Fast track: Has it changed patient care in the emergency department?

Objective: To determine whether the introduction of a designated fast-track area altered the time to care and patient flow in an Australian mixed adult and paediatric ED. Methods: Retrospective cohort study of all patients presenting to the ED between 08.00 and 22.00 hours, during a 6 month period before and after the opening of a fast-track area. Data were stratified according to Australasian Triage Scale (ATS) category, and comparisons were made for performance indicators, waiting time, length of stay and did-not-waits. Results: During its operational hours, fast track managed 14.9% of all patients presenting to the ED. There was a significant increase in the proportion of all ATS 4 patients seen within their target times (77.8% to 79.9%, P < 0.001). There was a trend towards improved performance in ATS categories 2, 3 and 5. Median patient waiting times were significantly decreased in ATS 4 (24 to 22 min, P < 0.001) and ATS 5 (27 to 25 min, P < 0.05), but increased in ATS 2 (3 to 4 min, P < 0.05). No deterioration in performance or waiting time for ATS I was shown. There was a decreasing trend in the proportion of patients who did not wait to be assessed by a doctor in ATS categories 4 and 5. These improvements occurred despite a 12% increase in patient attendances and no change in medical staffing levels. Conclusions: Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower-acuity patients to be seen quickly without a negative impact on high-acuity patients.