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The concept of See and Treat has been heralded as something new and innovative that will ease the plight of emergency departments throughout England. However, anyone who has been in emergency care over the past 20 years will recognise this process as the norm during the early 1980s. Indeed triage was introduced to clinically risk manage this system of first come first serve and to re-direct the focus of scarce nursing and medical staff away from the most minor of presentations. For those who do remember these times there must have been a strong sense of déjà vu during their See and Treat workshop.
The Department of Health workshops focused on a series of exemplar hospitals who have introduced See and Treat. It is of note that they all appear to have a number of similarities, namely:
streaming for major and minor patients did not exist before introducing See and Treat
the waiting times did not appear excessive before See and Treat
the case mix appears skewed to more minor cases
It would be appropriate to put this information clearly into the public domain so that others can see how close the situation in these hospitals is to their own. Once this is done it will be easier to judge how much of the apparent benefit can be attributed to streaming as compared with See and Treat.
We agree with Leaman who describes blocked beds and long trolley waits and questions the appropriateness of diverting senior clinical staff away from more complex cases …