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Non-urgent. Howewer, all of these are interchangeable and indentity the same priorities. The percentage
of patients seen within target times incorporated into the scale is stipulated locally and managent will
need to scrutinize accurate and organized information on clinical activity to determine the effectiveness
of the system within individual department.

MANCHESTER INNOVATION

The Manchester Triage Group, established in 1994, developed a methodology to allow practitioners of
triage to work to a set standard when applying the national triage scale. The design adopted a systematic
approach to triage through the use of algorithms and offered a patient management system modifiable
to most A & E depertements. Through the use of decision-making strategies and general discriminators
the aim is to provide a standard triage method. With a combination of the British Association for
Accident and Emergency Medicine and Royal College of Nursing national triage scale and structured
techniques such as those devoleped by the Manchester Triage Group, analysis of national standards of
triage and subsequent actions of triage personnel should be more rational and logigal.

THE NEW NHS

The new NHS( Doh,1997) has established a national institute for clinical excellence to ensure that
standards are met and cost effectiveness is achieved. The Government proclaimed that nationally this
means consistent access to services across the country. Locally clinical governance will mean NHS trusts
ensuring clinical standards are avchieved, whilst a Commission of Health Improvement will oversee the
quality of services and intervene directly when a problem arises. If effective, this should go some way
toward monitoring a national standard of triage including issues such as assuring quality, good practice
and maintenance ofperfomance standards.

O’Dowd (1998) expressed concern that there had been no mention of membership for the United
Kingdom Central Council within the National Institute for Clinical Excellence. The author echoes this
concern and believes that modification to practice cannot take place effectively without consultation
with members of all multidisciplinary teams involved in assuring that quality and standards are met.

THE PATIENT’S CHARTER

With raised expectations on the part of helath service consumers and the publishing of the Department
of Health Patient’s Charter document (1992), nurses and managers aware os the need conform to
national and local Charter standards. The document coerced A&E departments into providing a formal
triage assessment by inclusion of Standard Five, which guaranteed patients an immediate clinical
assessment to determine their need for treatment. This was undoubtedly effective in ensuring a
reduction os possible detrimental effects of delays in the waiting room for seriously ill or injured
patients. However, the fluctuating workload within A&E depart-ments made the provision of immediate
assessment unrealistic within most departments, even after the introduction of a formal triage system.
This resulted in brief eunconters, which denied patients a effective, safe an accurate assessment and
failed to give those involved time to develop patients/nurse relationships. Structured local protocols
have now ensued and most A&E depart-ments have established their own charter guidelines detailing
standards and waiting times. Difficulties and differences in opinion stil occur but these protocols have
helped resolve many problems.

Local charter guidelines offer a longer period of time for triage assessment , allowing a higher
and safer level of assessment with improved standards of care foll all categories of patients . local NHS
trusts have concentrated their efforts on adapting and implement-ing guidelines in priority clinical areas
to suit local needs.