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Emergency medicine response to the COVID-19 pandemic in England: a phenomenological study
  1. Henry Walton1,2,
  2. Annakan Victor Navaratnam3,
  3. Martyn Ormond4,
  4. Vanita Gandhi3,
  5. Clifford Mann5
  1. 1 Clinical Workforce Productivity Improvement, NHS England and NHS Improvement, London, UK
  2. 2 Newham Emergency Department, Barts Health NHS Trust, London, UK
  3. 3 Fellows Unit, NHS England and NHS Improvement, London, UK
  4. 4 Oral Medicine Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  5. 5 Emergency Department, Taunton and Somerset NHS Foundation Trust, Taunton, UK
  1. Correspondence to Dr Henry Walton, Clinical Workforce Productivity Improvement, NHS England and NHS Improvement, London SE1 6JW, UK; henry.walton1{at}


Background The COVID-19 pandemic has stretched EDs globally, with many regions in England challenged by the number of COVID-19 presentations. In order to rapidly share learning to inform future practice, we undertook a thematic review of ED operational experience within England during the pandemic thus far.

Methods A rapid phenomenological approach using semistructured telephone interviews with ED clinical leads from across England was undertaken between 16 and 22 April 2020. Participants were recruited through purposeful sampling with sample size determined by data saturation. Departments from a wide range of geographic distribution and COVID-19 experience were included. Themes were identified and included if they met one of three criteria: demonstrating a consistency of experience between EDs, demonstrating a conflict of approach between emergency departments or encapsulating a unique solution to a common barrier.

Results Seven clinical leads from type 1 EDs were interviewed. Thematic redundancy was achieved by the sixth interview, and one further interview was performed to confirm. Themes emerged in five categories: departmental reconfiguration, clinical pathways, governance and communication, workforce and personal protective equipment.

Conclusion This paper summarises learning and innovation from a cross-section of EDs during the first UK wave of the COVID-19 pandemic. Common themes centred around the importance of flexibility when reacting to an ever-changing clinical challenge, clear leadership and robust methods of communication. Additionally, experience in managing winter pressures helped inform operational decisions, and ED staff demonstrated incredible resilience in demanding working conditions. Subsequent surges of COVID-19 infections may occur within a more challenging context with no guarantee that there will be an associated reduction in A&E attendance or cessation of elective activity. Future operational planning must therefore take this into consideration.

  • emergency department operations
  • major incident
  • planning
  • disaster planning and response

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Handling editor Margaret Samuels-Kalow

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  • Contributors HJW is the lead author, coordinating work and acting as principle author of the paper. HJW, AVN, MO and VG designed and performed data collection, undertook data analysis and assisted with review and drafting of paper. CM supervised work, reviewing and approving data collection protocol/ methodology and reviewing drafts of final paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Anonymised interview summaries available from lead author via ORCID ID: 0000-0001-8710-0407. Data reuse would need to be discussed with study participants prior to permission being given.