Protocols 51–53
Emergency Department Protocol Commons
Consultation Edition, Version 0.9
Phase VIII addresses three complex emergency-care pathways in which autonomy, capacity, serious illness, uncertainty, family needs, legal duties and operational pressures must be balanced without abandonment, coercion, non-beneficial treatment or unsafe delay.
The protocols provide structured pathways for capacity assessment and refusal of care, departure before completion, palliative emergencies and treatment ceilings, death in the emergency department, and active observation or short-stay care—from immediate clinical assessment and stabilization through supported decision-making, symptom relief, reassessment, safeguarding, admission, transfer, discharge, bereavement support or governance follow-up.
These protocols are intended for professional review and responsible local adaptation. They are not approved clinical policies and must not be implemented without verification against current guidance, consent and capacity law, mental-health and child-protection legislation, death-verification and certification requirements, coronial or forensic procedures, local palliative-care resources, medication formularies, observation-unit staffing and monitoring capability, referral arrangements and institutional governance requirements.
Download Phase VIII
The complete phase may be downloaded in either of the following formats:
Download the complete Phase VIII package — PDF and editable Word copies
Download the Phase VIII editable Word package for local adaptation
Readers may also review the individual PDF consultation copies below.
How to Review This Phase
Reviewers are not expected to comment on all three protocols.
Please select the protocols most relevant to your experience and consider:
Clinical safety and accuracy
Consent, capacity, supported decision-making and informed refusal
Emergency treatment when valid consent cannot be obtained
Harm reduction, safeguarding and response to unplanned departure
Communication of serious illness, goals of care and treatment ceilings
Palliative symptom control and medication safety
Death verification, certification, notification and forensic requirements
Family, cultural, spiritual, bereavement and staff-support needs
Observation eligibility, exclusions, staffing, monitoring and time limits
Handover, outstanding-result follow-up and documentation requirements
Resource-variable and small-island realities
Important omissions or unnecessary complexity
Please submit a separate feedback form for each protocol being reviewed.
Submit feedback on a Phase VIII protocol
Protocol 51 — Capacity, Refusal of Care, and Departure Before Completion
This protocol provides a humane and legally aware pathway for patients who refuse an investigation, treatment, admission or transfer, request to leave before care is complete, or depart without staff awareness.
It covers supported decision-making, decision-specific capacity assessment, informed refusal, emergency treatment when valid consent cannot be obtained, harm reduction, self-directed and unplanned departure, missing vulnerable patients, outstanding results, documentation, follow-up and governance review.
Read or download the PDF consultation copy
Protocol 52 — Palliative Emergencies, Treatment Ceilings, and Death in the Emergency Department
This protocol addresses serious illness, palliative emergencies, treatment ceilings, expected dying and unexpected death in the emergency department.
It covers recognition and treatment of reversible emergencies, person-centred goals of care, advance plans and treatment ceilings, rapid relief of distress, preferred and feasible place of care, verification and certification of death, required notification and evidence preservation, family and staff support, and mortality review.
Read or download the PDF consultation copy
Protocol 53 — Emergency Department Observation and Short-Stay Care
This protocol establishes active, time-limited observation and short-stay care for selected stable patients who require focused assessment or treatment before a safe disposition decision.
It covers eligibility and exclusion criteria, defined clinical questions, same-day and bedded tracks, staffing and named responsibility, monitoring and milestones, deterioration triggers, maximum time limits, discharge, conversion to admission or transfer, audit and prevention of observation areas being used for boarding.
Read or download the PDF consultation copy
Submit Feedback
Feedback from emergency clinicians, nurses, palliative-care and critical-care teams, mental-health and paediatric professionals, social workers, safeguarding personnel, pharmacists, geriatric and rehabilitation teams, observation-unit staff, chaplaincy and spiritual-care providers, health-information personnel, legal and risk-management advisers, administrators, patient-safety personnel and other relevant reviewers is welcomed.
Please identify:
The protocol number
The relevant section or page
The concern or recommendation
Suggested replacement wording where possible
Supporting evidence or local experience
Whether the issue may represent an urgent patient-safety concern
Submit feedback on the Emergency Department Protocol Commons
Complete Protocol Index
Browse all 59 protocols and download individual PDF or editable Word copies
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