title: Patient perceptions of emergency department fast track: a prospective pilot study comparing two models of care.
abstract: BACKGROUND
  Emergency department (ED) fast track has been shown to improve patient flow for low complexity presentations.(1) The optimal model of care and service delivery for fast track patients has not been established.
  
  
  OBJECTIVE
  The objective of this pilot study was to compare patient satisfaction using two models of ED fast track - one in a tertiary hospital emergency department staffed by doctors and the other in a nearby urban district hospital staffed by nurse practitioners. We also wanted to determine the proportion of fast track patients who would prefer to see a General Practitioner (GP) instead of presenting to the ED. This pilot study was the foundation for subsequent studies later conducted by Dinh et al.(2,3) METHODS: This was an observational study using a convenience sample of patients. Eligible fast track patients were asked to complete a standardised satisfaction survey. Presenting problems and waiting times of patients were collected using patient information systems. Primary outcome measure was satisfaction rating using a 5-point Likert scale. Secondary outcomes were surrogate satisfaction measures encompassing questions on likelihood of returning to ED. A multivariate analysis was performed to obtain odds ratio for higher satisfaction scores.
  
  
  RESULTS
  In total, 353 patients were recruited: 212 patients in the doctor treated group (DR) and 141 were in the nurse practitioner treated group (NP). The two groups had similar baseline characteristics in terms of age, gender, referral source and waiting times. Overall, 320/353(86%) patients rated their care as either very good or excellent, with only 0.6% rating their care as poor. Satisfaction scores in the NP group were higher than those in the DR group (median score 4 vs. 3, p<0.01). A greater proportion of patients in the NP group reported that they would return to the ED for a similar problem (99% vs. 91% p<0.01). Overall, 175/353 (50%) of patients indicated that they would prefer to see a general practitioner for a similar problem if available nearby. These numbers were slightly lower in the NP group (43% vs. 53%, p=0.05).
  
  
  CONCLUSIONS
  Most patients were satisfied with ED fast track, irrespective of model of care. Patient satisfaction was greater in the group of patients using the nurse practitioner model of care. Around half of the fast track patients would prefer to see a general practitioner for a similar problem if available nearby.
authors.affiliation: Canterbury Hospital, Emergency Department, Campsie, NSW 2194, Australia. Electronic address: mattlutze@hotmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lutze
authors.affiliation: CareFlight Northern Operations (NT), PO Box 1932, Darwin, NT 0800, Australia; Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Electronic address: markr@med.usyd.edu.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Ross
authors.affiliation: Canterbury Hospital, Emergency Department, Campsie, NSW 2194, Australia. Electronic address: Matthew.Chu@sswahs.nsw.gov.au.
authors.forename: Matthew
authors.initials: M
authors.lastname: Chu
authors.affiliation: Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Sydney University, Sydney, New South Wales, Australia. Electronic address: tim.green@sswahs.nsw.gov.au.
authors.forename: Tim
authors.initials: T
authors.lastname: Green
authors.affiliation: Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Sydney University, Sydney, New South Wales, Australia. Electronic address: dinh.mm@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Dinh
mesh_terms: D000328:Adult; D001315:Australia; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D017146:Models, Organizational; D024802:Nurse's Role; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D010865:Pilot Projects; D011446:Prospective Studies; D014850:Waiting Lists
keywords: Emergency department; Fast track; Nurse practitioner; Patient satisfaction; Pilot study