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Effect of clinician designation on emergency department fast track performance
  1. Julie Considine1,
  2. Matthew Kropman2,
  3. Helen E Stergiou2
  1. 1Deakin University—Northern Health Clinical Partnership, School of Nursing, Deakin University, Victoria, Australia
  2. 2Emergency Department, The Northern Hospital, Northern Health, Victoria, Australia
  1. Correspondence to Dr Julie Considine, Deakin University—Northern Health Clinical Partnership, School of Nursing, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia; julie.considine{at}deakin.edu.au

Abstract

Objective To examine the effect of clinician designation on emergency department (ED) fast track performance.

Design and Setting A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia.

Participants Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n=8714).

Main Outcome Measures Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group.

Results Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n=6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (χ2=498.539, df=6, p<0.001).

Conclusions Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.

  • Clinical care
  • emergency care systems
  • emergency department
  • emergency medicine
  • fast track
  • resuscitation

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Footnotes

  • Competing interests None declared.

  • Ethics approval The Northern Health Quality Committee deemed the audit met the National Health and Medical Research Council criteria for a quality assurance activity. Submission of a full application to the Human Research and Ethics Committee was waived.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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