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Reducing time spent in the ED using RAT+

In partnership with Health Education England, King’s College Hospital NHS Foundation Trust piloted a project which focused on reducing the length of time patients spent in the emergency department, using the Rapid Assessment & Treatment (RAT+) model


Rapid Assessment and Treatment (RAT) teams have existed in one form or another in UK emergency departments (ED) for some time. The principle idea behind RAT is to provide a team of senior clinicians to assess and implement a prompt care plan for patients with major incidents. The intention is to make early senior decisions about patient care thus improving the quality of care and reducing the length of time in the ED.
In early 2012 King’s piloted a RAT system in the ED. This pilot primarily focused on the establishment of a RAT system in the majors area (and the development of a new role – the advanced assessment practitioner. The project team then used this concept to develop the BTBC pilot project, more formally known as the RAT+ system, which has two key differences from the traditional RAT model:

  • A team approach: the traditional RAT model proposes a sole clinician delivering RAT. RAT+ consisted of a consultant and an advanced assessment practitioner, thereby not only developing a team approach but also developing an innovative nursing role.
  • RAT+ placed two consultants in the patient journey. One as part of the initial assessment team and the other working with trainee medical staff in the majors area supporting their decision making, training and development.

The RAT+ model was designed to deliver improved time to treatment and time to referral from arrival for majors patients, minimalise total time in the ED and improve supervision, education and learning opportunities for trainees.

How they did it

Using the RAT+ system, they placed a senior clinician at the beginning of the patient journey in the majors area, enabling early decision making, improving the quality of care and reducing the length of time spent in the ED.


  • A 4.3% reduction in time to treatment, along with a 43.6% reduction in mean time to referral to inpatient teams from arrival
  • 10% reduction in the total time patients spent in the ED
  • A reduction in the median time to treatment for majors patients; 53 minutes compared to 69 minutes for the non-RAT+ group
  • Nursing staff (60%) and medical staff (67%) agreed that RAT+ improved the quality of care for patients in the major’s area
  • Clinical staff (78%) communicated that RAT+ improved patient safety and improved flow through the majors department
  • Increased productivity and support for the trainees and an improvement in multi-professional team working.


Please look at the toolkit materials in the related documents below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects.
Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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