Effects of a fast-track area on emergency department performance

doi:10.1016/j.jemermed.2005.08.019

The Journal of Emergency Medicine

Volume 31, Issue 1, July 2006, Pages 117-120

https://doi.org/10.1016/j.jemermed.2005.08.019 Get rights and content

Abstract

To determine if a fast-track area (FTA) would improve Emergency Department (ED) performance, a historical cohort study was performed in the ED of a tertiary care adult hospital in the United States. Two 1-year consecutive periods, pre fast track area (FTA) opening—from February 1, 2001 to January 31, 2002 and after FTA opening—from February 1, 2002 to January 31, 2003 were studied. Daily values of the following variables were obtained from the ED patient tracking system: 1) To assess ED effectiveness: waiting time to be seen (WT), length of stay (LOS); 2) To assess ED care quality: rate of patients left without being seen (LWBS), mortality, and revisits; 3) To assess determinants of patient homogeneity between periods: daily census, age, acuity index, admission rate and emergent patient rate. For comparisons, the Wilcoxon test and the Student’s t-test were used to analyze the data.

Results showed that despite an increase in the daily census (difference [diff] 8.71, 95% confidence interval [CI] 6 to 11.41), FTA was associated with a decrease in WT (diff −51 min, 95% CI [−56 to −46]), LOS (diff −28 min, 95% CI [−31 to −23]) and LWBS (diff −4.06, 95% CI [−4.48 to −3.46]), without change in the rates of mortality or revisits.

In conclusion, the opening of a FTA improved ED effectiveness, measured by decreased WT and LOS, without deterioration in the quality of care provided, measured by rates of mortality and revisits.

Introduction

Due to the continuing pressure to see increasing numbers of patients efficiently and safely, Emergency Departments (EDs) have sought innovative ways to accomplish this goal. The creation of a “fast-track” program staffed by midlevel practitioners has been assumed to increase ED throughput for non-emergent patients (1). However, a reasonable concern arises as to whether this might occur at the cost of a decrease in overall ED performance or safety variables. This study was designed to assess the effects of a fast-track area opening, staffed by midlevel practioners, on ED effectiveness and quality.

Section snippets

Study Design

We performed a historical cohort analysis of all patients registered at our ED the year before (February 1, 2001 to January 31, 2002) and the year after (February 1, 2002 to January 31, 2003) the opening of a new fast-track area (FTA) in order to assess variables evaluating ED performance.

Setting and Population

Our hospital is an American urban 700-bed tertiary care adult teaching hospital that, at the time of the study, treated approximately 75,000 patients per year in the ED. All patients are seen by a triage nurse

Results

In spite of a 4.43% increase in the daily census within the second period, FTA opening was able to reduce both WT and LOS for the total patient population by 50% and 9.79%, respectively. The concern about FTA opening influencing quality markers was addressed by the decrease in LWBS rate (−52.18%) without a worsening in the revisit rate (−1.31%), or mortality rate (−3.57%). Independent variables used to assess any external condition change between periods did not show any significant

Discussion

Recently, scrutiny of the capabilities and function of the United States’ (U.S.) emergency medical system has arisen. This has been from within the specialty of Emergency Medicine and from outside, extending to the front pages of periodicals such as Time magazine. In most areas of the U.S. ED patient volume continues to rise while the total number of EDs declines. As a consequence, 92% of academic Emergency Medicine EDs were reported to be overcrowded in 1999 and dissatisfaction and frustration

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: Administration of Emergency Medicine is coordinated by Eugene Kercher, md, of Kern Medical Center, Bakersfield, California and Richard F. Salluzzo, md, of Conemaugh Meridian Health Group, Johnstown, Pennsylvania

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Administration of emergency medicineEffects of a fast-track area on emergency department performance

Abstract

Introduction

Section snippets

Study Design

Setting and Population

Results

Discussion

J Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Administration of emergency medicine
Effects of a fast-track area on emergency department performance