Occupations and Terms of Reference › Head of emergency department
Universal terms of reference · POS-135 · version 1.0 · status: draft · next review 2027-10-27
Head of emergency department
To lead the emergency department, so that patients arriving in emergency are assessed quickly, treated safely and moved on or admitted without avoidable delay.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You lead the emergency department. You run clinical care, staffing and flow, lead major incident response, and make sure emergency standards are met every shift.
Reports to: Medical director.
Leads or supervises: Triage nurses and emergency nurses.
What you do on a typical day
- Review department flow and waiting times at the start of each shift.
- Lead clinical decisions on the most unwell patients.
- Escalate capacity problems to the COO early.
- Lead learning from serious incidents in the department.
- Check staffing and skill mix with the nursing lead.
Working conditions and demands
- Emergency work is high pressure and unpredictable.
- On call for major incidents.
- Decisions affect life and death.
What good looks like
- Patients are triaged and seen on time.
- Serious incidents lead to visible learning.
- The department copes with surges safely.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- The right patient gets to the right care, at the right place, without avoidable delay.
- Patient safety comes before speed, cost or convenience.
- Clinical handover is complete and recorded every time.
- Vehicles, aircraft and equipment are checked and fit before every journey.
- Crews work within their scope of practice and call for help when out of their depth.
- Every incident and near miss is reported, and learning is shared.
- Staff and patients are protected from violence and harm during transport.
- Confidential patient information is protected in every journey and record.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-135 |
| ISCO-08 | 1342 (skill level 4) |
| ESCO | to map |
| Department | Emergency and transport |
| Facility types | Hospital, Ambulatory, Transport, Medevac, Fitness, Aesthetic |
3. Reporting line and working relationships
Reports to: POS-012. Supervises: POS-136, POS-089.
| Works with | Nature of the relationship |
|---|---|
| Medical director | Emergency medicine standards. |
| Bed manager / patient flow coordinator | Admission and discharge flow. |
| Chief nursing officer | Emergency nursing staffing. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Clinical care | Makes sure the most unwell patients are seen and treated safely. | Serious case reviews within policy timeframe | Monthly | C-01 | T-07 | POL-INC | 2 |
| Flow | Manages department flow and escalates capacity problems early. | Waiting time targets met; escalations logged | Daily | C-02 | T-07 | – | 2 |
| Major incidents | Leads the department's response to major incidents and exercises. | Exercise held annually; plan current | Annually | C-03 | T-07 | POL-INC | 2 |
| Team | Leads and supports the emergency team. | Team appraisals completed on time | Annually | C-04 | T-08 | POL-EQUAL · POL-WHISTLE | 2 |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Clinical priorities on shift | Serious incidents with patient harm (medical director and CQO) |
| Department staffing within agreed plan | Major incidents needing external resources (CEO and emergency services) |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Medical degree and current licence to practise | Yes | per regulator |
| Q-02 | Emergency medicine specialist qualification | Yes | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Emergency medicine experience, including senior clinical leadership | 8 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | – |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | – |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | C-01 · C-02 · C-03 |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | C-04 |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-01 | Immunity to vaccine-preventable diseases relevant to the setting, documented at entry | At entry or as set | essential | Documented hepatitis B status at entry |
| H-02 | Tuberculosis screening at entry, then as the national rule requires | At entry or as set | essential | Symptom screening at entry and after exposure |
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Emergency clinical decision-making | Makes sound decisions in own practice | Leads care of unwell patients | Sets emergency clinical standards | Case review | Every 12 months | T-07 |
| C-02 | Department flow and surge management | Manages own patients | Manages department flow | Designs surge plans | Surge exercise | Every 12 months | T-07 |
| C-03 | Major incident command | Takes part in exercises | Leads a major incident response | Designs major incident plans | Exercise review | Every 12 months | T-07 |
| C-04 | Leading emergency teams | Works in a team | Leads a shift team | Leads department change | 360 feedback | Every 24 months | T-08 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Patients seen within triage target | 95% or more | ED system | Daily |
| PI-02 | Serious incidents reviewed in time | 100% | incident register | Monthly |
| PI-03 | Major incident exercise held | 100% | exercise record | Annually |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Head of emergency department | 8 years (recommended) | Q-01, Q-02 | C-01 expert, C-03 practitioner | T-07 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |