Too many patients are missing out on their life-saving prescription drugs, or being given them late, in Emergency Departments – and hospital overcrowding is making the problem worse.

These are some of the findings the Royal College of Emergency Medicine (RCEM) can share today, 3 June, from its latest Quality Improvement Programme (QIP) report.

RCEM’s QIPs aim to drive improvements in specific areas of practice within A&E departments. The Time Critical Medication (TCM) QIP began in 2023 and will run until 2027.

The second report of the QIP focuses on the administration of TCM to Parkinson’s and Diabetes patients in the EDs across the UK.

TCM refers to drugs such as Levodopa and Insulin, which are used to treat Parkinson’s and Diabetes respectively and which, when missed or delayed, can cause a significant deterioration in a patients’ condition. Avoidable prolonged delays to the administration of TCM can cause severe adverse effects on patients with resulting increased and avoidable length of stay in hospital.

The QIP report, which covers 1 January to 31 December 2025, measured ED performance against three standards:
All TCM patients should be identified within 30 minutes of arrival

All TCM should be administered within 30 minutes of the expected time

No doses should be missed during a patients’ stay in the ED
The report found that around two thirds (66.16%) of TCM doses were administered late, and that roughly 40% of doses were missed – meaning they took more than six hours, or were not given at all.

Meanwhile, fewer than half (44.4%) of patients who are normally prescribed and take regular Levodopa or Insulin were identified within 30 minutes of arrival into the ED, a fall compared to the 2024 QIP report data.

Performance against the clinical standards was better between the months of April and September. These are the months in which EDs are less overcrowded.

Meanwhile, during the busiest months for EDs, patients with TCM needs were more likely to not be identified, to be given their life-saving medication late- or to miss out altogether.


The clinical team behind the report made the following recommendations:
TCM patients must be identified early to ensure their needs are addressed

Systems must be in place to facilitate the timely administration of TCM

Access must be given to up-to-date patient medication information

There must be a clear, informed protocol for timely prescribing and administrating of TCM from the moment of arrival of an ED to their departure

Responding to the report’s findings, Dr Jonny Acheson, Time Critical Medication QIP Topic Lead, said: “There are some encouraging signs of improvement in this latest report, compared to the previous year’s data.

“But far too many patients with Time Critical Medication needs are still being let down.

“We need systemic changes within EDs to ensure that patients do not fall through the cracks and come to harm.”

Dr Ian Higginson, RCEM President, said: “This second-year QIP report is an important piece of work which will help to drive improvements in care for patients with TCM needs in our departments.

“The findings show that there are still clear gaps in our practice which, if filled, will stop patients missing out on crucial medication.

“But changes to the way we work can only go so far. It is no coincidence that TCM patients are better served in the less pressured months, though this is a problem throughout the year.

“In large part, this is such an issue because ED staff are looking after too many patients. Inpatient wards are full, causing a backlog of patients with TCM needs in EDs.

“We, those tasked with meeting our patients’ clinical needs, must continue to do our part and replicate what works elsewhere in our own departments.

“But, ultimately, we need action from policymakers to tackle overcrowding and unacceptable ED waits of eight, 12 or even 24 or more hours – or our efforts will continue to be undermined.”

Rowan Wathes, Associate Director of Policy and Health Strategy at Parkinsons UK, said: “The timely administration of Parkinson’s medication in emergency departments is crucial for people with Parkinson’s to prevent avoidable harm from delayed or missed doses. Even short delays can worsen symptoms, while missing doses can lead to severe and irreversible harm, and in the worst cases, can even be fatal.

“Our 2025 UK Parkinson’s audit found that only 42% of people with Parkinson’s get their medication on time every time in hospital. And while 80.5% of all doses were administered on time, only 12.5% of patients got every dose on time, showing that more needs to be done.

“We highly commend this Programme's efforts to tackle these challenges on a national scale within emergency departments. While there is still much work to be done, we are encouraged by early signs of progress, such as the decrease in missed doses. The new TCM QIP dashboard could be a ‘game changer’ by incorporating data into local quality improvement meetings.

“We look forward to continued progress in the next phase of the Programme."

The full report can be read here.