Hospital shows how to cut A&E waiting

Doctors at an east London hospital believe they may have the answer to queues in casualty after they halved waiting times for patients.

Consultants at the Royal London Hospital in Whitechapel have cut the average time between a patient's arrival in accident and emergency and their discharge to three hours by radically overhauling their procedures.

In the month-long initiative, which ends on Friday, they scrapped two health service traditions: the strict demarcation between consultants, nurses and technicians; and the concept of triage, where the most injured patients are treated as a priority, rather than "first-come, first-served".

The hospital claims more than 85 per cent of patients were treated and discharged within three hours, and the number of in-patient admissions were cut by 15 per cent. Before the initiative, patients waited an average of six hours.

The project could solve one of the most troubling issues facing Tony Blair and the Secretary of State for Health, Alan Milburn – NHS waiting lists. Ministers have set a new national target that A&E departments will treat each patient within four hours, but the last national figures suggested only a third have met that goal. The Government has endured embarrassing rows over waiting times for patients such as Rose Addis, 94 – who was kept for three days on a trolley at the Whittington in north London – and has devoted £100m to speeding up A&E procedures.

The Prime Minister was briefed when the project was finalised. The initiative could be picked up nationally after members of the NHS Modernisation Agency visit the Royal London this week.

Dr Gareth Davies, an A&E consultant, said the principle was to abolish traditional rules such as those preventing nurses from ordering X-rays and assessing injuries or nurse technicians from taking blood tests or swabs. The small teams of specialist staff included a dedicated unit of consultant radiologists and radiographers, permanently attached to A&E to immediately take scans rather than wait for the patient to be transferred.

Senior doctors and consultants were also replacing inexperienced junior doctors, so patients could be seen and assessed quickly, on a first-come, first-served basis. "What we've tried to do is multiskill, getting radiographers, nurses and doctors to do different things. The effect has been to increase flow. There are no queues. If there are no queues, there's no triage," Dr Davies said.

The system, which would cost £600,000 to introduce permanently, has relieved pressure at the hospital. But it has highlighted other problems, such as "bed blocking" by in-patients with nowhere to go. Setting up the team of radiologists made a shortage of radiographers worse.