Fast-track and primary care in the emergency department: managing more, but not decongesting

In recent years, emergency departments (EDs) have been facing increasing overcrowding, largely driven by a rise in non-urgent visits. To alleviate this pressure, many healthcare systems have introduced alternative care pathways, such as fast-track services and integrated primary care clinics, designed to optimize the management of low-acuity patients. However, the effectiveness of these pathways on ED workload remains debated. We conducted a retrospective observational study at the ED of Bolzano General Hospital between November 2022 and December 2024. Non-urgent patients (triaged as blue or green) were classified into three categories: those treated via fast-track services, primary care clinics, or within the ED itself. Monthly trends were analyzed using linear and Poisson regression models. Over the study period, 209,904 ED visits were recorded, with 80% classified as non-urgent. Utilization of alternative pathways increased over time (fast-track: + 13.6/month; primary care: + 22.3/month), as did the number of non-urgent cases managed within the ED (+ 26.4/month). Poisson regressions analyses revealed statistically significant upward trends across all groups. The implementation of alternative care pathways did not alleviate the overall ED workload but was associated with a general increase in non-urgent visits. These findings underscore the need for a coordinated healthcare strategy that simultaneously enhances ED capacity and reinforces community-based care to more sustainably manage demand.