Introduction Emergency Departments (ED) attendances are rising year-on-year. Innovative measures are needed to improve capacity and continue to meet the 95% 4 hour target in the context of limited resources.

Methods North Middlesex University Hospital ED introduced 3 key interventions to improve performance. Two cubicles were converted to a seated treatment area. Adjacent to this staff and cubicles were specifically designated for ambulance handovers, this was coined the Fast Initial Treatment (FIT) Zone.

Interventions

1. Fit2Sit assessments determined if ambulance arrivals could be treated in a seated area rather than cubicles

2. The flexible FIT Zone would ‘expand’ or ‘contract’ with reallocation of space and staff according to rate of ambulance arrivals

3. Direct referrals of stable patients from ED triage to specialty assessment areas

InterventionsGrip and control was required in the novel areas during initial stages of intervention. A team of FIT Zone specialists initially oversaw implementation during a pilot period. A series of information and teaching sessions then informed and engaged colleagues about interventions to make distributed leaders ahead of extending the pilot.

Results 54% of non-blue light ambulance patients were ‘Fit2Sit’ and treated in chairs, optimizing use of space. 15% of patients were processed during ‘expansion periods’. Ambulance handover time improved (−18%) as well as Time to initial assessment (−45%), Time to see a clinician (−17%), and Time to referral (−12%). 4 hour performance 100 days after intervention had improved from 74% to 84%.

Staff feedback indicated that the department ran more efficiently (+28%), job-satisfaction had improved (+13%), perceived quality of care delivered had improved (+15%), and space was less frequently an issue (+26%).

Conclusion Fit2Sit assessments, FIT Zones, and direct referrals alongside a distributed leadership models can lead to improvements in ED performance, staff satisfaction, and ambulance handover time.