Emergency department - Royal London Hospital

After being registered, everyone who comes to the Emergency Department is assessed on arrival, so patients can be seen in order of priority. 

We understand that long waits can be frustrating, however, it means that the patients going ahead of you are more unwell or are expected by a different team of specialists, even if that isn’t always visible. 

Some of the sickest patients come directly through another entrance and you may not be aware of their arrival in the department. 

After you have had your initial assessment, you may be directed to another service, such as the co-located Urgent Treatment Centre, a community service or one of a number of co-located Same Day Emergency Care (SDEC) services within the hospital.  

If you remain in the emergency department you will either be seen in the adult or paediatric (children’s) area. 

Our adult emergency department is open 24 hours a day, 365 days per year. We look after all patients over the age of 18 years, and co-ordinate the admission of those over 16 years to an adult bed space where appropriate. We see about 85,000 adult patients in the Emergency Department per year, from around 215,000 patients in total who attend over our Adult, Paediatric and Urgent Treatment Centre areas of the Urgent and Emergency Care section of the hospital.

We are the Major Trauma Centre for North East London and Essex, a hyperacute stroke unit for inner north-east London, and the emergency access area for patient requiring general medical, surgical, orthopaedic and gynaecological services. We also provide emergency access for unwell patients requiring specialist services based at the Royal London such as kidney disease, gastroenterology, Ear Nose and Throat, Maxillo-Facial (facial surgeons), Plastics (reconstructive), urological (kidney, bladder and male genitalia surgeons), vascular (blood vessel surgeons), neurological (brain doctors) and neurosurgical (brain surgeons).  

We work closely with our colleagues from East London Foundation Trust who have a Mental Health Liaison team working in our emergency department to assess patient unwell from mental health disorders.

The adult emergency department is staffed by Consultants in Emergency Medicine, junior doctors in training in Emergency Medicine, senior and junior clinical fellows, foundation programme doctors, Advanced Clinical Practitioners in Emergency Medicine (nursing or paramedic background), Physician Associates, Emergency Nurse Practitioners, nurses (ranging from junior nurses 1-2 years qualified to senior nurses more than 8 years qualified), Emergency Department Assistants, Receptionists, Porters and cleaners. 

We have access to x-ray and CT scan services via the emergency radiology area of the emergency department which has 3 x-ray rooms and 2 CT scanners, staffed by highly experienced radiographers.

We have toilets with disabled facilities in all areas of our adult emergency department, except in our main waiting room, where the toilets in Zone D can be accessed as an alternative.

There is a vending machine in the main waiting room and there are 24-hour shops with daytime places to eat 200m away on Whitechapel Road. A small coffee shop in the main hospital entrance is open from 8am to 3pm daily, and a hospital canteen on the 5^th floor (accessible via lift core 5). 

We supply hot and cold drinks to our patients in all clinical areas of the emergency department, and for those staying in the department for longer than 4 hours, there are sandwiches and snack bags. For those waiting more than 8 hours for a ward bed space then hot meals are served at meal times (as they are on the wards).

On our small observation ward (Clinical Decision Unit) hot meals and snacks are available in line with all our ward areas in the hospital.

Where possible we ask that each patient only has 1 family member or friend with them – this is because when the department is busy we can have 60 patients who are waiting in our main waiting room, and we only have physical space for about 80 chairs. We may then have another 40-50 patients in other areas of the department – this quickly becomes many more people that we physically have space for.

The exceptions are :

• Critically unwell patients, including those who are dying.
• Patients with cognitive impairment or chronic confusion who may need extra support.
• Patients with learning difficulties or additional needs who may need extra support.

If you wish to contact a patient in the department please call 02033777000 and ask for the main emergency department – you will need details such as name and date of birth to be able to confirm where in the department the patient is being assessed or treated. 

We are unable to offer clinical advice via phone. Please call 111 or access 111 online if you need advice. In an emergency then call 999.

Providing waiting times is difficult as some patients are seen by general Emergency Medicine clinicians and some by specialist teams (of whom there is sometimes only 1 team member on-site outside normal hours). General Emergency Medicine clinicians also have to respond to immediately life-threatening emergencies when required and can require variable resources.  We do try to ensure we have adequate staff in all areas of our department to see patients for assessment, treatment and discharge in 4 hours as per national standards. 

As a department we welcome all adults with additional needs whether that is learning disabilities or neurodivergent adults, such as those with autism.

We know that many adults with additional needs will attend our emergency department and we know that the emergency department is a busy, noisy, bright, unpredictable and highly stimulating environment with plenty of strangers amongst our large team of staff as well as other patients and their loved ones. 

Our staff are keen to support and champion additional needs and know that particularly autistic patients will find the Emergency Department a very challenging environment.

Please ensure that reception, initial assessment nurses, area nurses and treating clinicians are informed of any additional needs. If you or your loved one has a hospital passport please bring it for review by staff, this will help us determine how best we try to accommodate specific requests or reasonable adjustments.  

We will do our best to place patients with additional needs in spaces where light and noise can be more controlled where this is available, although sometimes there will be a delay in identifying and making available this space when we are very busy. 

Please also inform staff of any special dietary requirements for patients who need to stay longer than 4 hours.

Additional information on visiting the Royal London Hospital when you are an adult with learning disabilities or neurodivergence, or with an adult with learning disabilities or neurodivergence, can be found here.

There is a breastfeeding room in our PED waiting room and two rooms with baby changing facilities. We keep a small number of nappies in the department but wherever possible please bring a supply with you when you attend the PED. 

There is a vending machine in the main adult waiting room, and there are shops on Whitechapel Road, a few minute's walk from the PED where food can be purchased. 

If you are asked to stay for observation, then staff can arrange a snack box or a hot meal. If your child has specific food & drink requirements, then please try wherever possible to bring these with you when you come to the PED. 

There are toys to help distract children while they are waiting to be seen. Our play specialist will help support children needing distraction when they are available. If you know your child would benefit from a specific distraction toy/device, then please try wherever possible to bring it with you when you come to PED (and any associated chargers). 

The Royal London has a specialist children's emergency department which is part of the wider emergency department. It is open 24 hours a day, 365 days a year. 

Our Paedaitric Emergency Department (PED) treats children from new-born to 17 years old. Anyone attending after their 18th birthday will be directed to the adult ED. 

Children aged 16 and above who require admission to the Royal London Hospital as in inpatient will usually be admitted to an adult ward under the care of the appropriate adult team. 

Children over 16 years old who are under ongoing care of specialist teams at our Children's Hospital and yet to transition to adult services will continue to be admitted to one of our children’s wards. The PED sees over 37,000 babies, children & young people, with a wide range of injuries and illnesses, both physical and mental health related. They are cared for by a dedicated tam of nurses and doctors who work in PED. They are also supported by a play specialist, who is in the department during normal working hours. 

Patients needing to be seen by one of our specialty teams will usually be seen in the PED. Patients needing a longer period of assessment may be admitted to our Paediatric Clinical Decision Unit (PCDU) located next to PED, or transferred to the Paediatric Assessment Unit (PAU) located within the Children’s Hospital on the 7th floor or they may be admitted to one of the Children’s Hospital wards. 

Wherever possible we would ask that only one parent attends the PED with their child when they need assessment and that again where possible, no other siblings are brought to PED. This is to help us with infection control in our waiting room and to ensure there is sufficient space for all children and one parent to be seated in our waiting room. 

The exceptions to this are: 

• Critically unwell patients 

• Those under 28 days 

• Those with significant learning disability or complex needs requiring two people to look after them. 

• Children who are being admitted and are resident in a PED cubicle awaiting admission can have two parents sit with them inside the cubicle. 

If you wish to contact a parent of a child in the department, you are best to call them on their personal phone. If for any reason you are unable to reach them, then please call the main hospital switchboard on 020 3377 7000 and ask to be transferred to the PED. 

We are unable to offer any clinical advice by phone. Please call 111 or access 111 online if you need advice. If you are concerned that is it an emergency then you can call 999. 

We are also unable to provide waiting times. Patients are seen at different times depending on how sick they are and which team they need to be seen by. We always endeavour to aim to diagnose, treat and discharge or admit all children within four hours (in line with national guidance). Please do not call the department to ask for the waiting times. 

We know that for children and young people with additional needs, the PED environment can be overwhelming due to the light, sound and activity. Please let the nurse who sees you at your initial assessment know if your child has additional needs and may require some additional accommodation. 

Whenever possible, we will try to accommodate any child or young person with additional needs in a quieter area and we can provide sensory play equipment on request.  

As above, if your child or young person has any specific food or distraction device requirements or if they require any sensory protection equipment, please try wherever possible to bring this with you as we cannot guarantee we can provide specific equipment that meets every individual's needs. 

Additional information on visiting the Royal London Hospital when you have a child or young person with additional needs can be found here and here