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 |