Emergency department digital front door solutions: Early implementation insights at King’s College Hospital NHS Foundation Trust
The urgent and emergency care (UEC) system is under sustained pressure in England, including emergency departments (EDs). In response, national policy increasingly highlights digital transformation as a key lever for UEC recovery Introduction of ED digital front door (DFD) solutions is a recognised strategy to support streaming and initial assessment of patients presenting at EDs. The NHS England London Digital UEC team is leading a London-wide programme to accelerate adoption of ED DFD solutions.
Launched in 2025, the programme procured eTriage by eConsult (a Huma company). eTriage is a digital solution that enables patient self check‑in on arrival and streams and triages patients according to clinical need. King’s College Hospital NHS Foundation Trust (KCH) was the first London programme site to implement the solution. The Digital UEC team commissioned the Health Innovation Network South London (HIN) to evaluate the implementation of ED DFD solutions across London.
Alongside a wider evidence and ecosystem review, this formative evaluation focuses on early implementation and impact at King’s College Hospital NHS Foundation Trust (KCH).
What is an ED DFD solution?
ED DFD solutions are electronic systems (typically tablet or mobile format) that use touch screen interfaces and algorithm-driven questions to capture patient-provided information and support check‑in, triage, streaming and redirection.
Implementation and adoption insights
KCH implemented eTriage at pace, alongside a change in the urgent treatment centre (UTC) provider. This marked eConsult’s first deployment within a co‑located UTC. Strong leadership, supported by targeted pre‑ and post‑implementation strategies, enabled relatively high patient adoption of the solution (67%), and helped build staff confidence and ensured safe clinical processes.
Staff acceptability was mixed. Clinical staff reported early challenges, including an initial streaming inversion that shifted patients towards ED (now corrected) and confirmatory triage emerging as a pressure point. There were concerns about reception staff role changes and personal safety, while volunteers were generally supportive but noted risks around confidentiality and accountability.
Patient experience was broadly acceptable, with 77% of participants finding the solution easy to use. However, over half received some level of support to use the ED DFD solution and experiences varied across patient groups.
Patients and staff highlighted opportunities to reduce question volume, improve the product design, and retain appropriate human support.
Emerging operational benefits
Implementation of the DFD solution enabled KCH to redesign its front door model. This led to an ED-led front door in line with Royal College of Emergency Medicine guidance and early cash‑releasing benefits through UTC staff changes.
- Based on estimates, 7,026 hours of staff time was saved on patient registration, streaming and triage between October 2025 and February 2026, equivalent to 10.4 minutes per patient. These gains may not be fully realised due to training requirements and the increased initial ED streaming.
- Staff reported improved waiting room visibility and reduced patient queues. Notably, 93% of patients registered in under two minutes.
- Achievement of the 15‑minute initial assessment target increased by 72 percentage points compared with the same period in the previous year (5% to 77%). These figures may differ from other Emergency Care Data Set (ECDS) reporting, due to existing validation logic that assigns a ‘NULL’ value to timestamps recorded within 60 seconds, excluding these records.
Early learning
The Implementation Research Logic Model guided the evaluation objectives and this visual summary.
Conclusions and recommendations
KCH is in the early stages of implementation. As the model continues to embed and mature, further operational, financial, and patient-experience benefits are expected to materialise. Findings from this evaluation suggest that DFD solutions represent a scalable and sustainable approach to front door transformation in ED.
A number of important factors should be considered to support successful implementation and sustainable scaling. Recommendations, developed with input from NHS England London Digital UEC team, KCH, and eConsult are provided in full in the report.
This includes recommendations for:
- Trusts
Position ED DFD solution implementation as service transformation, aligning ED and UTC pathways, reducing duplication in steps, and adapting workforce models accordingly. Ensure strong multidisciplinary programme management, sufficient testing, and structured change management with staff. Following implementation, prioritise high patient adoption, continuous optimisation using data and feedback, targeted workforce support, and proportionate governance. - Suppliers
Invest in product development to improve user experience, strengthen implementation support with clearer roles and practical tools for trusts, and develop data sharing to support learning and improvement. - NHS England London
Establish a London‑wide reference group to support shared learning, alignment, and coordinated scaling across the system.
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