Introduction Ambulatory Majors was set up in the Countess of Chester Hospitals Emergency Department to take the workstream of ‘non minor injury’ patients, who are not suitable for the Urgent Treatment Centre and do not need a bed to wait on. Ambulatory Majors has the largest throughput of patients, but has minimal senior doctor supervision. Patients have long waits to be seen with their consultation time disproportionately shorter. Patients are having cannulation or blood tests which are not required which increases patient length of stay. Their length of stay is the biggest factor causing congestion which leads to the impression of chaos to both patients and staff.

Methods The aim of this project was to decrease the length of time from patients’ arrival to being seen and patients’ arrival to depart. A force field analysis, Driver diagram and a literature search are used to help identify possible solutions to the problem. Buy in was gained from key stakeholders.

Intervention A team-based approach to seeing patients in Ambulatory Majors was adapted which included two doctors and a nurse seeing each patient. Whilst one doctor saw the patient, the other doctor recorded the notes in real time and the nurse preformed any investigations necessary.

Results The average arrival to seen improved from an average of 139.63 minutes to 112.5 minutes during the first month and average arrival to departure time from an average of 194 minutes to 162.5 minutes. Results over the year saw an initial decrease for the month of March when the intervention was introduced but this was not sustained throughout the year.

Conclusion This project explored ways of reducing time to be seen and the length of overall stay in ambulatory majors. Strategies using alternative team working and environmental change were used. Despite some promising initial results, benefits were not sustained which were multifactorial.