A&E Trolley Safety Failure: What Happens When Clinical Judgement Replaces Protocol

Should cot sides always be raised in emergency care? A nursing expert unpacks the legal nuance

When a young, otherwise healthy man suffered a fall from a hospital trolley, it seemed a straightforward case of negligence. The trolley cot sides had not been raised, and the patient had been left alone in an A&E cubicle. But in a detailed expert witness response, Apex’s nursing opinion revealed that while the outcome was unfortunate, the clinical decision not to raise the cot sides may still fall within the scope of reasonable care.

In this case, the claimant experienced a fall shortly after arriving in A&E. The allegation centred on whether cot sides should have been raised on the trolley to prevent this. However, the nurse expert stressed that A&E trolley safety failure cannot be evaluated in isolation or with hindsight. Instead, it must be judged against what was known at the time and the absence of policy mandating cot side use.

Clinical judgment vs A&E trolley safety failure: Understanding real-time risk

This was a fit and alert individual, presenting with a normal Glasgow Coma Scale. He was placed in a standard cubicle in A&E, not a monitored bay or inpatient ward. Nursing and medical staff were within close range. From a professional nursing perspective, there was no obligation to raise the cot sides unless the patient exhibited signs of confusion, agitation, or sedation. None of which applied.

The expert noted:

• A&E cubicles are staffed and monitored, and patients can request help

• There was no hospital policy requiring cot sides to be raised in all cases

• The decision not to raise them fell within the attending clinician’s discretion

• A fall “could have happened anywhere, even post-discharge”

This was not a blanket failure of care, but a clinical judgment call made without the benefit of foresight. Labelling it as negligence based on the outcome alone reflects hindsight bias.

“Of course, knowing what we know now it would have been better for the cot sides to be raised, but the question is what was reasonable at the time.”— Apex Nurse Expert Witness

When is omission negligent and when is it clinical discretion?

In emergency departments decisions are made quickly and based on observable risk, not theoretical ones. The expert witness was careful to stress that A&E trolley safety failure should not be inferred from an isolated omission unless it breaches accepted standards of practice. The absence of a policy mandating cot side use played a significant role.

The opinion ultimately deferred to medical colleagues under the Bolam test, asking whether a responsible body of similar practitioners would have acted the same way. There was no indication of a breach in documentation, environment, or vigilance that would suggest the fall was predictable or preventable based on what was known at the time.

What this means for legal teams assessing emergency department claims

Solicitors reviewing A&E-based injury claims should assess:

1. The presence or absence of Trust policy relevant to equipment safety

2. Whether the patient was confused, medicated, or displaying altered cognition

3. Whether staff proximity and cubicle monitoring were adequate

4. How the Bolam and Bolitho principles apply in real-time clinical discretion

This case reinforces the principle that adverse outcomes are not, by default, evidence of negligence. Without clear clinical red flags or procedural breaches, not all falls equate to fault.

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