Royal Infirmary of Edinburgh

Emergency Department

The RIE ED is the biggest adult ED in Scotland, and thrives on seeing a high acuity of patients and delivering true emergency critical care at the front door.  In 2012, we cared for 113,000 patient attendances, and have a majors:minors ratio of approximately 1:1.  Despite this, we have a well-maintained admission rate of just around 30%, helped by increased Emergency Physician presence, real-time decision support, and continual innovation to treat patients closer to home or in ambulatory settings.

The RIE ED manages approximately 700 trauma cases annually, making it the busiest trauma receiving hospital in Scotland. Major trauma (ISS>15) accounts for around 120 of these cases. There is a helipad on site and increasing numbers of patients attend by air ambulance. It also acts as the base for our EM flying squad “Medic One”, which attends patients in pre-hospital situations of any aetiology approximately 100 times a year, including victims of trauma, and we have excellent links and working relationships with the Scottish Ambulance Service.  Emergency Physicians ‘team lead’ all trauma resuscitation cases with excellent support from radiologists, surgeons, anaesthetists and intensivists. With the exception of plastics, burns and maxillo-facial surgery all specialties will be on site from 2017.

The Royal Infirmary of Edinburgh has been chosen as one of Scotland’s four major trauma centres and the major trauma workload will increase by more than thirty percent.   This is an exciting time for trauma in Edinburgh and we believe our department offers the opportunity to improve the practical, clinical and non technical skills required to manage these challenging patients.

We also routinely perform all our own procedural sedations (approx 7-800/yr), Rapid Sequence Inductions (approx 350/yr with anaesthetic support), Bier’s Block anaesthetics and manipulations, and the team have developed a robust quality assurance infrastructure and culture of positive change and behaviours. 

We also benefit from a fully developed 24hr Emergency Nurse Practitioner service, as well as 7 day Occupational Therapy assessment with support from the the Elderly Care Assessment Team, Physiotherapy practitioners, Clinical Decision-Making ED Nurses, Cardiology and Respiratory Clinical Nurse Specialists, and enhanced role Radiographers.

The unit has a fabulous team ethos – all junior doctors work in a team for their whole attachment, with registrars supervising and mentoring more junior doctors in training, for all their shifts.  There is a clear consultant supervisor structure, and consultants are present on the shop floor from 0745hrs to 2300hrs, 7 days a week.   The Emergency Medicine team was a finalist in the BMJ Healthcare Improvement Awards ED team of the year 2012.