All patients who present to the Emergency Department undergo the process of triage. This is a complex assessment to allocate a priority score identifying how long they can safely wait to be seen by a doctor (ACEM 2006). As a consequence the score can facilitate direct access to care for triage one, two and three or result in waiting one to two hours or potentially longer for triage four and five. The process is based on strict criteria however as any process with a human dynamic open to human interpretation and manipulation. The subtle variations in triage assessment can produce individual inequities in the system. As a result of longer waiting times patients leave the department without being seen by the doctor.
This research aims to explore the groups of people that ‘did not wait’ focusing on patients identified triage four and five who present out of hours. This focus was chosen as the emergency department is the sole health care provider during this period. Therefore these patients were identified as disenfranchised with no other choice of health provider.

The methodological approach utilised was critical social theory as this seeks to emancipate the disenfranchised. Exploring the barriers that exist, providing a mechanism for change and highlighting ethical ways to practice nursing (Carnegie & Kiger 2009). Retrospective routinely collected electronic data was extracted from the organisational data base. Five year trend analysis and descriptive statistical data patterns were produced to identify the specific groups of out of hour’s patients that ‘did not wait’. The significant groupings who showed marked increases in ‘did not wait’ presentations were Mäori children (0-5), teenage males (15-19) and Mäori women (20-39) from low socio-economic areas.

In conclusion removing the identified barriers that currently exist for these groups of patients will include; recognition that rural emergency departments play a vital role in primary healthcare out of hours. Reducing waiting times through advanced nursing practice, role development and nurse initiated treatment pathways. Finally by implementing a whole systems and community wide approach to out of hours care.