites across England.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 2 September 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Position
Insufficient information about the UTC’s role and STREAMing Model prevents a specific response to concerns about prioritising chest pain.
Stated by Royal College of Emergency MedicineUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The STREAMing pathway does not unduly prioritise cardiac-sounding chest pain, and directing this patient to MedOCC was appropriate after low-risk assessment.
Stated by NHS EnglandDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Modifying the STREAMing pathway would probably not have predicted the rapid deterioration or altered the initial assessment outcome.
Stated by NHS EnglandDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
The prioritisation system and acute-care organisation concerns fall outside NICE’s remit.
Stated by National Institute for Health and Care ExcellenceOutside remitThe respondent said that this matter was outside its role or authority.
Position
NHS England is responsible for addressing concerns about its STREAMing prioritisation system.
Stated by National Institute for Health and Care ExcellenceRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Bedfordshire and Luton
Concerns raised1
Insufficient information gathering during emergency-department streaming to UGPC
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
East London
Concerns raised1
Failure to update streaming guidance in line with relevant learning and guidance
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Review and submit joint streaming guidance incorporating THINK AORTA learning for governance approval.
Stated by Barts Health NHS Trust and North East London NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 29 April 2021.
Avon
Concerns raised2
Failure of front-door ED streaming to include basic physiological measurements
Lack of integrated front-door ED streaming by primary and secondary care clinicians
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures in emergency-department streaming and initial front-door assessment arrangements, including information gathering, clinical assessment, physiological checks, integration between primary and secondary care, pathway selection, risk-based escalation and maintenance of streaming guidance.
