The Model Emergency Department
Internal ED pathways: streaming and redirection, rapid assessment and treatment, resus, extended emergency medicine ambulatory care (EEMAC), priority cohorts, and enablers such as coding, site-level data and payment.
What the models are
NHS England published the Model ED and the Model Acute Pathway on 9 February 2026, and the Model discharge pathway on 7 July 2026. Read separately, each looks like a set of local expectations for one part of the hospital. Read together, they describe a single chain of events from arrival to leaving, each with an expected time and a named owner.
The Model Emergency Department sets out how an ED should be organised internally, from the front door to the point at which a patient leaves. The Model Acute Pathway, developed with the Royal College of Physicians, the Society for Acute Medicine and the British Geriatrics Society, sets fifteen standards for the first 72 hours of hospital care for acutely unwell patients. A self-assessment tool accompanies the acute standards and describes how trusts should evidence and report their position to the board.
The Model discharge pathway applies to acute and community bedded care, for patients of all ages and for both physical and mental health. It covers in-hospital discharge planning and delivery, the daily ward practices within the control of hospital teams, and the standardisation of basic processes. It refers back to the other two models directly, describing a whole pathway approach in which early senior decision-making in the first 72 hours makes timely discharge possible later.
This explainer treats the three documents as one system: arrival, assessment, decision, referral, review, request, transfer, readiness and discharge. It draws on a conceptual information model and business capability model built from the standards to show the structure that the text implies.
The Model Acute Pathway
Fifteen standards for acute receiving areas in the first 72 hours, grouped under early decision-making, care navigation, continuity, 7-day working, data recording, patients and carers, and board assurance.
Self-assessment tool
Twelve insightful questions, four national measures, suggested evidence for each standard and an outline board assurance report, completed at baseline and then at least every six months.
The Model discharge pathway
Seven principles of discharge, core elements for acute and community hospitals, the organisational arrangements needed to deliver them, discharge pathway definitions 0 to 3, and cohorts at greater risk from delayed discharge.
What they aim to achieve
The Model ED aims to make the emergency department a destination rather than a default. The Model Acute Pathway aims to make the first 72 hours after admission timely, continuous and clearly owned. The Model discharge pathway aims to make timely, clinically-led discharge routine, so that patients leave hospital as soon as they no longer need to be there.
The Model ED starts from five principles: the ED is for patients most in need of emergency care; overcrowding makes it harder to find the sickest and most vulnerable patients; overcrowding also makes the whole pathway less efficient; patients should not come to harm through undue waits; and the ED cannot deliver good care without the rest of the hospital. It supports the constitutional pledge that 95% of A&E patients are admitted, transferred or discharged within four hours.
The Model Acute Pathway begins with the scale of the problem it addresses: 1.7 million people spent 12 hours or more in EDs in 2024, and average length of stay is around 10% longer than before the pandemic. Its five themes are early senior decision-making with patient and carer involvement, continuity and coordination, care in the right place at the right time, 7-day working, and accurate capture of decisions and activity. If fully implemented, it expects shorter ED stays, fewer 12-hour waits and less corridor care, better quality and safety, less distress for carers, clearer ownership of care, and fewer unnecessary long stays.
The Model discharge pathway rests on seven principles: discharge is a clinical decision, not an administrative one, planned from admission; staying in hospital longer than necessary causes harm; timely discharge is essential to flow and safety across the urgent and emergency pathway; home is the default destination; discharge is everyone's business every day, with clear decision rights; patients and carers are partners; and decisions rest on timely, transparent data. It asks for a change of mindset in which only patients who need inpatient care are admitted and discharge is treated as part of care from the point of admission.
Where the documents meet. The Model ED governs care until the ED has finished; the acute standards take over on the acute receiving area. The discharge model does not simply follow the acute pathway. It overlaps it, because discharge planning starts at admission and the same 6 and 14 hour expert review is the point at which both models expect the plan to be set. The boundaries between the three documents are where most of the practical difficulty in winter sits.
The three clocks
All three documents express many of their expectations as elapsed time between two recorded events. That makes them measurable, and also makes them dependent on data.
Walk the pathway
Thirteen stages run from the front door to leaving hospital, grouped by the document they come from. Discharge planning starts at admission, so Stage 10 runs alongside Stages 5 to 9 rather than after them. Choose a stage to see what the standards expect, which records in the model would show whether it happened, and the pressure that winter tends to place on it. Choose a lens to see the question each group of leaders might bring to that stage.
Lens
The model underneath
A conceptual information model names the things an organisation must be able to record and says how they relate. It is not a system design and does not prescribe a product.
Its value here is that every time limit in the standards depends on two records existing, being timed, and being linked to the same patient and the same episode. Where one of the pair is missing, the standard cannot be evidenced, however well the care was delivered. The model built from the two documents gathers around a small number of ideas. Each group below is described in plain terms, with the model's own entity names shown for those who will work with the repository.
From arrival to leaving
One attendance or admission, with the places the patient occupies along the way. The ED attendance starts the four-hour clock; the encounter carries the acute pathway.
PatientEDAttendanceEncounterLocationStay
Timed clinical acts
Each linked to the clinician who performed it and that clinician's decision-maker tier, which is what lets a trust show that the patient was seen by an expert where the standard requires one.
FrontDoorAssessmentRATAssessmentFrailtyScreeningClinicalAssessmentClinicalDecisionDecisionMakerTier
Pairs that open and close a wait
Each request carries a time and an urgency; each response carries the time it was given.
SpecialtyReferral→SpecialtyConsultation
DiagnosticRequest→DiagnosticResult
MedicationOrder→PharmacyReview
From decision to a specific bed
A decision to admit leads to a bed request, an allocation, a specific bed and a recorded move between two location stays, so the 12-hour transfer standard can be measured from request rather than inferred from a ward move.
ClinicalDecision→BedRequest→BedAllocation→Bed→PatientTransfer
Who owns care, and when it is reviewed
Who is responsible for the patient, under which treatment function code, and the daily events through which teams review care and hand it on.
CareAttributionCareTeamFlowLeadershipShiftBoardRoundWardRoundHandoverEscalationEvent
How a trust assures its board
The local documents and periodic judgements through which a trust sets out how it will meet the standards and tells its board whether it has.
OperationalPolicyInternalProfessionalStandardsDocumentStandardComplianceAssessmentBoardAssuranceReportSupportServiceAvailability
Proposed extension for discharge
The current model records the end of an encounter or location stay, but holds no discharge records of its own. The Model discharge pathway depends on several things that need to exist as records before its expectations can be evidenced. The entities below are proposed to close that gap. They are shown dashed throughout this page and are not yet in the model repository.
- DischargePlan
- Reason for admission, expected date of discharge, intended pathway and destination, set from admission and revised daily.
- DischargeCriterion
- Patient-specific physiological and functional criteria agreed by an expert decision-maker, against which nurses and therapists can discharge.
- FunctionalBaseline
- The patient's usual abilities, recorded on admission so that recovery goals and deconditioning can be judged.
- CriteriaToResideAssessment
- The daily judgement of whether the patient still needs care that only an inpatient setting can give.
- DischargeReadiness DischargePathwayAssignment
- The discharge ready date, when criteria to reside are no longer met, and the assigned pathway from 0 to 3.
- DischargeTask
- Preparatory work completed in parallel: medicines to take out, therapy, equipment, documentation and transport.
- Discharge TransferOfCare
- The discharge event, with time, pathway and destination, and the handover of clinical responsibility to a community service.
- DischargeDelay
- Reason, named owner, actions and timescales for each patient not discharged as expected.
- CareTransferHubReferral CommunityCapacity
- Referral of complex discharges to the care transfer hub, and the community capacity that discharge teams need to see.
- PostDischargeFollowUp
- A follow-up contact after discharge, such as a telephone call within 24 hours for older people with frailty.
The same approach would add capabilities beneath Flow Management and Escalation for criteria-led discharge, discharge delay management, transfer of care co-ordination and discharge lounge operations, each traced to these records.
Capabilities: what the organisation must be able to do
Alongside the information model, a business capability model describes the abilities a hospital needs to meet the standards, independent of which team or system provides them. Each capability is traced to the information it depends on. Discharge currently sits under Flow Management and Escalation as Discharge Planning and Admission Avoidance.
Emergency Department OperationsStreaming and redirection, RAT, resuscitation, majors and minors, EEMAC, SDEC interface, UTC pathway, children and young people, mental health assessment, crowding monitoring
Acute Receiving and First 72 Hours DeliveryAcute receiving area management, care attribution (TFC), consultant flow leadership, ward rounds and huddles, continuity, expert assessment, frailty screening, internal professional standards, 7-day support services
Clinical AssessmentSenior and expert review
Clinical Decision-MakingDecision recording and documentation
Care Coordination and HandoverClinical huddles, handover standards
Bed Management and TransferRequesting, allocating and executing transfers, with escalation when they do not happen
Diagnostics ManagementInvestigation turnaround
Flow Management and EscalationDischarge planning and admission avoidance, escalation for delays and disputes
Data Capture, Attribution and ReportingEvent timestamp capture, metric definitions and dashboards
Governance, Assurance and Continuous ImprovementBoard assurance reporting, operational policies and pathway criteria
Patient and Carer CommunicationInformation about waits, involvement in decisions, plans for going home
Standards lookup
Each row links a requirement to the records that would evidence it, the capability that delivers it, and how it is evidenced. For the acute standards this follows the self-assessment tool. For the discharge model it shows whether an element feeds one of its national operational metrics or is assessed by baselining practice against the core elements. Dashed names are proposed records.
| Standard | Expectation | Records in the model | Capability | Evidence |
|---|
Limitations
The models are a sound basis for planning and assurance. They also have boundaries that leaders should keep in view when they use them.
Standards set expectations; they do not create capacity
The 12-hour transfer standard and the 72-hour limit on acute receiving areas depend on downstream beds, discharge and social care. Daily specialty review while a patient waits manages risk during a delay without removing its cause.
Deliberately bounded scope
The Model ED addresses elements within the ED's control and states that further guidance will follow on urgent community services, 7-day working, mental health EDs, neighbourhood health, frailty and children's pathways. The Model discharge pathway refers to a Community Beds Delivery Model and Discharge Ready Date guidance that were pending when it was published, and separate guidance covers discharge from mental health inpatient settings.
ED time sits outside the 72 hours
The acute standards do not yet count time spent in the ED within the first 72 hours, and ask teams to take a patient-oriented approach. A long ED wait can consume much of the window in which early expert review matters, without appearing in the acute measures.
Local determination limits comparison
Medical and nursing directors decide locally how to deliver the standards. Self-assessments and board reports are not collected nationally, and only a small number of national benchmarking measures are planned.
Much is evidenced by policy, not data
Seven of the fifteen acute standards have a suggested data report; the other eight are evidenced by written policies, rosters, job plans and audits. The discharge model has no self-assessment tool. It asks for a baseline against its core elements and two operational metrics, with a review of discharge data requirements to follow and a refreshed sitrep as a time-limited measure.
Data readiness is uneven
The self-assessment tool acknowledges that treatment function coding and some timestamps may not yet be recorded, and asks trusts to run the measures anyway and surface the gaps. A national review of ED counting and coding began in 2026, with revised guidance expected later in the year.
Time limits measure timeliness only
A clock met shows that a decision-maker of the right tier was present in time. It does not show that the decision was right. Standard 14, on dignity, involvement and information for patients and carers, has no time limit and relies on feedback and notes audit.
The conceptual model is an interpretation
The information and capability models are a reading of the published text, structured to make dependencies visible. They do not describe staffing, demand or capacity, and each trust's systems will hold these records differently. The acute standards are framed for adults; paediatric care is guided by Facing the Future. The discharge records shown dashed are a proposed extension, not yet in the repository.
Discharge depends on partners outside the hospital
The discharge model sets no new requirements for social care providers. Pathways 1 to 3 depend on local authorities, social care, housing and voluntary sector partners, through commissioned arrangements and the Better Care Fund. Hospital records can show where a delay sits; they cannot by themselves resolve it.
Winter 2026/27
NHS England's winter planning letter for 2026/27 (PRN02603) asks trusts to implement the Model ED, Model acute pathway and Model discharge pathway requirements before winter, and treats the elimination of corridor care as a patient safety priority. All three models covered here are therefore part of this year's winter expectations.
Requirements in place before winter
Model ED, Model acute pathway and Model discharge pathway requirements to be implemented ahead of winter.
A patient safety priority
Elimination of corridor care is treated as a patient safety priority. The acute pathway board report counts patients cared for in corridors.
15 minutes, never over 45
Ambulance services to work with acute partners towards 15-minute handovers, with none exceeding the 45-minute maximum.
OPEL coordination
ICBs to run a 7-day coordination centre using the OPEL framework, with tested escalation, surge and mutual aid arrangements.
Statements signed by 30 September
Signed board assurance statements were due by 30 September 2026, following regional stress tests in September.
A six-monthly cycle
Baseline self-assessment formed part of winter 2025/26 assurance, with progress reports to the board at least every six months.
Occupancy down before Christmas
ICBs to commission social care and intermediate care jointly with local authorities, with discharge planned together, sufficient capacity through winter and agreed plans to reduce hospital occupancy ahead of Christmas.
Contingency agreed in advance
The discharge model asks for surge and contingency plans with system partners, including funding, for periods when demand exceeds planned provision, particularly in winter.
Where winter shows in the architecture
Pressure moves backwards through the chain, and often starts with a patient who is ready to leave but has not. A patient waiting for a downstream bed holds an acute receiving bed, which holds an ED cubicle, which delays an ambulance handover. Each link is an interval between two records in the model, so each can be watched separately and the point of first failure identified.
| Pressure signal | Measured between | Standard |
|---|---|---|
| Front door absorption | EDAttendance arrival and FrontDoorAssessment; outcome of each StreamingDecision | Model ED, front door: 15 minutes |
| Extended care used for boarding | EEMACEpisode start and end; episodes that end in admission | Model ED, EEMAC: 4 + 8 hours |
| Frailty and delirium recognition | Arrival and FrailtyScreening with CFS and 4AT scores | Acute standard 2: 30 minutes |
| Expert review delay | Referral or arrival on the acute receiving area and expert ClinicalAssessment | Acute standard 1: 6 hours by day, 14 overnight |
| Specialty delay | SpecialtyReferral request, response and face-to-face review | Acute standard 9: 2 and 4 hours |
| Downstream bed wait | BedRequest and PatientTransfer | Acute standard 10: 12 hours |
| Acute receiving area congestion | Duration of each LocationStay on the acute receiving area, and sanctions beyond 72 hours | Acute standard 11: expected 24 to 48 hours |
| Weekend discharge | SupportServiceAvailability by day against discharges by day | Acute standard 12: 8am to 8pm, 7 days |
| Discharge output and timing | Discharge events by day, pathway and time of day, against discharges required | Discharge model, core metric |
| Patients ready to leave | CriteriaToResideAssessment and DischargeReadiness by pathway, compared with 12-hour ED waits and corridor care | Discharge model, core metric |
| Delays on pathways 1 to 3 | DischargeDelay reason, owner, opening and closing times | Discharge model, active management of delays |
| Unresolved disputes and breaches | EscalationEvent trigger and resolution times | Acute standards 3, 10 and 11 |
Using the models over the coming months
- Check that each clock has both of its records. For every time limit above, confirm that the start and end events are captured with times and linked to the same episode. Where they are not, record the gap in the board report as the self-assessment tool advises.
- Make the boundary explicit. Agree in the internal professional standards who is responsible for a patient referred from the ED who has no acute receiving bed, and how disputes about responsibility or location are escalated.
- Hold the daily rhythm over holidays. Confirm that board rounds, consultant-led ward rounds, huddles and senior-led handovers are rostered on every weekend and bank holiday day, as Standards 7 and 8 require.
- Watch every link in the chain. Report the intervals above alongside 4-hour and 12-hour performance, preferably as SPC charts, so that the first link to slow down is visible before it reaches the front door.
- Make discharge visible every day. Report discharges required and delivered by pathway, and patients with no criteria to reside, at ward and site level, as the discharge model asks. Where these cannot yet be recorded, the proposed discharge records show what would be needed.
- Feed the six-monthly report. Use winter experience in the next self-assessment, against the twelve insightful questions and the outline board assurance report.
Sources
Primary sources are the published NHS England documents. The information and capability models are an analytical interpretation of them.
- NHS England. The Model Emergency Department: high performing urgent and emergency care pathways. PRN02373, 9 February 2026.
- NHS England, Royal College of Physicians, Society for Acute Medicine, British Geriatrics Society. The Model Acute Pathway: standards for care of acutely unwell patients in their first 72 hours in hospital. PRN02076, 9 February 2026.
- NHS England. Self-assessment tool for the Model Acute Pathway: guidance for NHS trusts. 9 February 2026.
- NHS England. Model discharge pathway. PRN02543, 7 July 2026.
- NHS England. Winter planning 2026/27: expectations and assurance. PRN02603.
- Agile Health Informatics. Conceptual information model and business capability model for the Model ED and Model Acute Pathway (Sparx Enterprise Architect repository, 2026), with a proposed extension for discharge described on this page.
This explainer interprets the published standards for planning and assurance purposes. It is not clinical guidance. Where it differs from the source documents, the source documents take precedence.