title: Effects of a fast-track area on emergency department performance.
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.
authors.affiliation: Emergency Medicine Section, Emergency Area, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Sanchez
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Smally
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Grant
authors.forename: Lenworth M
authors.initials: LM
authors.lastname: Jacobs
mesh_terms: D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011787:Quality of Health Care; D018709:Statistics, Nonparametric; D013996:Time and Motion Studies; D014218:Triage