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An alternative way ahead
  1. Alan Michael Leaman
  1. Correspondence to Dr Alan Michael Leaman, Emergency Department, Princess Royal Hospital, Telford, UK; alan.leaman{at}

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We had a visit from the Intensive Support Team recently. In common with other Emergency Departments (ED), we have struggled a little to achieve the national 4 h throughput target. The response of our health authority was to send in the IST.

The team, which did not contain an emergency physician, spent about an hour in the department, and of course we were interested to see what they had discovered in an hour which had not been apparent to us over many years. We hoped that their report would recognise that the main causes of our failure to meet the target were the increasing numbers of major cases being brought to the ED, and the inability of our hospital to find accommodation for these patients in a timely fashion.

We were therefore disappointed by the ED section of the report which suggested that senior emergency medicine (EM) physicians should be doing something called RAST (rapid assessment and triage), that nurse practitioners should be seeing the minor injuries and that we should abandon our follow-up clinics. I suppose it is possible that such measures might have an impact on our throughput figures, but this does not sound much like emergency medicine as it is generally understood. Furthermore, there was no indication of how these proposals might impact on patient care or on the education of our juniors.

So, how did we get to a situation where in order to achieve the ED throughput target we are being encouraged to dismantle EM as most of us know it?

Of course, there would be no problem if there was no …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.