The Emergency Department (ED) is based at the Leicester Royal Infirmary (LRI), which is one of three hospitals making up the University Hospitals of Leicester NHS Trust (the other two being Leicester General Hospital and the Glenfield Hospital) and is one of the biggest and busiest departments in the UK (and possibly even Europe).

The department looks after both adults and children (in a dedicated paediatric ED) and is made up of a variety of different areas (see below). We are also a Trauma Unit within the East Midlands Major Trauma Network (EMMTN), with the designated Major Trauma Centre (MTC) being QMC in Nottingham.

Working in ED can, at times, feel stressful and overwhelming, but it can also be incredibly enjoyable, with huge variety in the cases that you will see, an excellent team to work alongside , and a multitude of different training opportunities. If you are a more junior member of the team, then we would hope that you have constant support and help when needed - you should never feel like you are on your own! There is at least one consultant present in the department from 08:00-01:00. Outside of these hours, there is a consultant on call from home (increasingly, there is also a consultant present in the department for the whole night) and there will always be support from senior registrars/middle grades, as well as a very experienced team of nurses, ACPs and ENPs.

Below, is a map of the department and an outline of the different areas within it:

(For a more detailed version of this map, please click here)

The paediatric and adult departments are separated by the imaging corridor, which contains 2 CT scanners and 3 x-ray rooms. At one end, this corridor leads to the Emergency Room (ER, AKA Resus), which has 12 bays, 10 for adult patients and 2 for paediatrics. The other end of the imaging corridor leads to AMU and a link corridor to the rest of the hospital (see map here).

Adult Injuries is now located in the Balmoral Building (next to Fracture Clinic). We also have an Emergency Decisions Unit (EDU), which is situated just outside of the ED, on the same corridor as AFU/EFU.

Patients will largely arrive at the department in 2 different ways - walk-in or ambulance. In Adults, the majority of patients coming via ambulance are bought to Ambulance Assessment/PEP for their initial triage, investigations and ‘STAT’ assessment (as needed). More unwell/unstable patients, may be ‘pre-alerted’ to the ER and will be taken directly there on their arrival. PED does not have an Ambulance Assessment area. Instead, patients come to the PED Ambulance Entrance before booking in and having an initial assessment, with the ‘pre-alerted’ patients going straight to the ER, in either bay 1 or 2.

Adult walk-in patients will book in at reception, and will then have a very brief assessment by a VAC nurse/clinician. At this point, and depending on their presentation, they may be asked to go directly to Injuries, or be redirected to e.g. MIaMI (Minor Injuries and Minor Illnesses), GPAU, MAU etc. Remaining patients will await triage before then being allocated to the appropriate area, within the department (with relevant investigations, referrals etc instigated). Patients will also be assigned a priority score at this point, highlighting those that may need to be seen more urgently. They will then wait to be seen by a clinician.

Similarly, in PED, patients will book in at the PED reception (with a VAC nurse present). They will then be triaged, prioritised as needed and allocated to the appropriate area within PED. As with adults, they will then wait to be seen by a clinician.

In Adults, ‘Majors’ is split into Red Majors, with 32 cubicles, and Blue Majors, with 16. There is also an ‘Ambulatory’ area, for patients who do not need a trolley space. This is next to the Blue Majors area, linking directly to the waiting room, and has 9 rooms (some of which will be used for nurses and HCAs to complete e.g. bloods, ECGs etc).

As you will see on the map above, there is also an area called the ‘PEP’. This stands for POA (patient on ambulance) Escalation Area. This area has provision for 14 adult patients and was introduced in an effort to avoid patients having to wait on an ambulance when the department is busy and there is no capacity in Ambulance Assessment.