Streaming by case complexity: Evaluation of a model for emergency department Fast Track

  1. Susan Ieraci1,*,
  2. Erol Digiusto2,
  3. Paul Sonntag1,
  4. Linda Dann1,
  5. Debra Fox1

Article first published online: 6 MAY 2008

DOI: 10.1111/j.1742-6723.2008.01087.x

Issue

Emergency Medicine Australasia

Emergency Medicine Australasia

Volume 20, Issue 3, pages 241–249, June 2008

Additional Information

How to Cite

Ieraci, S., Digiusto, E., Sonntag, P., Dann, L. and Fox, D. (2008), Streaming by case complexity: Evaluation of a model for emergency department Fast Track. Emergency Medicine Australasia, 20: 241–249. doi: 10.1111/j.1742-6723.2008.01087.x

Author Information

  1. 1

    Emergency Department, Bankstown Hospital, Bankstown, and

  2. 2

    South-Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia

*Dr Sue Ieraci, Senior Staff Specialist ED, Bankstown Hospital, LMB 1600 Bankstown, NSW 2200, Australia. Email: sue.ieraci@swsahs.nsw.gov.au

Publication History

  1. Issue published online: 6 MAY 2008
  2. Article first published online: 6 MAY 2008
  3. Accepted 21 January 2008

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Keywords:

  • complexity;
  • emergency department;
  • Fast Track;
  • streaming

Abstract

Objectives:  To evaluate a patient flow streaming system within a teaching hospital's ED, using functional principles to separate patients into two streams on the basis of complexity rather than acuity, severity or disposition.

Methods:  The project used conceptual principles, such as patient complexity and ‘lean thinking’ theory, to create a new Fast Track patient stream, which was separately resourced. Data collected before and after implementation of the Fast Track system were analysed to evaluate the system.

Results:  Following implementation of the system, significant improvements were observed in several key ED performance indicators. Mean waiting time was reduced from 55 to 32 min, mean treatment time was reduced from 209 to 191 min, compliance with New South Wales Department of Health waiting-time benchmarks increased from 59% to 77% and the percentage of patients who did not wait to complete their treatment halved from 6.2% to 3.1%.

Conclusions:  Key features in the success of the system included use of dedicated senior staff for Fast Track patients, and quarantining of clinical resources. The ED aiming to improve their waiting times and throughput should consider using complexity as a key criterion for triaging patients into separate streams. A low-complexity patient stream in the ED provides an ideal focus for advanced nursing practice.

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