Fast track: Has it changed patient care in the emergency department?

Kwa, Paul; Blake, Denise

doi:10.1111/j.1742-6723.2007.01021.x

Cited by 47 publications

(30 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Given the overlap between triage and fast track efforts, we see research reporting improvements in performance metrics through the implementation of both, despite an increase in patient census (Sanchez et al, 2006;Kwa and Blake, 2008). Fast track benefit to LOS is ultimately aligned with a time-tested understanding in OR/OM of the benefits of processing time prioritization (Lawler and Moore, 1969;Davis and Patterson, 1975).…”

Section: Ed Fast Trackmentioning

confidence: 95%

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

Saghafian

Austin

Traub

2015

IIE Transactions on Healthcare Systems Engineering

122

View full text Add to dashboard Cite

In recent years, Operations Research/Management (OR/OM) has had a significant impact on improving the performance of hospital Emergency Departments (EDs). This includes improving a wide range of processes involving patient flow from the initial call to the ED through disposition, discharge home, or admission to the hospital. We review approximately 350 related papers to (i) demonstrate the influence of OR/OM in EDs, and (ii) assist both researchers and practitioners with the OR/OM techniques already available to optimize ED patient flow. In addition, we elaborate on some practical challenges yet to be addressed. By shedding light on some less studied aspects that can have significant impacts on ED operations, we also discuss important possibilities for future OR/OM researchers.

show abstract

Section: Ed Fast Trackmentioning

confidence: 95%

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

Saghafian

Austin

Traub

2015

IIE Transactions on Healthcare Systems Engineering

122

View full text Add to dashboard Cite

show abstract

“…Some ED target patients likely to go home5 22 and other ED use case complexity rather than probable disposition as a basis for fast track inclusion criteria9 Nevertheless, the intent is the same: fast track is aimed at the management of patients with apparent diagnoses who can be managed rapidly and do not require concentrated emergency nursing care 9…”

Section: Discussionmentioning

confidence: 99%

Effect of clinician designation on emergency department fast track performance

Considine

Kropman

Stergiou

2010

Emergency Medicine Journal

View full text Add to dashboard Cite

Objective To examine the effect of clinician designation on emergency department (ED) fast track performance. Design and Setting A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia. Participants Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n¼8714). Main Outcome Measures 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 (n¼6278) 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) (c 2 ¼498.539, df¼6, 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.Emergency department (ED) fast track systems have evolved to improve the management of patients with non-urgent complaints by decreasing waiting time, ED length of stay (LOS) and overcrowding, and increasing patient and staff satisfaction with ED care.1e6 A statewide survey of fast track services in Victorian ED showed most metropolitan and major rural ED in Victoria had a formal fast track system. 7 The majority of fast track systems in Victorian ED operated during hours that matched periods of peak demand and most ED offered a fast track service for 12e16 h per day. 7In order to optimise the function and capacity of ED fast track systems, a geographically dedicated area staffed by dedicated senior medical and nursing staff is recommended.1 4 8 It is proposed that dedicated senior medical and nursing staff optimise the performance of fast track systems as they have the ability to make timely treatment and disposition decisions with minimal consultation. 1 4 8 9 In addition, dedicated fast track staffing is thought to promote faster patient throughput by reducing handovers and fragmentation of ED care. 4 8Although 83.4% of Victorian ED roster specific staff to their fast track area, there is variation in the staffing profile of fast track systems across Victoria. 7 The majority of ED used a combination of medical and nursing staff; however, 86.7% of ED with dedicated fast track staffing allocated staff using a rotating roster. 7 The level of medical staff rostered to fast tracks systems was variable and ranged from emergency physicians to interns.7 In contrast, the majority of ED used senior nursing staff in their fast track areas a...

show abstract

“…[12] Implementation of a fast track system has allowed many hospitals to reduce wait times and length of stay for low acuity patients while maintaining quality care under the stress of an increasing number of annual patients and relatively static resources. [13][14][15][16] While the implementation of fast track systems have been shown to have positive effects in the ED, there is a large variation in how successful the implementation is depending upon operating conditions of pre-implementation. For example, in one study the hospital was already using an acuity level based triage system and once the fast track system was implemented it served 14.9% of ED entries and level 4 and 5 patients saw a decrease in wait time by 2 minutes, 24 to 22 minutes and 27 to 25 minuutes respectively; [16] in another study the hospital was not using an acuity level based triage system and the overall patient wait time was decreased by 50%, from 102 to 51 minutes.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16] While the implementation of fast track systems have been shown to have positive effects in the ED, there is a large variation in how successful the implementation is depending upon operating conditions of pre-implementation. For example, in one study the hospital was already using an acuity level based triage system and once the fast track system was implemented it served 14.9% of ED entries and level 4 and 5 patients saw a decrease in wait time by 2 minutes, 24 to 22 minutes and 27 to 25 minuutes respectively; [16] in another study the hospital was not using an acuity level based triage system and the overall patient wait time was decreased by 50%, from 102 to 51 minutes. [14] However, not all patients are reaping the benefits of these new programs; level 3 patients account for the largest patient group and experience the longest average stays in the ED.…”

Section: Introductionmentioning

confidence: 99%

Treatment allocation for the potential urgent patients in hospital emergency department to reduce length of stay – a simulation approach

Huang

2015

IJH

View full text Add to dashboard Cite

Extended waiting in the emergency room continues to be a recognized problem; to alleviate this many hospitals have adopted triage systems which classify patients based on their priority level and fast track processes for low acuity patients. This paper aims to reduce the length of stay in Emergency Department (ED) by allocating urgent patients in either the traditional treatment or the fast track route without compromising care for higher acuity patients. This study focuses on the five-priority level system and evaluates the concept using simulation and classification techniques. Literature has reported that priority three patients, whose conditions are initially not life threatening but may progress to a critical level, are the majority and normally encounter the longest wait. The simulation was built based on a difined ED patient flow considering factors such as patient arrival patterns, treatment times, and resource capacity. Analysis of Variance was conducted to determine the impact of each factor to the decision on level 3 patient allocation. A regression model was constructed to estimate the cycle time savings. Decision tree was used to further provide ED a general guideline on the allocation of level 3 patients. The study concludes that the fast track route as an option for level 3 patients is adequate if the fast track has higher or similar capacity as the traditional treatment route especially for the rural EDs where level 3 patients are identified 61% of time and required longer treatment. The patient cycle time saving estimated as much as three hours.

show abstract

Fast track: Has it changed patient care in the emergency department?

Abstract: Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower-acuity patients to be seen quickly without a negative impact on high-acuity patients.

Cited by 47 publications

References 14 publications

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

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

Effect of clinician designation on emergency department fast track performance

Treatment allocation for the potential urgent patients in hospital emergency department to reduce length of stay – a simulation approach

Contact Info

Product

Resources

About