Box 1
Key themes cutting across the groups:
• Streaming of care to the most appropriate provider, determined by rapid assessment at first point of contact by a nurse who replaced the more formal roles of the triage nurse
• See and treat
• Early access to diagnostics, with prioritisation of ED requests
• Improved senior and middle grade staffing of EDs
• Blurring of the boundaries between health care professionals in emergency care
• Escalation policies
• Proactive discharge planning
• Whole systems multi-disciplinary input
• Breach analysis on a daily basis
Early data from the Emergency Services Collaborative revealed the following improvements in 4-h target performance nationally [3]:
	2002	September 2003
Wave 1	83.4%	90%
Wave 2	72.4%	89.3%
Wave 3	75.45%	88.7%
Wave 4	80.39%	91.6%
The continuing trends are reflected in data from Barnet and Chase Farm Hospitals NHS Trust in North London. Our hospitals’ performance in terms of the 4-h target is detailed below:
The initial target was 90% of patients should be seen, treated and discharged within 4 h up to 2004
	Performance	Total attendances
2002/2003	71.9%	113,915
2003/2004	80.55%	125,269
The target moved to 98% of patients to be seen, treated and discharged within 4 h from 2004
2004/2005	88.5%	137,251
2005/2006	95.05%	146,758
2006/2007	97.55%	148,436
2007/2008	99.1%	Figures being verified

Source: http://www.performance.doh.gov.uk/hospitalactivity/datarequests/index.htm