Nobody likes to queue. Whether in a supermarket, an airport, a post office, or an emergency department, few of us wish to wait too long for service.

The clinical consequences of waiting too long for urgent treatment in an emergency department are all too obvious. The increased morbidity that can result from delayed transfer to a ward after assessment and treatment in the emergency department may be more subtle in manifestation but no less significant or serious. Sensational media headlines, combined with a powerful political agenda, led to the introduction of the four hour target for emergency department treatment, discharge, referral, and admission of patients. From a gentle beginning, with the target set at 90% for all ED attendances, the bar has risen higher and higher, …