Objective: To see whether three hours of combined doctor and nurse triage would lead to earlier medical assessment and treatment and whether this benefit would carry on for the rest of the day when normal triage had resumed. Method: Eight days were randomly selected; four for team triage and four for the normal nurse led triage. Team triage was coordinated by a middle grade or consultant from 9 am to 12 noon. Times to triage, to see a doctor, radiology, admission, and discharge were recorded. No additional medical or nursing staff were used and staffing levels were similar each day. All patients including blue light emergencies and minor injuries were included. Results: Median times were significantly reduced (p,0.05) during the intervention to triage (2 min v 7 min, p = 0. 029), to see a doctor (2 min v 32 min, p = 0.029), and to radiology (11.5 min v 44.5 min, p = 0.029). Waiting times at midday were longer for patients in the non-intervention group. More patients were seen and discharged within 20 minutes in the intervention group (18 of 95 (19%) v 2 of 69 (3%) p = 0.0043). No significant knock on effect was demonstrable for the remaining 21 hours after the intervention ceased. Conclusion: Three hours of combined doctor and nurse triage significantly reduces the time to medical assessment, radiology, and to discharge during the intervention period. Waiting times at midday were shorter in the triage group. There was no significant knock on effect the rest of the day.

Objective-To compare pre-hospital parental administration of pain relief for children with that of the accident and emergency (A&E) department staff and to ascertain the reason why pre-hospital analgesia is not being given. Designlmethods-An anonymous prospective questionnaire was given to parents/guardians of children < 17 years. The children were all self referred with head injuries or limb problems including burns. The first part asked for details of pain relief before attendance in the A&E department. The second part of the questionnaire contained a section for the examining doctor and triage nurse to fill in. The duration ofthe survey was 28 days. MethodsThe questionnaire (fig 1) was devised after discussion with staff from the hospital and the local university (Magee). Further modifications were made over a 48 hour period, to the satisfaction of both medical and nursing staff. The questionnaire was then piloted for a full week (without further modification) to encourage staff participation. The questionnaire was administered over a 28 day period in spring 1998. One questionnaire was distributed per child.The questionnaire was in two parts. The first was filled in by a parents or guardians of the child attending the A&E department. All children were <17 years old. Children entered in the study were self referred with head injuries and limb problems including lacerations and burns. Children attending by ambulance or directly from school or with abdominal, chest, or dermatology conditions were excluded from the study.The first part of the survey ascertained the age of the child, the occupation of the parents/ guardians, the delay in presentation, and if there were painkillers suitable for children at home. When pain relief was given before A&E department attendance, the type and the dose of analgesic were documented. The reason for analgesia not being given was recorded. The second part of the questionnaire was completed by A&E department staff. This included the type, dose, and timing of administration of analgesia. The problem, whether a limb injury, burn, laceration, or head injury and the result of radiography (if required) was recorded. The diagnosis and whether the child required a general anaesthetic were documented. The authors checked each proforma every day against the A&E department ledger and completed any unfinished second part of the proformas. SETTINGThe A&E department serves an urban/rural catchment of more than 250 000. In the year, the busiest periods with children are summer and autumn; 40% of the 43 500 new patient attendances are children. The