title: Effect of clinician designation on emergency department fast track performance.
abstract: OBJECTIVE
  To examine the effect of clinician designation on emergency department (ED) fast track performance.
  
  
  METHODS
  A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia.
  
  
  METHODS
  Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n=8714).
  
  
  METHODS
  Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group.
  
  
  RESULTS
  Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n=6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (χ(2)=498.539, df=6, p<0.001).
  
  
  CONCLUSIONS
  Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.
authors.affiliation: Deakin University-Northern Health Clinical Partnership, School of Nursing, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia. julie.considine@deakin.edu.au
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.forename: Matthew
authors.initials: M
authors.lastname: Kropman
authors.forename: Helen E
authors.initials: HE
authors.lastname: Stergiou
mesh_terms: D000328:Adult; D001315:Australia; D054869:Clinical Audit; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000592:standards*; D016529:Emergency Nursing / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008503:Medical Staff / Q000592:standards; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*; D014218:Triage / Q000379:methods