title: How does fast track affect quality of care in the emergency department?
abstract: OBJECTIVE
  Use of fast track has been shown to improve the emergency department flow of less urgent patients. It has been speculated, however, that this could negatively affect the care of urgent patients. The objective of this study was to determine whether a dedicated fast track for less urgent patients [Canadian Triage and Acuity scale category 4/5 (CTAS 4/5)] affected (1) the time to assessment for urgent patients (CTAS 3), (2) the length of stay for less urgent patients (CTAS 4 and 5), and (3) the left-without-being-seen rate.
  
  
  METHODS
  In June 2003, fast track was opened in our emergency department from 13:00 to 19:00 h. A before-after intervention comparison analysis was completed for 1 week in Aug 2002 and the same week in Aug 2003. Data collected included (1) time to assessment of CTAS 3 patients, (2) the length of stay for CTAS 4/5 patients, and (3) percentage of patients who left without being seen.
  
  
  RESULTS
  A total of 368 patients were reviewed for 2002 and 380 patients were reviewed for 2003. Median time to assessment of CTAS 3 patients presenting from 13:00 to 19:00 h was reduced from 66 min (Interquartile range: 40, 94 min) in 2002 to 60 min (IQR: 38, 108 min) after fast track was open in 2003 (P = 0.95). Median length of stay of CTAS 4 and 5 patients was reduced from 170 min (IQR: 111, 256 min) to 110 min (IQR: 69, 185 min) (P < 0.001). The overall left-without-being-seen rate decreased from 5% (20/368) to 2% (9/380).
  
  
  CONCLUSIONS
  A dedicated fast track for CTAS 4/5 patients can reduce the length of stay and the left-without-being-seen rate with no impact on CTAS 3 patients seen in the main emergency department.
authors.affiliation: Division of Emergency Medicine, McMaster University, Hamilton Health Sciences, Ontario, Canada. Edarrab@hotmail.com
authors.forename: Ayad Al
authors.initials: AA
authors.lastname: Darrab
authors.forename: Jerome
authors.initials: J
authors.lastname: Fan
authors.forename: Christopher M B
authors.initials: CM
authors.lastname: Fernandes
authors.forename: Rosanne
authors.initials: R
authors.lastname: Zimmerman
authors.forename: Rhonda
authors.initials: R
authors.lastname: Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.forename: Teresa
authors.initials: T
authors.lastname: Smith
authors.forename: Kelly
authors.initials: K
authors.lastname: O'Connor
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009864:Ontario; D011787:Quality of Health Care; D013996:Time and Motion Studies; D014218:Triage / Q000379:methods