34 emergency nurse vol 10 no 2 may 2002 The Department of Health (England) document Reforming Emergency Care (DoH 2001) suggests AE this has often been our defense in justifying long waits for other patients. Yet we now have to provide a first class service for all A&E attenders. The A&E department at Kettering General Hospital (KGH) saw about 60,000 new attendances last year. Like many other A&E departments it takes medical and surgical patients referred by GPs to ‘on call’ teams who are asked to attend A&E when there are no beds available on the medical and surgical assessment units The staff at KGH had always been proud of their ability to maintain The Patient’s Charter target of 75 per cent of patients beginning treatment within one hour. However, over the past 18 months, the demand upon the service has been ever increasing, with waiting times dramatically rising as a consequence. It was evident that it was patients in the lower triage categories whose wait was ever increasing. It is estimated that this patient group comprises as many as 70 percent of all A&E attenders. There was also a significant increase in complaints relating to long waits from patients who presented with a minor injury. The trust management team at KGH had formed a ‘Redesign Project Board – Emergency Care’, with the objective of transforming the patient’s experience of emergency care to ensure the system is better able to cope. This provided the platform for A&E to explore the concept of the traditional way of treating patients, with the aim of providing a more efficient service for attenders. Instead of making the patient fit the tradition of the A&E service, we changed to meet their needs. In order to systematically examine the patient’s experience, we mapped the time patients spent on their journey through A&E (Figs. 1, 2). The process highlighted several reasons and steps contributing to unnecessary delays in the system. > No staff working on minor injuries area as other areas, such as, resuscitation, majors very busy > Patients being called into a cubicle and waiting excessive times for the doctor > Following consultation with the doctor the patient then waited excessive times for the nurse to carry out the treatment > Patients care involved several members of A&E staff > The time patients spent having nothing done dramatically exceeded the time spent with a practitioner Following this exercise, it was identified that patients were spending too much time waiting for treatment and that care was fragmented. It was also apparent that when a patient was seen by the nurse practitioner, who carried out the treatment, the patient spent significantly less time in the department. Marisa Shrimpling BSc(Hons), RN, EN is Lead Nurse – Minor Injuries, Kettering General Hospital A&E Department