<p>Over a period of years, A&amp;E departments have become busier and, paradoxically, the increased workload has been felt most in well-run departments. The increase has been due to:</p> <p>• A true rise in the number of cases being seen</p> <p>• A greater filtering function performed by the department. The filtering function is time-consuming because it requires doctors requesting X-rays and pathology tests that would have been requested by inpatient staff a decade ago when there were more beds available</p> <p>• The greater need to discharge patients back into the community to save on hospital admissions</p> <p>• The process required in making a wise and safe decision by A&amp;E and inpatient staff means that the time spent in A&amp;E can be increased.</p>