Streaming by case complexity: evaluation of a model for emergency department Fast Track.
OBJECTIVE
To evaluate a patient flow streaming system within a teaching hospital's ED, using functional principles to separate patients into two streams on the basis of complexity rather than acuity, severity or disposition.


METHODS
The project used conceptual principles, such as patient complexity and 'lean thinking' theory, to create a new Fast Track patient stream, which was separately resourced. Data collected before and after implementation of the Fast Track system were analysed to evaluate the system.


RESULTS
Following implementation of the system, significant improvements were observed in several key ED performance indicators. Mean waiting time was reduced from 55 to 32 min, mean treatment time was reduced from 209 to 191 min, compliance with New South Wales Department of Health waiting-time benchmarks increased from 59% to 77% and the percentage of patients who did not wait to complete their treatment halved from 6.2% to 3.1%.


CONCLUSIONS
Key features in the success of the system included use of dedicated senior staff for Fast Track patients, and quarantining of clinical resources. The ED aiming to improve their waiting times and throughput should consider using complexity as a key criterion for triaging patients into separate streams. A low-complexity patient stream in the ED provides an ideal focus for advanced nursing practice.
Ieraci
Susan
S
Emergency Department, Bankstown Hospital, Bankstown, New South Wales, Australia. sue.ieraci@swsahs.nsw.gov.au
Digiusto
Erol
E
Sonntag
Paul
P
Dann
Linda
L
Fox
Debra
D
D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D008962:Models, Theoretical; D009517:New South Wales; D011787:Quality of Health Care; D014850:Waiting Lists