scholarly journals Impact of streaming "fast track" emergency department patients

2006 ◽  
Vol 30 (4) ◽  
pp. 525 ◽  
Author(s):  
Debra O'Brien ◽  
Aled Williams ◽  
Kerrianne Blondell ◽  
George A Jelinek
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Waiting Time ◽  
Fast Track ◽  
Average Length ◽  
Waiting Times ◽  
Relative Reduction ◽  
Average Waiting Time ◽  
Discharged Patients ◽  
Track Area

Objective: Fast track systems to stream emergency department (ED) patients with low acuity conditions have been introduced widely, resulting in reduced waiting times and lengths of stay for these patients. We aimed to prospectively assess the impact on patient flows of a fast track system implemented in the emergency department of an Australian tertiary adult teaching hospital which deals with relatively few low acuity patients. Methods: During the 12-week trial period, patients in Australasian Triage Scale (ATS) categories 3, 4 and 5 who were likely to be discharged were identified at triage and assessed and treated in a separate fast track area by ED medical and nursing staff rostered to work exclusively in the area. Results: The fast track area managed 21.6% of all patients presenting during its hours of operation. There was a 20.3% (?18 min; 95%CI, ?26 min to ?10 min) relative reduction in the average waiting time and an 18.0% (?41 min; 95%CI, ?52 min to ?30 min) relative reduction in the average length of stay for all discharged patients compared with the same period the previous year. Compared with the 12-week period before the fast track trial, there was a 3.4% (?2.1 min; 95%CI, ?8 min to 4 min) relative reduction in the average waiting time and a 9.7% (?20 min; 95%CI, ?31 min to ?9 min) relative reduction in the average length of stay for all discharged patients. There was no increase in the average waiting time for admitted patients. This was despite major increases in throughput and access block in the study period. Conclusion: Streaming fast track patients in the emergency department of an Australian tertiary adult teaching hospital can reduce waiting times and length of stay for discharged patients without increasing waiting times for admitted patients, even in an ED with few low acuity patients.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Measuring and Analyzing Waiting Time Indicators of Patients’ Admitted in Emergency Department: A Case Study

2015 ◽  
Vol 8 (1) ◽  
pp. 143 ◽  
Author(s):  
Saeed Amina ◽  
Ahmad Barrati ◽  
Jamil Sadeghifar ◽  
Marzeyh Sharifi ◽  
Zahra Toulideh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Waiting Time ◽  
Waiting Times ◽  
Hospital Data ◽  
Governance System ◽  
Cross Sectional ◽  
Average Waiting Time ◽  
Study Population

<p><strong>BACKGROUND</strong><strong> </strong><strong>&amp;</strong><strong> </strong><strong>AIMS:</strong> Measuring and analyzing of provided services times in Emergency Department is the way to improves quality of hospital services. The present study was conducted with aim measuring and analyzing patients waiting time indicators in Emergency Department in a general hospital in Iran.</p> <p><strong>MATERIAL</strong><strong> </strong><strong>&amp;</strong><strong> </strong><strong>METHODS:</strong> This cross-sectional, observational study was conducted during April to September 2012. The study population consisted of 72 patients admitted to the Emergency Department at Baharlo hospital. Data collection was carried out by workflow forms. Data were analyzed by t.<strong> </strong>test and ANOVA.</p> <p><strong>RESULTS:</strong> The average waiting time for patients from admission to enter the triage 5 minutes, the average time from triage to physician visit 6 minute and the average time between examinations to leave ED was estimated 180 minutes. The total waiting time in the emergency department was estimated at about 210 minutes. The significant<strong> </strong>correlation between marital status of patients (P=0.03), way of arrive to ED (P=0.02) and type of shift work (P=0.01) with studied time indicators were observed.</p> <p><strong>CONCLUSION:</strong> According to results and comparing with similar studies, the average waiting time of patients admitted to the studied hospital is appropriate. Factors such as: Utilizing clinical governance system and attendance of resident Emergency Medicine Specialist have performed an important role in reducing of waiting times in ED.</p>

scholarly journals Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions

2014 ◽  
Vol 52 (195) ◽  
pp. 878-885 ◽  
Author(s):  
Oya Durmus Cakir ◽  
Sebnem Eren Cevik ◽  
Mehtap Bulut ◽  
Ozlem Guneyses ◽  
Sule Akkose Aydin
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Average Length ◽  
Waiting Times ◽  
Pediatric Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Factors Affecting ◽  
Average Length Of Stay ◽  
Bed Capacity

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.  Keywords: bed capacity; crowding; emergency department; length of stay.  

scholarly journals Biased and unbiased estimation of the average length of stay in intensive care units in the Covid-19 pandemic

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nathanael Lapidus ◽  
Xianlong Zhou ◽  
Fabrice Carrat ◽  
Bruno Riou ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Parametric Method ◽  
Estimation Methods ◽  
Unbiased Estimation ◽  
Bed Occupancy ◽  
Average Length Of Stay ◽  
Discharged Patients ◽  
First Admission

Abstract Background The average length of stay (LOS) in the intensive care unit (ICU_ALOS) is a helpful parameter summarizing critical bed occupancy. During the outbreak of a novel virus, estimating early a reliable ICU_ALOS estimate of infected patients is critical to accurately parameterize models examining mitigation and preparedness scenarios. Methods Two estimation methods of ICU_ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). Methods were compared on a series of all COVID-19 consecutive cases (n = 59) admitted in an ICU devoted to such patients. At the last follow-up date, 99 days after the first admission, all patients but one had been discharged. A simulation study investigated the generalizability of the methods' patterns. CPE and DPE estimates were also compared to COVID-19 estimates reported to date. Results LOS ≥ 30 days concerned 14 out of the 59 patients (24%), including 8 of the 21 deaths observed. Two months after the first admission, 38 (64%) patients had been discharged, with corresponding DPE and CPE estimates of ICU_ALOS (95% CI) at 13.0 days (10.4–15.6) and 23.1 days (18.1–29.7), respectively. Series' true ICU_ALOS was greater than 21 days, well above reported estimates to date. Conclusions Discharges of short stays are more likely observed earlier during the course of an outbreak. Cautious unbiased ICU_ALOS estimates suggest parameterizing a higher burden of ICU bed occupancy than that adopted to date in COVID-19 forecasting models. Funding Support by the National Natural Science Foundation of China (81900097 to Dr. Zhou) and the Emergency Response Project of Hubei Science and Technology Department (2020FCA023 to Pr. Zhao).

scholarly journals EP.WE.727Upper GI Surgery Clinic Referrals; Can We Improve the Patient Experience?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Abouelazayem ◽  
Raluca Belchita
Keyword(s):  
Patient Experience ◽  
Waiting Time ◽  
Waiting Times ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Post Discharge ◽  
Average Waiting Time ◽  
Upper Gi

Abstract Aim To review the new referrals to the Upper GI surgery clinic for appropriateness, investigations requested, and waiting times and to identify potential pathways to reduce waiting times and improve the patient experience. Method Patients who attended the UGI clinic over 2 months period were identified. Data were collected from GP referrals and Electronic Patient Records. Follow up, post-discharge appointments, and Did Not Attends were excluded. Data collected included time from referral to first clinic, symptoms, investigations requested, suitability for a pathway, and appropriateness of referral. A first clinic outcome was concluded from reading the GP referral, there were 5 outcomes to choose from; direct to another specialty, discharge back to GP, clinic, surgery, pre-investigate and clinic. Results 147 referrals were analysed. The average waiting time from referral to the first clinic was 51 days (range 7-119 days). 73% of the referrals were GP referrals and 27% from other specialties. The most common referral was for gallstones and the most common 2 outcomes were Pre-investigate and surgery. Conclusion Most of the investigations and outcomes suggested from the project were the same as those from clinic letters. The following pathways can be developed to cut waiting times and costs for the trust:

scholarly journals Diversity for diversity: A “fast track” nursing service model to complement conventional emergency medicine service in a busy urban area emergency department

2020 ◽  
pp. 102490792093170
Author(s):  
Ng Hing Yin ◽  
Fan Kin Ping ◽  
Lo Chor Man
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Fast Track ◽  
Waiting Times ◽  
Clinical Protocols ◽  
Service Model ◽  
Nursing Service ◽  
Life Threatening ◽  
Emergency Department Patients ◽  
High Level

Background: In a busy local emergency department, patients with certain non-life-threatening conditions which only require relatively quick and straightforward management may encounter long waiting times. A new service model called the “Fast Track” Nursing Service attempts to lessen the service load of the regular service queues and to improve patient outcomes. Objectives: This article reports the service outcomes of the Fast Track Nursing Service. Methods: Nurses at our department are selected and trained under clinical protocols specially developed for this service. Assessments and quality assurance audits ensure the quality of service. Results: This service resulted in comparatively shorter waiting times for patients included in predetermined clinical protocols. There was also a high level of patient satisfaction with this service. Conclusion: Our Fast Track Enhanced Nursing service is a model of tailored service diversification to shorten waiting times, thus improving patient satisfaction and outcome.

scholarly journals Specialized fast track: a sustainable model to improve emergency department patient flow

2015 ◽  
Vol 4 (5) ◽  
pp. 40
Author(s):  
Emilpaolo Manno ◽  
Marco Pesce ◽  
Umberto Stralla ◽  
Federico Festa ◽  
Silvio Geninatti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Fast Track ◽  
Patient Flow ◽  
Wait Time ◽  
Emergency Department Patient ◽  
Care Needs ◽  
Time Length ◽  
Hospital Units ◽  
Ed Visits

Objective: Emergency department (ED) overcrowding is a hospital-wide problem that demands a whole-hospital solution. We developed and implemented a fast track model for streaming ED patients with low-acuity illness or injury to specialized care areas (gynecology-obstetrics, orthopedics-trauma, pediatrics, and primary care) staffed by existing specialist resources with access to general ED services. The study aim was to determine whether streaming of ED visits into specialized fast track areas increased operational efficiency and improved patient flow in a mixed adult and pediatric ED without incurring extra costs.Methods: We retrospectively reviewed the ED discharge records of patients who were mainstreamed or fast tracked during the 3-year period from 1 January 2010 through 31 December 2012. ED visits were identified according to a five-level triage scheme; performance indicators were compared for: wait time, length of stay, leave before being seen and revisit rates.Results: A reduction in wait time, length of stay, and leave before being seen rate was seen with fast track streaming (p < .01). These improvements were achieved without additional medical and nurse staffing.Conclusions: Specialized fast track streaming helped us meet patients’ care needs and contain costs. Lower-acuity patients were seen quickly by a specialist and safely discharged or admitted to the hospital without diverting resources from patients with high-acuity illness or injury. Involvement of all stakeholders in seeking a sustainable solution to ED crowding as a hospital-wide problem was key to enhancing cooperation between the ED and the hospital units.

Improving service in an emergency department by designing the health production flow

2019 ◽  
Vol 33 (2) ◽  
pp. 76-85
Author(s):  
Oscar Barros ◽  
Rodrigo Riffo ◽  
Inti Paredes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Average Length ◽  
Conservative Estimate ◽  
Health Production ◽  
Production Flow ◽  
Large Hospital ◽  
Direct Evaluation ◽  
Average Length Of Stay ◽  
Formal Design

Background Most emergency departments have overcapacity with poor service measured by length of stay. We hypothesized that a formal design of the emergency department production flows will improve service. Thus, we propose a methodology that was tested in a large hospital, including new flow implementation. Results We implemented new workflows during June to July 2017. A comparison of the patients’ average length of stay from June to September shows a decrease of 26%. Additionally, a comparison with 2016 shows a decrease of 50%. Direct evaluation of the value generated reveals an emergency department admissions increase of 540 monthly, equivalent of a savings of approximately US$250.000 annually. This savings is a very conservative estimate because the most significant value of this work is fast service that diminishes the patients’ risks. Conclusions Production design is an important problem in health services in terms of potential service improvements, executable with a formal, systemic, replicable method founded on several disciplines. Thus, we are replicating the approach at other hospitals with extensions to other services.

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