Effect of a Emergency Department Fast Track Service on Quality of Care Indicators

Friday, 11 July 2008: 8:30 AM
Julie Considine, RN, BN, GDipNurs, MNurs, PhD, FNRCA , School of Nursing / Emergency Department, Deakin University / Northern Health, Burwood, VIC, Australia
Matthew Kropman , Emergency Department, The Northern Hospital, Northern Health, Epping VIC, Australia
Erin Kelly, RN, BN, GradCertEmergNurs , Emergency Department, The Northern Hospital, Northern Health, Epping VIC, Australia
Craig Winter, MB, MS, FACEM, GMQ, MBA , Emergency Department, The Northern Hospital, Northern Health, Epping VIC, Australia

Learning Objective 1: describe the aim and structure of Emergency Department fast track systems

Learning Objective 2: understand the effect of Emergency Department fast-track systems on quality of care indicators

Background: Emergency Department (ED) fast-track systems aim to decrease waiting times and ED length of stay, reduce ED overcrowding, and increasing patient and staff satisfaction. Fast track systems are designed to improve ED capacity in times of peak demand and are usually staffed by senior medical and nursing personnel who are able to make timely discharge decisions.

Aim: The aim of this study was to examine the effect of ED fast-track on quality of care indicators for patients with distal wrist fractures: waiting time, ED length of stay, and frequency and timing of x-ray and analgesia.

Methods: A pair-matched case-control design was used. The study intervention was ED fast-track that was implemented in November 2006. Cases were patients treated via ED fast-track and controls were patients managed via usual ED processes prior to establishment of the fast-track system. Cases were matched to controls according to age, gender, triage category and ED discharge diagnosis. Wrist fracture was the most common ED discharge diagnosis among fast-track patients and results from a subset of 133 case matched pairs with wrist fracture are presented in this paper. Data were collected using the ED Information System and medical record audit.

Results: The distribution of Australasian Triage Scale categories was: Category 3 = 1%, Category 4 = 55% and ATS Category 5 = 44%. Cases had a higher incidence of analgesia administration: (63% versus 36%, p = 0.03) however there was no significant between-group difference in median time to analgesia. Median time to x-ray was 136 minutes for cases and 100 minutes for controls (P=0.01)

Conclusion: Fast-track decreased ED length of stay for non admitted patients and may improve quality of emergency care for specific patient groups.

This study was generously funded by a Northern Health Small Research Grant