title: Evaluation of a fast track unit: alignment of resources and demand results in improved satisfaction and decreased length of stay for emergency department patients.
abstract: BACKGROUND
  Emergency departments (EDs) are struggling with overcrowding. The Institute for Healthcare Improvement recently concluded that reducing delays is critical to improving all aspects of emergency care. To reduce cycle times and improve patient flow, we developed a separate stream of care focused on low-acuity patients in our academic ED.
  
  
  METHODS
  Strict triage criteria were developed, and patients were seen by a physician's assistant in a dedicated section of the ED. Two anonymous surveys (patient and staff) and a time cycle analysis were performed before and after the intervention.
  
  
  RESULTS
  Eighty-seven preintervention patient surveys (response rate = 60%) and 91 postintervention surveys (response rate = 79%) were collected. Demographic data were comparable. All domains of patient satisfaction were significantly improved in the postintervention group and were correlated with the length of stay that decreased from 127 to 53 minutes (P < .001).
  
  
  CONCLUSIONS
  This study supports an emphasis on improving turnaround time as a primary driver of satisfaction, and demonstrates that a simple intervention characterized by focusing existing resources on the needs of a specific population can significantly improve health care delivery. Thoughtful alignment of resources with the needs of specific patient populations should similarly streamline care in other clinical settings.
authors.affiliation: Section of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Scott.W.Rodi@hitchcock.org
authors.forename: Scott W
authors.initials: SW
authors.lastname: Rodi
authors.forename: Maria V
authors.initials: MV
authors.lastname: Grau
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Orsini
mesh_terms: D000328:Adult; D003625:Data Collection; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D017060:Patient Satisfaction