This weekend, it was Brendan Drumm who said the wrong thing. He infuriated hospital consultants when he pointed an accusing finger in their direction.

They volleyed back the blame in the form of bed shortages. Mary Harney was also doing her bit, sparring with opposition parties about declaring a national emergency in the shadow of a general election. And the queues remained, and the trolleys overflowed, and another week passed without progress.

Except at St Luke's Hospital in Kilkenny, where staff were busy revolutionising the system.

Building relationships with local GPs, making sure patients were admitted on the same day as they arrived, and streaming sick people so that no one ended up in A&E unless they really, truly, needed to be there. It's been three years since St Luke's has had patients on trolleys in the corridors. What are they doing so right?

For 25 years, St Luke's struggled with the same problems as everywhere else. It had queues, and waiting lists, and duplication of treatment. It had 27 trolleys in the corridor, always full. Then, in 2000, it opened a Medical Assessment Unit (MAU) and completely changed the way it worked. According to consultant physician Garry Courtney, things have been looking up ever since.

"Basically, we're operating under the assumption that no one knows a patient better than their own GP, " he told the Sunday Tribune. "So if a GP can talk directly to someone in the hospital, they can decide together what type of care the patient needs.

"But a lot of the time, GPs can't get through on the phone, or they're put on hold for ages, and at the end of it all, they're just told to send the patient to A&E anyway. This ends up in the patient not even bothering to go to the GP, and going directly to Casualty."

In St Luke's, there is a designated bed manager, who liaises directly with local GPs. If a child has a high fever, the bed manager will notify the paediatric department. The child will arrive at the hospital, bypass A&E, and go directly to this department.

A pregnant woman will go to obstetrics. Someone with vaginal bleeding will go to the gynaecological department. The system uses the knowledge of the GP to stream patients directly where they need to go.

"This means that a pregnant woman doesn't end up sitting beside a drunk, violent person in A&E for hours on end, " said Courtney.

The MAU comes into play in the more complex cases. According to Courtney, 20% of A&E patients have medical problems such as a stroke or a heart attack rather than physical injuries or trauma, like a broken leg, or knife laceration.

Even though medical problems make up the minority of cases in A&E, they are always prioritised, and are more time-consuming than the physical injuries. "With medical cases, A&E staff regularly call in the medical team for a consultation, and they sometimes have to consult the surgical team, and all of this is taking hours, and the patient is being shuttled around like a ping-pong ball, " said Courtney.

Consequently, a few medical cases in an A&E department can result in a massive backlog of trauma cases. St Luke's MAU seeks to alleviate this by physically removing the medical cases from the A&E, and treating them immediately with medical doctors.

"The MAU is open from 8am to 8pm, " said Courtney. "Five physicians take it in turns to run it, so none of us get burned out, and when our turn comes, we're enthusiastic instead of exhausted. Every night, the unit is emptied of people and cleaned, so when you arrive in the morning you have a totally fresh start. That's very important, psychologically."

While assessments are taking place, a coordinator from St Luke's Patient Discharge Unit (PDU) . . . the only one of its kind in the country . . .

is already making plans to get the patient back home.

"Once the acute treatment of a patient is over, sometimes they need a few more days in hospital, just to recover, " said Courtney. "They're moved to the PDU, where they and their relatives know that they're getting ready to go home.

Some people actually don't want to leave from hospital, so this prepares them psychologically.

"Also, the discharge co-ordinator will be working to arrange home oxygen, or a commode or bed steps for when they go home. It so often happens that a patient is ready to be discharged, and there's a three-day delay because no one is responsible for looking after these type of arrangements and they haven't been done."

St Luke's also runs an Emergency Out-Patient Department one day a week. This means that patients will not be tempted to go directly to Casualty in a bid to avoid waiting for months for an appointment in the OPD.

Since the MAU was set up in 2000, representatives from 28 of the country's 35 A&E hospitals have visited St Luke's to observe how its system works. Health minister Mary Harney and HSE chief Prof Brendan Drumm have also been to visit. St Luke's is not a secret to the medical world, and yet there's no big rush to follow suit.

"I think one of the reasons is pure exhaustion, " said Courtney. "When I worked in Dublin, change didn't even occur to me because I was too tired.

When you're working so hard, even the idea of change is exhausting.

"Here, every single person had to reform the way they were working and that's the hardest thing in the world to get people to do. As well as that, this system wouldn't suit everyone. It's not set in stone, and would have be changed to suit different hospitals.

"But the idea is sound. Positive thinking, working together instead of against each other. Not this nasty fighting that's going on this weekend.

It's getting really vicious. And the patients are just falling through the cracks."