Authors: Tom Bannister / Codes: ELP5, EnC3, GC1, GC6, IC6, SaP2, SeC3, SLO10, SLO11, XC3, XC4 / Published: 01/05/2024

Scope / Reason for development

Children and adults attending emergency departments. The term ‘screening’ is used in a very broad sense in this document covering the whole spectrum, from specific conditions which have a recommendation from the National Screening Council to opportunistic case findings. Screening may refer to a specific test or the process of questioning.

Emergency department (ED) patients are being targeted with increased frequency for screening initiatives, some of which are unrelated to the patient’s reason for attending (opportunistic). The aim of this guidance is to provide recommendations to EDs when considering implementing a screening initiative.

Summary of Recommendations

  1. Screening information should be obtained after triage / initial assessment process and should not interfere with timely access to care. Initial triage processes should limit the focus and content of questions to information pertinent to the patient’s condition to determine the priority in which patients should be seen and allow a limited risk assessment should they decide to leave without being seen.
  2. Screening should only occur if there is sufficient capacity such that the primary role of the ED and key quality metrics are largely unaffected.
  3. The benefit gained by the individual from the screening should outweigh any harms, for example from over diagnosis, overtreatment, false positives, false reassurance, uncertain findings, and complications.
  4. There should be agreed evidence-based policies covering which individuals should be offered interventions and the appropriate intervention to be offered.
  5. Any screening process that is developed must minimise the burden placed on ED clinical staff and there must be clear governance processes in place, particularly with regards to who has the responsibility for follow-up after screening and dealing with the impact of ‘false positive’ screening.
  6. When considering implementing screening processes, prioritisation should be given to those conditions which frequently present symptomatically to the ED and that are amenable to intervention within the resources of the ED.
  7. Screening processes should be developed which are implementable within the ED workflow and that minimize impact on patients and ED staff.
  8. Local disease prevalence and risk factors should be central to deciding whether to implement a screening programme.
  9. Screening interventions should be sustainable both in terms of ED resources (staff time etc.) and the wider costs and benefits to the healthcare system as a whole.
  10. Involve patients in the implementation of any screening programme / initiative.
  11. There are clear benefits to embedding screening into electronic health records, however caution must be exercised when considering mandating any form of screening.
  12. The use of screening measures as performance metrics is generally discouraged.

Ensure that you read the full Screening in the Emergency Department Guideline