Table 1
From: The impact of process re-engineering on patient throughput in emergency departments in the UK
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 |