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

Area of Science:

• Emergency Medicine
• Healthcare Management
• Health Services Research

Background:

• Emergency department (ED) crowding is a significant healthcare challenge.
• Fast tracks are a strategy to improve ED patient flow.
• Limited research exists on fast track effectiveness in small hospitals with single physician coverage.

Purpose of the Study:

• To evaluate the impact of implementing a fast track in a single-physician coverage ED.
• To assess changes in wait times (WT) and length of stay (LOS) for low-acuity patients.
• To determine if fast track implementation affects high-acuity patient care or patients leaving without being seen (LWBS).

Main Methods:

• A daytime fast track was implemented in a community hospital ED in 2010.
• Pre-intervention (2009) and post-intervention (2011) ED visit data were compared.
• Analysis included Canadian Triage and Acuity Scale (CTAS) patients, comparing WT, LOS, meeting national guidelines (MNCTG), and LWBS rates.

Main Results:

• Wait times decreased by 6 minutes (88 to 82 min) and length of stay by 15 minutes (158 to 143 min) post-intervention.
• CTAS 4 patients experienced the largest WT reduction (13 min).
• Statistically significant improvement in meeting national CTAS time guidelines was observed; no impact on high-acuity patients or LWBS rates.

Conclusions:

• Fast track implementation in a community hospital ED with single physician coverage improves patient throughput.
• Decreased WT and LOS were achieved without negatively affecting high-acuity patient outcomes.
• This strategy is clinically relevant for hospital administrators aiming to meet national WT standards.