How does fast track affect quality of care in the emergency department?

Darrab, A. Al; Fan, Jerome; Fernandes, Christopher M.B.; Zimmerman, Rosanne; Smith, Rhonda L.; Worster, Andrew; Smith, Tammy; O'Connor, Kelly

doi:10.1097/00063110-200602000-00008

Cited by 55 publications

(39 citation statements)

References 11 publications

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“…This is consistent with the lean thinking theory, which suggests it is inherently more efficient to serve batches of quick customers to reduce crowding. 5,6 We did not find a decrease in number of patients LWBS after the intervention, a finding in contrast to other studies, 1,[7][8][9][10][11]16 even in subgroup analysis where the WT decrease was most dramatic. Thus an important question remains: does a decrease in WT of between six and 13 minutes result in a change in crowding that patients notice or deem to be significant?…”

Section: Discussioncontrasting

confidence: 99%

“…[8][9][10] However, our study results suggests two important features that previous work has not investigated: 1) increased throughput can be accomplished even in a single physician ED; and 2) increased throughput can be accomplished even when no additional staff are added in the restructuring process. The FT restructuring at our study location involved little change in resources and no additional physical space, but rather simply a change in patient and staff flow.…”

Section: Discussionmentioning

confidence: 61%

“…Previous studies have suggested that improvement in LWBS is related to patient satisfaction. 1,10,16,17 It is possible that our study failed to show a clinically significant change for this metric due to an already low proportion of patients that LWBS at our hospital before the intervention (<5%). In addition, LWBS may not be the only indicator of patient satisfaction; two prior studies have indicated that the most important factor determining satisfaction is decreasing WT.…”

Section: Discussionmentioning

confidence: 84%

“…4,[7][8][9] There is also evidence indicating that FTs do not negatively impact higher-acuity patients. [10][11][12][13] However, there have been few studies to evaluate FTs in Canadian settings. Moreover, many FT studies are potentially confounded by simultaneous increases in either total physician and nursing hours or ED beds.…”

Section: Introductionmentioning

confidence: 99%

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

Copeland

Gray

2015

CJEM

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Objectives: Fast tracks are one approach to reduce emergency department (ED) crowding. No studies have assessed the use of fast tracks in smaller hospitals with single physician coverage. Our study objective was to determine if implementation of an ED fast track in a single physician coverage setting would improve wait times for low-acuity patients without negatively impacting those of higher acuity. Methods: A daytime fast track opened in 2010 at Strathroy Middlesex General Hospital, a southwestern Ontario community hospital. Before and after intervention groups comprised of ED visits in 2009 and 2011 were compared. Pooled comparison of all Canadian Triage and Acuity Scale (CTAS) patients in each period, and between subgroups CTAS 2-5 comparisons were performed for: wait time (WT), length of stay (LOS), WTs that met national CTAS time guidelines (MNCTG), and proportion of patients that left without being seen (LWBS). Results: WT and LOS were six minutes (88 min to 82 min, p = 0.002) and 15 minutes (158 min to 143 min, p < 0.001) lower, respectively, in the post-intervention period. Subgroup analysis showed CTAS 4 had the most pre-to postintervention decrease in WT, of 13 minutes (98 min to 85 min, p < 0.001). There was statistical improvement in MNCTG in the post-intervention period. No differences were found in outcome measures for higher-acuity patients or LWBS rates. Conclusions: Implementation of a fast track in a mediumvolume community hospital with single physician coverage can improve patient throughput by decreasing WT and LOS without negatively impacting high-acuity patients. This may be clinically relevant, particularly for hospital administrators, given the improvement in meeting national WT standards we found post-intervention. RÉSUMÉObjectif: Le traitement accéléré des patients est un moyen de réduire l'encombrement des services des urgences (SU). Toutefois, aucune étude n'a porté sur le traitement accéléré des patients dans les petits hôpitaux où un seul médecin est de garde. L'étude visait à déterminer si la mise en oeuvre du traitement accéléré des patients dans un SU où un seul médecin est de garde diminuerait les délais d'attente pour les patients souffrant de troubles peu graves, sans toutefois se répercuter défavorablement sur les patients se trouvant dans un état grave. Méthode: Un processus de traitement accéléré des patients a été mis en oeuvre, le jour, en 2010, au Strathroy Middlesex General Hospital, un hôpital communautaire situé dans le sud-ouest de l'Ontario. Il y a eu comparaison des groupes de patients qui ont consulté au SU, en 2009 et en 2011, soit avant et après la mise en oeuvre du traitement accéléré. Les auteurs ont procédé à des comparaisons globales de tous les patients, selon l'Échelle canadienne de triage et de gravité (ECTG) pour chaque période, ainsi qu'à des comparaisons partielles entre des sous-groupes de patients du 2 e au 5 e degré de priorité selon l'ECTG, en ce qui concerne les délais d'attente (DA), la durée de séjour (DS), le respect des lignes directr...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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

Copeland

Gray

2015

CJEM

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“…[16][17][18][19][20] Such a process focuses on CTAS 4 and 5 patients, who otherwise are a very low priority and sometimes even overlooked. The LWBS proportion is primarily a measure of efficiency in the care of CTAS 4 and 5 patients.…”

Section: Discussionmentioning

confidence: 99%

The impact of computerized provider order entry on emergency department flow

Gray

Fernandes

Aarsen

et al. 2016

CJEM

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Objectives: Computerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS). Methods: We conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1-5) individually, as well as for admitted patients only. Results: A significant increase in WT of 5 minutes (p = 0.036) and LOS of 10 minutes (p = 0.001), and an increase in LWBS from 7.2% to 8.1% (p = 0.002) was seen after CPOE implementation. Admitted patients' LOS increased by 63 minutes (p < 0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p = 0.001) and 39 minutes (p = 0.005), and LWBS proportion increased significantly for CTAS 3-5 patients, from 24.3% to 42.0% (p < 0.001) for CTAS 5 patients specifically. Conclusions: CPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits. RÉSUMÉObjectif: Un système informatisé d'entrée des prescriptions (SIEP) par des professionnels autorisés a été mis sur pied afin d'améliorer la sécurité des patients en évitant les erreurs de médicaments; toutefois, on ne connaît pas l'incidence du système sur le roulement des patients au service des urgences (SU). Aussi les auteurs ont-ils examiné l'incidence de la mise sur pied du SIEP sur trois indicateurs de performance des SU, soit le délai d'attente (DA), la durée de séjour (DS) et la proportion de patients qui sont partis sans avoir vu de médecin. Méthode: Une étude rétrospective de cohorte a été menée parmi tous les patients de 18 ans et plus qui ont consulté au SU du London Health Sciences Centre, en juillet et en août de 2013 et de 2014, soit avant et après la mise sur pied du SIEP. Ont fait l'objet de comparaison les trois principales variables relevées durant les deux périodes indiquées. Des analyses de sous-groupes ont aussi été faites pour chacun des niveaux (1 à 5) de l'Échelle canadienne de triage et de gravité (ECTG), séparément ainsi que pour le seul groupe de malades hospitalisés. Résultats: Une augmentation importante du DA de 5 minutes (p = 0,036) et de la DS de 10 minutes (p = 0,001) ainsi qu'une augmentation de la proportion de patients partis sans avoir vu de médecin, qui est passée 7,2% à 8,1% (p = 0,002), ont été observées après la m...

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The Management of an emergency department: How to face the challenge of overcrowding?

Beltramini

Debuc

Pateron

2014

Ann. Fr. Med. Urgence

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How does fast track affect quality of care in the emergency department?

Abstract: A dedicated fast track for CTAS 4/5 patients can reduce the length of stay and the left-without-being-seen rate with no impact on CTAS 3 patients seen in the main emergency department.

Cited by 55 publications

References 11 publications

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

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

The impact of computerized provider order entry on emergency department flow

The Management of an emergency department: How to face the challenge of overcrowding?

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