Fast track: has it changed patient care in the emergency department?
OBJECTIVE
To determine whether the introduction of a designated fast-track area altered the time to care and patient flow in an Australian mixed adult and paediatric ED.


METHODS
Retrospective cohort study of all patients presenting to the ED between 08.00 and 22.00 hours, during a 6 month period before and after the opening of a fast-track area. Data were stratified according to Australasian Triage Scale (ATS) category, and comparisons were made for performance indicators, waiting time, length of stay and did-not-waits.


RESULTS
During its operational hours, fast track managed 14.9% of all patients presenting to the ED. There was a significant increase in the proportion of all ATS 4 patients seen within their target times (77.8% to 79.9%, P < 0.001). There was a trend towards improved performance in ATS categories 2, 3 and 5. Median patient waiting times were significantly decreased in ATS 4 (24 to 22 min, P < 0.001) and ATS 5 (27 to 25 min, P < 0.05), but increased in ATS 2 (3 to 4 min, P < 0.05). No deterioration in performance or waiting time for ATS 1 was shown. There was a decreasing trend in the proportion of patients who did not wait to be assessed by a doctor in ATS categories 4 and 5. These improvements occurred despite a 12% increase in patient attendances and no change in medical staffing levels.


CONCLUSIONS
Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower-acuity patients to be seen quickly without a negative impact on high-acuity patients.
Kwa
Paul
P
Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia. paulkwa78@yahoo.com
Blake
Denise
D
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D011793:Queensland; D012189:Retrospective Studies; D017748:Time Management / Q000379:methods*; D014850:Waiting Lists