Effects of a fast-track area on emergency department performance

Sánchez, Miquel; Smally, Alan Jon; Grant, Robert J.; Jacobs, Lenworth M.

doi:10.1016/j.jemermed.2005.08.019

Cited by 104 publications

(85 citation statements)

References 11 publications

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“…This is consistent with the lean thinking theory, which suggests it is inherently more efficient to serve batches of quick customers to reduce crowding. 5,6 We did not find a decrease in number of patients LWBS after the intervention, a finding in contrast to other studies, 1,[7][8][9][10][11]16 even in subgroup analysis where the WT decrease was most dramatic. Thus an important question remains: does a decrease in WT of between six and 13 minutes result in a change in crowding that patients notice or deem to be significant?…”

Section: Discussioncontrasting

confidence: 99%

“…[8][9][10] However, our study results suggests two important features that previous work has not investigated: 1) increased throughput can be accomplished even in a single physician ED; and 2) increased throughput can be accomplished even when no additional staff are added in the restructuring process. The FT restructuring at our study location involved little change in resources and no additional physical space, but rather simply a change in patient and staff flow.…”

Section: Discussionmentioning

confidence: 64%

“…Previous studies have shown that FTs can decrease wait times, length of stay (LOS), and crowding in tertiary care centers. 4,[7][8][9] There is also evidence indicating that FTs do not negatively impact higher-acuity patients. [10][11][12][13] However, there have been few studies to evaluate FTs in Canadian settings.…”

Section: Introductionmentioning

confidence: 99%

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A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department

Copeland

Gray

2015

CJEM

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Objectives: 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 postintervention 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 mediumvolume 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. RÉSUMÉObjectif: Le traitement accéléré des patients est un moyen de réduire l'encombrement des services des urgences (SU). Toutefois, aucune étude n'a porté sur le traitement accéléré des patients dans les petits hôpitaux où un seul médecin est de garde. L'étude visait à déterminer si la mise en oeuvre du traitement accéléré des patients dans un SU où un seul médecin est de garde diminuerait les délais d'attente pour les patients souffrant de troubles peu graves, sans toutefois se répercuter défavorablement sur les patients se trouvant dans un état grave. Méthode: Un processus de traitement accéléré des patients a été mis en oeuvre, le jour, en 2010, au Strathroy Middlesex General Hospital, un hôpital communautaire situé dans le sud-ouest de l'Ontario. Il y a eu comparaison des groupes de patients qui ont consulté au SU, en 2009 et en 2011, soit avant et après la mise en oeuvre du traitement accéléré. Les auteurs ont procédé à des comparaisons globales de tous les patients, selon l'Échelle canadienne de triage et de gravité (ECTG) pour chaque période, ainsi qu'à des comparaisons partielles entre des sous-groupes de patients du 2 e au 5 e degré de priorité selon l'ECTG, en ce qui concerne les délais d'attente (DA), la durée de séjour (DS), le respect des lignes directr...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 64%

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A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department

Copeland

Gray

2015

CJEM

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“…2010, Vol. 33, Suplemento 1 do SUH puede visitar simultáneamente 15 . Se trata de espacios físicos dentro del propio servicio donde se atienden a los pacientes de menor gravedad, aquellos que, en general, pueden ser dados de alta rápidamente con un mínimo, si no ninguna, exploración complementaria.…”

Section: áReas De Visita Rápidaunclassified

“…En el argot anglosajón se les conoce como nurse practitioner o physician asistant y, en nuestro entorno, sería el equivalente a enfermeras con probada experiencia en urgencias que realizarían un aprendizaje especial y específico de 2 años enfocado a explorar, diagnosticar y tratar a estos pacientes. Se ha demostrado que estas áreas con este tipo específico de personal sanitario son capaces de disminuir el tiempo de espera, el tiempo total de estancia en urgencias y el porcentaje de pacientes que se marchan del SUH antes de ser visitados, sin detrimento en la calidad técnica dispensada 15 .…”

Section: áReas De Visita Rápidaunclassified

Áreas organizativas específicas y circuitos preferentes para patologías prevalentes en urgencias

Sánchez

Santiago

2010

Anales Sis San Navarra

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RESUMENEl incremento de la demanda y las habituales situaciones de colapso de los Servicios de Urgencias Hospitalarios (SUH) obliga a continuos cambios organizativos en busca de un óptimo funcionamiento y una asistencia de mayor calidad.Los principales cambios se han basado en la implantación de diferentes sistemas de triaje, a fin de estructurar la atención en función de la urgencia, y el cambio adaptativo en la asistencia médica mediante diferentes fórmulas, como la derivación sin visita, las áreas de visita rápida (fast-track areas) y los circuitos asistenciales específicos, como las unidades de dolor torácico, de código ictus o de código sepsis, entre las más extendidas en los SUH.Por otro lado, los SUH se han visto obligados a buscar y utilizar métodos que favorezcan el flujo de salida de los pacientes desde los propios servicios, la mayor parte de las veces entorpecida por la mala gestión de camas hospitalarias por parte de las administraciones sanitarias. Para ello se utilizan diferentes alternativas a la hospitalización convencional como son: unidades de observación, unidades de estancia corta, hospitales de día y hospitalización domiciliaria.Palabras clave. Áreas específicas. Circuitos asistenciales. Alternativas a la hospitalización convencional. ABSTRACTThe increase in demand and the normal situations of overload of the Hospital Emergency Department (HED) make continuous organisational changes compulsory in the search for optimum working and greater quality of care.The main changes have been based on the implementation of different triage systems, with the aim of structuring care according to urgency, and adaptive change in the medical service through different formulae, such as referrals without consultation, fast-track areas and specific care circuits, such as units for thoracic pain, stoke code or sepsis code, amongst the most widespread in HED.On the other hand, HEDs have been forced to seek and use methods that favour the discharge of patients, often hindered by poor management of hospital beds by the health administrations. Hence, different alternatives to hospitalisation are suggested, such as: observation units, short stay units, day hospitals and hospitalisation at home.

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Simulation‐based optimisation approach to improve emergency department resource planning: A case study of Tunisian hospital

Daldoul

Nouaouri²,

Bouchriha

et al. 2022

Health Planning & Management

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Background: The emergency department (ED) is a gateway to hospitals and is in the centre of hospital management efforts. It is often saturated by a continuous flow of patients, which causes excessive patient waiting time.Aims: This study integrates simulations with optimisation to design planning decision support for an ED. We considered all the processes of the ED, from triage to bed assignment. This study's main objective was to determine the optimal number of doctors, nurses, and beds required to schedule patients with different acuity levels to minimise both the total patient waiting time and the patient average length of stay and balance the resource utilisation rates. The problem is also characterised by multiple uncertainties, such as the patient arrival rate and service times in each stage of the process.Method: We first propose a stochastic mixed-integer programing model that is solved using the sample average approximation approach. The resulting resource sizing is then evaluated using a discrete-event simulation model by comparing different patient scheduling rules.Results: Numerical experiments highlight the performance of the proposed approach using data from a Tunisian ED hospital.

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Effects of a fast-track area on emergency department performance

Cited by 104 publications

References 11 publications

A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department

A Daytime Fast Track Improves Throughput in a Single Physician Coverage Emergency Department

Áreas organizativas específicas y circuitos preferentes para patologías prevalentes en urgencias

Simulation‐based optimisation approach to improve emergency department resource planning: A case study of Tunisian hospital

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