The impact of a fast track area on quality and effectiveness outcomes: A Middle Eastern emergency department perspective

被引：17
作者：
Devkaran S. [1 ]
Parsons H. [2 ,5 ]
Van Dyke M. [3 ]
Drennan J. [4 ]
Rajah J. [2 ,5 ]
机构：
[1] Royal College of Surgeons in Ireland, Dubai Healthcare City, Dubai
[2] Institute of Pediatrics, Sheikh Khalifa Medical City
[3] Institute of Emergency Medicine, Sheikh Khalifa Medical City
[4] Midwifery and Health Systems, University College Dublin, Belfield
[5] Institute of Pediatrics, Sheikh Khalifa Medical City
来源：
BMC Emergency Medicine | / 9卷 / 1期
关键词：
Emergency Department; United Arab Emirate; Triage Category; Urgent Patient; Emergency Department Overcrowding;
D O I：
10.1186/1471-227X-9-11
中图分类号：
学科分类号：
摘要：
Background: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED. Methods: The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (n = 4,779) versus a post-intervention study group (January 2006) (n = 5,706). Results: Mean WTs of Canadian Triage Acuity Scale (CTAS) 4 patients decreased by 22 min (95% CI 21 min to 24 min, P < 0.001). Similarly, mean WTs of CTAS 5 patients decreased by 28 min (95% CI 19 min to 37 min, P < 0.001) post FTA. The mean WTs of urgent patients (CTAS 2/3) were also significantly reduced after the FTA was opened (P < 0.001). The LWBS rate was reduced from 4.7% to 0.7% (95% CI 3.37 to 4.64; P < 0.001). Opening a FTA had no significant impact on mortality rates (P = 0.88). Conclusion: The FTA improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates) whereas mortality rate remained unchanged. © 2009 Devkaran et al; licensee BioMed Central Ltd.
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  • [1] Derlet R., Richards J., Overcrowding in the nation's emergency departments: Complex causes and disturbing effects, Ann Emerg Med, 35, pp. 83-85, (2000)
  • [2] Lambe S., Washington D.L., Fink A., Waiting times in California's emergency departments, Ann Emerg Med, 41, pp. 35-44, (2003)
  • [3] Shull M.J., Slaughter P.M., Redelmeier D.A., Urban emergency department overcrowding: Defining the problem and eliminating misconceptions, Can J Emerg Med, 4, pp. 76-83, (2002)
  • [4] Drummond A.J., No room at the inn: Overcrowding in Ontario's emergency departments, Can J Emerg Med, 4, pp. 91-97, (2002)
  • [5] Shih F.Y., Huel-Ming M., Chen S., Wang H., Fang C., Shyu R., Huang G., Wang C., ED overcrowding in Taiwan: Facts and strategies, Am J Emerg Med, 17, pp. 198-202, (1999)
  • [6] Fry M., Thompson J., Chan A., Patients regularly leave emergency departments before medical assessment: A study of did not wait patients, medical profile and outcome characteristics, Aust Emerg Nurs J, 6, pp. 21-26, (2005)
  • [7] Cooke M.W., Wilson S., Pearson S., The effect of a separate stream for minor injuries and illnesses on accident and emergency waiting times, EMJ, 19, pp. 28-30, (2002)
  • [8] Trzeciak S., Rivers E.P., Emergency department overcrowding in the United States: An emerging threat to patient safety and public health, EMJ, 20, pp. 402-405, (2006)
  • [9] Browne G.J., McCaskill M.E., Giles H., Lam L.T., Fasher B.J., Exley B., Pediatric walk-out patients: Characteristics and outcomes, J Pediatr Child Health, 37, pp. 239-253, (2001)
  • [10] Boudreaux E.D., Ary R.D., Mandry C.V., Determinants of patient satisfaction in a large municipal ED: The role of demographic variables, visit characteristics, and patient perceptions, Am J Emerg Med, 18, pp. 394-400, (2000)
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