Research
Evaluation of the Fast Track Unit of a University Emergency Department

https://doi.org/10.1016/j.jen.2006.08.003Get rights and content

Introduction

The purpose of this study was to evaluate the efficacy of the newly developed fast track (FT) area in a University-affiliated emergency department. The goals of the FT unit included reducing patients' length of stay, improving patients' satisfaction, and decreasing ED overcrowding.

Methods

An exploratory descriptive design used to investigate length of stay in the emergency department, the rate of patients who left without being seen, unscheduled return visits to the emergency department within 72 hours of being seen, and patient satisfaction.

Results

During the evaluation period, 5995 patients were seen in the ED fast track area. The average time patients spent in the emergency department was 4.36 hours. The average time in room for the FT area was 1.97 hours. The left-without-being-seen rate for this time period for the main emergency department was 7%; the rate for the FT area was 4%. Additionally, 100% of respondents who completed a patient satisfaction survey in the FT area rated the care received by the nurse practitioner (NP) as good or excellent.

Conclusions

Although the average time in room and overall length of stay did not meet expectations, patients did move more quickly through the department after the addition of the FT unit. Patient satisfaction data suggested that the FT staffed by NPs is a welcome addition to the emergency department. The findings provide direction for the future study of NP utilization in the emergency department.

Section snippets

FT areas, patient flow, and throughput times

Evidence exists that FT areas are a positive addition to busy emergency departments. Studies have shown significant decreases in wait times in the emergency department after the initiation of an NP-run FT area.2 Others have examined wait time in relation to presenting complaint and found that many of the ED patients had minor, nonemergent, or self-limiting problems that ideally would be suited for an FT setting. FT areas have been shown to increase ED flow, decrease wait time, and use resources

Protection of human subjects

Prior to data collection, Institutional Review Board approval was obtained. In an effort to protect the confidentiality of participants, identifying information was removed prior to aggregating medical record data for this study. Additionally, the satisfaction surveys were anonymous and data are reported in the aggregate. Because this study involved review of charts retrospectively, informed consent was not obtained from individual participants, with the exception of those who filled out

Demographic data

A total of 5995 patients were seen in the ED FT area from September 1, 2004, through February 28, 2005, and there were 9130 patient visits to the MC area from September 1, 2003, through February 28, 2004. The population of these patients included roughly equivalent numbers of females and males. The majority of the patients was classified as self-pay or had no insurance (67%). The ethnic distribution of the sample was diverse. Complete demographic data for the patient visits to the FT and MC

Discussion

We expected our turnaround times to improve dramatically with the opening of the FT unit, and this was not the case. This may have happened for many reasons. In the past, the emergency department has not met our benchmarking time goals; expecting one change in process to immediately change years of practice may not have been realistic. Also, all but one of the NPs in the unit were new hires and did not have previous ED experience. The new NPs may have needed time to adjust to the FT setting and

Limitations

This study is limited because it was conducted in the first 3 months the FT unit was open. Taking a snapshot of the FT gives a limited view point. Several process issues were being worked out that probably influenced the time in department and TIR numbers, adversely skewing the data. Follow-up study is needed to determine the current impact of the FT area in the emergency department. Collecting data over time would give a fuller, more descriptive picture of the department. Also, comparing the

Conclusions

The purpose of this study was to determine the effectiveness and efficiency of a newly developed NP-staffed FT unit and to compare time data for the FT unit with the previously run MC area. The LOS data suggests the efficiency of the FT unit has room for improvement. However, the unit is effectively run in that the LWBS rate is low, the unscheduled return visits are kept to a minimum, and patients are highly satisfied with the care they receive. It will be helpful to collect data on an ongoing

Kathleen Nash is Assistant Professor, University of Texas Medical Branch School of Nursing, Galveston.

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Kathleen Nash is Assistant Professor, University of Texas Medical Branch School of Nursing, Galveston.

Brian Zachariah is Medical Director, University of Texas Medical Branch School of Nursing, Galveston.

Jennifer Nitschmann, Gulf Coast Chapter, is Administrative Director, University of Texas Medical Branch School of Nursing, Galveston.

Benjamin Psencik is FNP Student, University of Texas Medical Branch, Galveston.

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