Fast Track and the Pediatric Emergency Department: Resource Utilization and Patient Outcomes

Abstract

Abstract. Objective: To examine differences in the evaluation, management, and outcomes for patients seen in an on-site ''fast track'' (FT) vs the main ED. Methods: Over a three-month period, patients presenting to an urban pediatric ED were prospectively assessed. Patients included were: triaged as ''nonurgent''; aged 2 months to 10 years; not chronically ill; and had fever, or complaint of vomiting, diarrhea, or decreased oral intake. Evening and weekend care was provided in the FT; at all other times these low-acuity patients were seen in the ED. Seven days after the visit, families were interviewed by telephone. Results: Four hundred seventy-nine and 557 patients were seen in the FT and ED, respectively. The patients in the two settings did not differ in age, clinical condition, race, or commercial insurance status. Patient mean test charges were $27 and $52 for the FT and ED, respectively (p < 0.01). Twenty-four percent of the FT patients vs 41% of the ED patients had tests performed (p < 0.01). Average length of stay was 28 minutes shorter in the FT (95% CI = 19 to 36, p < 0.01). Follow-up was completed for 480 of 755 families with telephones (64%). The FT and ED patients did not differ at follow-up: 90% vs 88% had improved conditions (p = 0.53), 18% vs 15% had received unscheduled follow-up care (p = 0.44), and 94% of the families in both groups were satisfied with the visit (p = 0.98). Conclusions: Compared with those in the main ED, the study patients seen in the FT had fewer tests ordered and had briefer lengths of stay. These findings were not explained by differences in patient ages, vital signs, or demographic characteristics. No difference in final outcomes or satisfaction was detected among the families contacted for follow-up. Key words: fast track; resource utilization; outcomes; urgent care. ACADEMIC EMERGENCY MEDICINE 1999; 6:1153-1159 M ANY URBAN pediatric EDs provide care for a large number of nonemergent, ambulatory patients, particularly during the winter season.1,2 Assessment and management of these children may strain resources and increase waiting times for all patients. In response, many EDs have established on-site alternative locations to facilitate care of these nonacute cases, thus increasing capacity in the general ED for more acute or complicated patients.3-5 These units are often staffed by experienced practitioners, who manage a large volume of patients rapidly.6 As such, they are commonly known as ''fast tracks'' (FTs) or ''urgent care'' units. Fast tracks have been shown to decrease waiting times, and are generally regarded as a more efficient alternative to the main ED for care of uncomplicated patients with low-acuity concerns. 7,8 What has not been well-studied, however, are the differences in care provided in these settings. Specifically, it is unclear whether such patients are investigated and managed differently than they would have been in the main ED, and more important, whether such differences affect patient outcomes.We undertook this study to determine whether the...

Operations research/management contributions to emergency department patient flow optimization: Review and research prospects

“…Given that about 80% of ED visits are non-urgent, the use of an ED fast track lane is a great aid in serving lower acuity patients and reducing Downloaded by [Stockholm University Library] at 05:34 12 August 2015 overcrowding (Williams, 2006). Fast track implementation has found success in numerous ED environments, such as in an urban pediatric ED (Simon et al, 1996;Hampers et al, 1999), or a teaching hospital (Meislin et al, 1988). Roche and Cochran (2007) apply a queueing methodology to eight EDs, implementing fast tracks with different patient acuity, volume, and anticipated LOS in an effort to minimize patients LWBS.…”

Emergency Department Overcrowding

“…In another study the median length of stay was 36 minutes for fasttracked patients compared with 63 minutes for the control group [63]. This has worked equally well in pediatric units [64]. A recent study [65] of a fast-track unit also demonstrated an improvement in length of stay from 127 to 53 minutes (P < 0.001).…”

What Do Health Savings Accounts Mean for the Emergency Department?

“…For example, fast track EDs and urgent care centers may locate offsite from the hospital and specialize in relatively quick turnaround of low-acuity patients. These centers have shown some ability to manage patients quicker than regular EDs, and with a lower cost, [19][20][21][22] although these results are not adjusted for patient severity. Furthermore, once introduced to the concept of urgent care, patients often realize that such sites can meet many of their needs, and they may make fewer visits to the ED.…”