PP30 Rapid assessment and treatment zones (RATZ) – making strides or causing setbacks?

<h3>Background</h3> Overcrowding is common within Emergency departments (EDs). Consequently, a Rapid Assessment and Treatment Zone (RATZ) was implemented within an ED in South Wales. RATZ is a scheme where a senior clinician assesses patients presenting to the ED as soon as possible with the aim of timely senior assessment along with redirecting unsuitable patients to other services. <h3>Methods</h3> This was a mixed methods service evaluation utilising observation, interviews, and an online survey to create a visual model of ‘work as done’ using the Functional Resonance Analysis Method (FRAM). Qualitative data was analysed using thematic analysis. Longitudinal administrative data was used to quantify the time taken to complete key FRAM functions. Data on time to triage, first clinician assessment, discharge and admission was collected using Lightfoot Software. <h3>Results</h3> RATZ has not improved time from arrival to triage. It has improved time to first clinician when compared to the mean, one year earlier. Interviews highlighted that the main benefits of RATZ include timely investigations and access to consultants. The online survey showcased that most staff thought RATZ ‘somewhat’ improved staff satisfaction and patient safety. However, when RATZ is implemented in isolation it inadvertently created safety risks due to having an unobserved waiting room. Other negatives included poor staffing and inconsistency in RATZ operation by senior clinicians. Suggested improvements explored improving patient safety via electronic patient-reported triage and better monitoring of the waiting room. <h3>Conclusions</h3> The implementation of RATZ has faced several challenges, with patient safety being an important area requiring improvement. As a result of this study the waiting room has several inputs to try to improve patient safety. Additionally electronic triage is to be implemented. More data is needed to assess the long-term implications of RATZ and its benefits within this ED.