Redesigning the first point of contact for walk-in patients in the emergency department: a service evaluation of the First Encounter model

In UK emergency departments (EDs), crowding, lack of inpatient beds and high patient acuity, compounded by triage 'bottlenecks', inconsistent streaming and fragmented communication between healthcare professionals, can compromise patient care, safety and experience. This article details the evaluation of a service improvement initiative - the First Encounter model - that aimed to address these issues through redesigning the first point of contact for walk-in patients. The initiative involved the co-location of two senior healthcare professionals - a band 6 or 7 senior nurse and the emergency physician in charge (EPIC) - at the ED entrance during peak hours. The aim was to improve the timeliness of patient assessment, strengthen patient experience and support staff's confidence in their clinical decision-making. The findings revealed that the percentage of patients who received clinical engagement within 15 minutes of arrival at the ED more than doubled; the average triage time halved; compliance with the four-hour target improved modestly; waiting-room congestion reduced; and staff felt more confident in their clinical decision-making. The model appears scalable and adaptable to other EDs, although further evaluation is required to establish its sustainability and broader patient outcomes.