Research article

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

Subashnie Devkaran¹ , Howard Parsons² , Murray Van Dyke³ , Jonathan Drennan⁴ and Jaishen Rajah⁵

¹  Royal College of Surgeons in Ireland, Dubai Healthcare City, Dubai, United Arab Emirates

²  Institute of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, 51900, United Arab Emirates

³  Institute of Emergency Medicine, Sheikh Khalifa Medical City, Abu Dhabi, 51900, United Arab Emirates

⁴  Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland

⁵  Institute of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, 51900, United Arab Emirates

author email corresponding author email

BMC Emergency Medicine 2009, 9:11doi:10.1186/1471-227X-9-11

Published:	17 June 2009

Abstract

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.