Impact of streaming "fast track" emergency department patients

OBJECTIVE: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. METHODS: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area. RESULTS: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (-18 min; 95%CI, -26 min to -10 min) relative reduction in the average waiting time and an 18.0% (-41 min; 95%CI, -52 min to -30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (-2.1 min; 95%CI, -8 min to 4 min) relative reduction in the average waiting time and a 9.7% (-20 min; 95%CI, -31 min to -9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period. CONCLUSION: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.