title: A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department.
abstract: OBJECTIVE
  Fast tracks are one approach to reduce emergency department (ED) crowding. No studies have assessed the use of fast tracks in smaller hospitals with single physician coverage. Our study objective was to determine if implementation of an ED fast track in a single physician coverage setting would improve wait times for low-acuity patients without negatively impacting those of higher acuity.
  
  
  METHODS
  A daytime fast track opened in 2010 at Strathroy Middlesex General Hospital, a southwestern Ontario community hospital. Before and after intervention groups comprised of ED visits in 2009 and 2011 were compared. Pooled comparison of all Canadian Triage and Acuity Scale (CTAS) patients in each period, and between subgroups CTAS 2-5 comparisons were performed for: wait time (WT), length of stay (LOS), WTs that met national CTAS time guidelines (MNCTG), and proportion of patients that left without being seen (LWBS).
  
  
  RESULTS
  WT and LOS were six minutes (88 min to 82 min, p=0.002) and 15 minutes (158 min to 143 min, p<0.001) lower, respectively, in the post-intervention period. Subgroup analysis showed CTAS 4 had the most pre- to post-intervention decrease in WT, of 13 minutes (98 min to 85 min, p<0.001). There was statistical improvement in MNCTG in the post-intervention period. No differences were found in outcome measures for higher-acuity patients or LWBS rates.
  
  
  CONCLUSIONS
  Implementation of a fast track in a medium-volume community hospital with single physician coverage can improve patient throughput by decreasing WT and LOS without negatively impacting high-acuity patients. This may be clinically relevant, particularly for hospital administrators, given the improvement in meeting national WT standards we found post-intervention.
authors.affiliation: *Department of Family Medicine,Western University,London,ON.
authors.forename: Julie
authors.initials: J
authors.lastname: Copeland
authors.affiliation: *Department of Family Medicine,Western University,London,ON.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D003441:Crowding; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009864:Ontario; D062072:Patient Acuity; D010820:Physicians / Q000600:supply & distribution*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014218:Triage; D000078329:Workforce; D055815:Young Adult
keywords: emergency department; fast track; wait time