Two years ago, ministers pledged that no patient would wait more than four hours for treatment in A&E by 2004.

The results of the study by the Association of Community Health Councils in England and Wales (ACHCEW) suggests the government will seriously struggle to come anywhere near that target.

However, a pilot scheme established at a major London hospital earlier this year has shown that with some clever thinking and a flexible approach A&E waits could indeed become a thing of the past.

Pilot results

89% of patients treated within four hours Fewer patients admitted to hospital Traditional staff boundaries removed No delays waiting for ultrasound scanning or X-ray results

At the beginning of the year, half of all patients who turned up in A&E at Barts and The London NHS Trust waited more than four hours to be treated.

However, over the course of four weeks in March staff managed to reduce that figure to just one in 10.

Not only that, the new approach to emergency medical care managed to achieve what previously seemed impossible - an empty waiting room and happy patients.

Radical approach

The secret of this success was a radical fresh approach to managing the A&E department and changing the way staff there worked.

As part of what staff at the trust's Royal London Hospital called the Treatment Initiation Scheme (TIS), traditional barriers between doctors, nurses, technicians and receptionists were removed.

The traditional triage system - where nurses assess and prioritise patients - was abolished. This enabled nurses to start treating patients as soon as they arrived in A&E.

Nurses decided what treatments were needed and could order tests and X-rays which previously had to be requested by doctors.

It has meant a change of practice for all members of the team

Dr Gareth Davies, A&E consultant

Senior charge nurse in the department Adam Tinney said the changes had made a difference.

He said: "Triage is what distinguishes A&E nurses from other nurses but all it does is sort the queue. TIS means that nurses can focus on assessing and treating patients."

Nurses' time was freed up because some of their responsibilities were transferred to technicians, who could carry out heart checks, blood tests and put up drips.

The role of receptionists also changed. They were moved into the clinical areas of the department where they could help out after registering patients.

But arguably the most important change was the decision to incorporate radiologists and radiographers into the A&E team.

In the past, patients who needed ultrasound scanning or other hi-tech tests had to be admitted to hospital or given an out-patient appointment for a later date.

But with radiographers on hand, those tests could be carried out there and then with results taking just minutes rather than hours or even days to come through.

Similarly, X-rays could be ordered, carried out and examined almost instantly.

Major benefits

So while the scheme managed to dramatically improve services in A&E, it also had a major impact on the hospital as a whole as fewer patients needed to be admitted.

A&E consultant Dr Gareth Davies said the scheme also boosted the morale of staff.

"This has been driven by all the professional groups who work either in or with A&E.

"It has meant a change of practice for all members of the team and all have been very motivated and encouraged by how well it has been working."

The scheme was funded with �50,000 from the local health authority and came to an end of March.

Staff are now hoping that the extra money to needed to introduce the scheme permanently will be forthcoming shortly.

A&E consultant Dr Tim Coats said: "What we have shown is with different ways of working you can get the vast majority of patient though A&E within four hours."

But he added: "It requires resources and it does depend on where the priorities in the hospital are."

There is little doubt that the changes, which included increasing A&E staff numbers, would mean a sizeable increase in the departmental budget.

But there is hope that what started out as a pilot scheme could become a template for the rest of the health service.

Certainly, the early results have caught the attention of people inside and outside the hospital. Last week, junior health minister Hazel Blears visited the A&E department to discuss the results with staff herself.

Perhaps, she will champion the merits of the Bart scheme with her bosses as they decide how they can best spend the extra billions of pounds promised for the NHS by Chancellor Gordon Brown over the coming years.