Published: 03/06/2004, Volume II4, No. 5908 Page 7

The Modernisation Agency has claimed its 'see and treat' approach to accident and emergency waits as its most successful programme ever.

The initiative, which involves patients being seen and treated by the same clinician - and no triage for walk-in patients - has now been adopted by eight out of 10 A&E departments in England.

This week the agency published a report examining why the initiative had spread so quickly.

Director of service improvement Michael Scott told HSJ: 'In terms of getting our message out this has been our best project so far.'

The programme has been seen widely as key in the race towards the national target to deal with 98 per cent of all A&E cases within four hours by the end of this year.

Mr Scott said the scheme's work to clear blockages in A&E waits was now largely done. Next the agency would focus on bottlenecks at the point where patients were being admitted to beds and slow access to clinical opinion.

The agency would be helping trusts improve bed management and clinician cover arrangements by placing support teams in hospitals with the greatest difficulties.

Mr Scott said the roll-out approach for see and treat was now being adapted to help trusts tackle access to diagnostic radiology. The diagnostics project is at the planning stage and details should be available in the next few weeks.

The report examined the tactics used to encourage uptake of the programme. These included regional road shows, mass media and peer networks. A television documentary on the programme is credited with promoting understanding of the scheme. But Mr Scott said he had no doubt that the national focus on A&E targets was a key reason why trusts were motivated to try a new approach.

'People were ready to do it and wanted to know how to do it, 'Mr Scott said. 'There was certainly pressure to meet the targets.'

He explained the three main factors behind the initiative's successful roll-out were strong leadership, clear benefits for patients and staff and good timing. He said: 'People were persuaded to adopt it as a technique because they could see the benefits for patients and staff.

'It produced visible improvements for patients and staff liked working in that way. It improved the quality of their working lives, with less frustration and less violence in the department.'

But the study also showed that departments tend to lapse into old ways of working when the pressure is on. And some staff interviewed for the research thought the abandonment of triage carried some risks.

Looking good: principles of see and treat

On arrival in accident and emergency, patients are seen, treated and referred or discharged by one clinician.

More seriously ill patients are streamed to and dealt with in another area.

Walk-in patients are not triaged.

Dedicated staff are allocated to see and treat.

Staffing levels should be high enough to prevent a queue developing.