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