Academic journal article Australian Health Review

Impact of Streaming "Fast Track" Emergency Department Patients

Academic journal article Australian Health Review

Impact of Streaming "Fast Track" Emergency Department Patients

Article excerpt

Abstract

Objective: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients.

Methods: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area.

Results: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (-18 min; 95%CI, -26 min to -10 min) relative reduction in the average waiting time and an 18.0% (-41 min; 95%CI, -52 min to -30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (-2.1 min; 95%CI, -8 min to 4 min) relative reduction in the average waiting time and a 9.7% (-20 min; 95%CI, -31 min to -9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period.

Conclusion: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.

Aust Health Rev 2006: 30(4): 525-532

THE CONCEPT OF STREAMING patients with relatively low acuity conditions through a dedicated area, in order to reduce their waiting times and lengths of stay, was first trialled in the late 1980s in emergency departments (EDs) in North America.1 The success of these "fast track" systems resulted in their wider introduction internationally and in trials of variations of the original model.

Several fast track models are now in operation, but to date there has been no study detailing changes associated with their introduction in the Australian emergency department setting. In addition, with fast track systems mainly focused on low acuity presentations, it is unclear whether an emergency department with relatively few patients with minor illness or injury would benefit from the introduction of a fast track system.

This paper describes a prospective study undertaken to assess the impact of a fast track system in the emergency department of an Australian tertiary adult teaching hospital which deals with a predominantly complex medical casemix. Some emergency staff express concerns that while fast track areas reduce times for patients treated through those areas, this may be at the expense of patients in the remainder of the department. We hypothesised that streaming patients in this way would benefit all discharged patients, and would not adversely affect waiting times for admitted patients.

Aims

The aims of this study were therefore to assess the impact of the introduction of a fast track system in terms of the performance indicators:

* average length of stay for all discharged patients (time from triage to time of discharge);

* average waiting time for all discharged patients (time from triage to time seen by doctor);

* average waiting time for all admitted patients (time from triage to time seen by doctor).

Methods

Setting

The trial was conducted in the emergency department of a 500-bed metropolitan tertiary adult teaching hospital in Perth, Western Australia, over a 12-week period commencing in June 2004. …

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