The effect of a separate stream for minor injuries on accident and emergency department waiting times.
BACKGROUND
To decrease waiting times within accident and emergency (A&E) departments, various initiatives have been suggested including the use of a separate stream of care for minor injuries ("fast track"). This study aimed to assess whether a separate stream of minor injuries care in a UK A&E department decreases the waiting time, without delaying the care of those with more serious injury.


METHODS
A doctor saw any ambulant patients with injuries not requiring an examination couch or an urgent intervention. Any patients requiring further treatment were returned to the sub-wait area until a nurse could see them in another cubicle.


METHODS
Data were retrospectively extracted from the routine hospital information systems for all patients attending the A&E department for five weeks before the institution of the separate stream system and for five weeks after.


RESULTS
13 918 new patients were seen during the 10 week study period; 7117 (51.1%) in the first five week period and 6801 (49.9%) in the second five week period when a separate stream was operational. Recorded time to see a doctor ranged from 0-850 minutes. Comparison of the two five week periods demonstrated that the proportion of patients waiting less than 30 and less than 60 minutes both improved (p<0.0001). The relative risk of waiting more than one hour decreased by 32%. The improvements in waiting times were not at the expense of patients with more urgent needs.


CONCLUSIONS
The introduction of a separate stream for minor injuries can produce an improvement in the number of trauma patients waiting over an hour of about 30%. If this is associated with an increase in consultant presence on the shop floor it may be possible to achieve a 50% improvement. It is recommended that departments use a separate stream for minor injuries to decrease the number of patients enduring long waits in A&E departments.
Cooke
M W
MW
Centre for Primary Health Care Studies, University of Warwick, Coventry, UK. mathew.cooke@warwick.ac.uk
Wilson
S
S
Pearson
S
S
D001071:Appointments and Schedules; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D013997:Time Factors; D014218:Triage / Q000379:methods*; D006113:United Kingdom