Table 1

Summary of the three plan–do–study–act (PDSA) cycles

PDSA 1PDSA 2PDSA 3
Four rules:

  • No ‘stretcher patients’

  • Examination room always available

  • Forward movement

  • Huddle

Adaptation of four rules:

  • Definition of sitting and lying waiting areas after care

  • The lead of the huddles is given to the nurses

  • Standardisation of huddle

  • Definition and levels of overcrowding

  • System overcrowding, directives and actions plan