Effects of a fast-track area on emergency department performance

To determine if a fast-track area (FTA) would improve Emergency Department (ED) performance, a historical cohort study was performed in the ED of a tertiary care adult hospital in the United States. Two 1-year consecutive periods, pre fast track area (FTA) opening—from February 1, 2001 to January 31, 2002 and after FTA opening—from February 1, 2002 to January 31, 2003 were studied. Daily values of the following variables were obtained from the ED patient tracking system: 1) To assess ED effectiveness: waiting time to be seen (WT), length of stay (LOS); 2) To assess ED care quality: rate of patients left without being seen (LWBS), mortality, and revisits; 3) To assess determinants of patient homogeneity between periods: daily census, age, acuity index, admission rate and emergent patient rate. For comparisons, the Wilcoxon test and the Student’s t-test were used to analyze the data.Results showed that despite an increase in the daily census (difference [diff] 8.71, 95% confidence interval [CI] 6 to 11.41), FTA was associated with a decrease in WT (diff −51 min, 95% CI [−56 to −46]), LOS (diff −28 min, 95% CI [−31 to −23]) and LWBS (diff −4.06, 95% CI [−4.48 to −3.46]), without change in the rates of mortality or revisits.In conclusion, the opening of a FTA improved ED effectiveness, measured by decreased WT and LOS, without deterioration in the quality of care provided, measured by rates of mortality and revisits.