Abstract
Purpose
We sought to determine whether the introduction of a separate patient flow comprising patients with simple, non-complex health issues [Fast Track (FT)] in a Dutch emergency department setting (ED), without the introduction of additional staff, and treated by a physician assistant, would have favourable effects on waiting and turnaround times without deleterious effects for patients with a higher urgency.
Study design
We used a prospective comparative intervention design for our study.
Methods
The waiting times and length of stay for surgical and orthopaedic patients in the ED were measured and compared 3 months before and 3 months after the introduction of FT.
Results
During the study period, 1,289 patients were treated before, and 1,393 after the introduction of FT. After the introduction of FT, we observed a decrease of 12 min (13 %) in the median length of stay for the total group. The median waiting time decreased by 41 min (69 %). The group comprising patients with low to moderate urgency levels showed a median reduction of 12 min in length of stay, whereas the length of stay for urgent patients was reduced by 19 min. The waiting time for the low to moderate urgency patients decreased by 68 min, while the urgent patient group showed a reduction of 32 min.
Conclusions
The introduction of FT performed by a physician assistant resulted in a significant drop in waiting time and length of stay in a Dutch ED setting. This reduction was realised without the allocation of additional staff and even reduced waiting and turnaround times for the patients with a high urgency.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Guo B, Harstall C. Strategies to reduce emergency department overcrowding. Alberta Heritage Foundation for medical research (AHFMR) 2006; report No 38.
Schneider MME, Simons SAP, Minkman MMN. Acute opnamen verbeteren. Het doorbraak project Spoedeisende Hulp in het UMC Utrecht. Medisch Contact. 2002;57(12):466–70.
Cooke MW, Fisher J, Dale J, McLeod E, Szcepura A, Wally P, Wilson S. Reducing attendances and waits in emergency departments. Report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R and D (NCCSDO); 2004.
Counselman FL, Schafermeyer RW, Garcia R, et al. A survey of academic departments of emergency medicine regarding operation and clinical practice. Ann Emerg Med. 2000;36:446–50.
Rodi, Scott W, Grau, Maria V, Orsini CM. Evaluation of fast track unit: alignment of resources and demand results in improved satisfaction and decreased length of stay in emergency department patients. Quality Management Health Care. 2006;15(3):163–70.
Sanches M, Smally AJ, Grant RJ, Jacobs LM. Effects of a fast track area on emergency department performance. J Emerg Med. 2006;31(1):117–20.
Counselman FL, Graffeo CA, Hill JT. Patient satisfaction with physician assistants (PAs) in an ED fast track. Am J Emerg. Med. 2000;18:661–5.
Doan Q, Sabhaney V, Kissoon N, Sheps S, Singer J. A systematic review: the role and impact of the physician assistant in the emergency department. Emerg. Med. Australas. 2011;23(1):7–15.
O’Brien D, Williams A, Blandell K, Jelinek A. Impact of streaming “fast track” emergency department patients. Aust. Health Rev. 2006;30(4):525–32.
Seddon N. Is the future Dutch? Lancet. 2008;372:103–4.
Schoen C, Osborn R, Doty MM, Bishop M. Towards higher-performance health systems: adults’ health care experiences in seven countries. Health Aff (Millwood). 2007;26(6):w717–34.
Cooke MW, Wilson S, Pearson S. The effect of a separate stream for minor injuries on accident and emergency department waiting times. Emerg. Med. J. 2002;19(1):28–30.
Fernandes CM, Christenson JM. Use of continuous quality improvement to facilitate patient flow through the triage and fast track areas of an emergency department. J Emerg Med. 1995;13(6):847–55.
Fernandes CM, Christenson JM, Price A. Continuous quality improvement reduces length of stay for fast track patients in an emergency department. Acad Emerg Med. 1996;3:258–63.
Larsson G, Holgers K-M. Fast-track care for patients with suspected hip fracture. Injury. 2011;42:1257–61.
Rajmohan B. Audit of the effect of a fast tracking protocol on transfer time from A & E to ward for patients with hip fractures. Injury. 2000;31:585–9.
Dinah AF. Reduction of waiting times in A & E following introduction of ‘fast-track’ scheme for elderly patients with hip fractures. Injury. 2003;34:839–41.
Conflict of interest
Ed Theunissen declares that he has no conflict of interest. Sacha Lardenoye declares that she has no conflict of interest. Pascal Hannemann declares that he has no conflict of interest. Kevin Gerritsen declares that he has no conflict of interest. Peter Brink declares that he has no conflict of interest. Martijn Poeze declares that he has no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Theunissen, B.H.J.J., Lardenoye, S., Hannemann, P.H. et al. Fast Track by physician assistants shortens waiting and turnaround times of trauma patients in an emergency department. Eur J Trauma Emerg Surg 40, 87–91 (2014). https://doi.org/10.1007/s00068-013-0324-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-013-0324-0