Holiday Fast-Track Reduced Medical Cost and Length of Emergency Department Stay: Preliminary Report from a Single Secondary Care Hospital

Abstract

Introduction

The aims of this study were to compare the effect of a Holiday Fast-Track (HFT) unit on medical costs and emergency department (ED) length of stay (LOS) associated with low acuity patients attended during the same timeframe in two consecutive years in a single secondary care hospital ED.

Methods

Two groups (non-HFT vs. HFT), before and after the fast-track unit was implemented, were compared. The HFT unit was operated to improve the flow of low acuity patients, which were defined as the patients classified as level 4 or 5 by the modified Canadian Triage and Acuity Scale. Data were collected from March 1 to April 30, 2011 for the non-HFT group and during the same period in 2012 for the HFT group.

Results

A total of 894 (431 for non-HFT period and 463 for HFT period) patients of acuity level 4 or 5 visited the ED during the study period. Compared to the non-HFT group, the ED LOS of the HFT group decreased by 27 min and 3.5 min in the patients with acuity levels 4 and 5, respectively (p=0.005 and p=0.003, respectively). Furthermore, total medical costs and laboratory fees were also reduced significantly in the HFT group (p<0.001, p=0.038). However, there was no difference in the other variables between those two groups.

Conclusions

The HFT system decreases the medical costs and LOS in low acuity patients visiting the ED of a secondary care hospital. (Hong Kong j.emerg.med. 2015;22:84-92)

Keywords

Health care costs length of stay organisational efficiency outcome and process assessment time factor

References

Barrett

, Ford

, Ward-Smith

A bed management strategy for overcrowding in the emergency department.

Nurs Econ 2012; 30(2): 82–5.

Cooke

M.W.

, Wilson

, Pearson

The effect of a separate stream for minor injuries on accident and emergency department waiting times.

Emerg Med J 2002; 19(1): 28–30.

Grumbach

, Keane

, Bindman

Primary care and public emergency department overcrowding.

Am J Public Health 1993; 83(3): 372–8.

Considine

, Kropman

, Kelly

, Winter

Effect of emergency department fast track on emergency department length of stay: a case-control study.

Emerg Med J 2008; 25(12): 815–9.

Shin

T.G.

, Song

J.W.

, Song

H.G.

, Hong

C.K.

Characteristics of Frequent Users of Emergency Department.

J Korean Soc Emerg Med 2011; 22(1): 86–92.

Kim

T.H.

, Shin

H.J.

, Cha

Y.S.

, Cha

K.C.

, Kim

, Lee

K.H.

The Effectiveness of Fast Track for Minor Patients in the Emergency Department.

J Korean Soc Emerg Med 2012; 23(2): 255–61.

Cha

W.C.

, Shin

S.D.

, Song

K.J.

, Jung

S.K.

, Suh

G.J.

Effect of an independent-capacity protocol on overcrowding in an urban emergency department.

Acad Emerg Med 2009; 16(12): 1277–83.

Jung

J.H.

, Bae

H.A.

The Effectiveness of Operating Fast Track by Board Certified Emergency Physician in Emergency Medical Center of Teaching Hospital.

J Korean Soc Emerg Med 2008; 19(4): 372–7.

Choi

O.K.

, Kim

, Lim

K.S.

Fast Track System in Emergency Department of Tertiary Hospital.

J Korean Soc Emerg Med 1998; 9(3): 380–8.

10.

O'Brien

, Williams

, Blondell

, Jelinek

G.A.

Impact of streaming “fast track” emergency department patients.

Aust Health Rev 2006; 30(4): 525–32.

11.

Purnell

L.D.

A survey of emergency department triage in 185 hospitals: physical facilities, fast-track systems, patient-classification systems, waiting times, and qualification, training, and skills of triage personnel.

J Emerg Nurs 1991; 17(6): 402–7.

12.

Darrab

A.A.

, Fan

, Fernandes

C.M.

, Zimmerman

, Smith

, Worster

How does fast track affect quality of care in the emergency department?

Eur J Emerg Med 2006; 13(1): 32–5.

13.

Kim

S.K.

, Chung

J.Y.

, Jeong

J.W.

, Cho

S.J.

Effectiveness of Emergency Management by the Medical Staff in the Emergency Department.

J Korean Soc Emerg Med 2003; 14(5): 500–7.

14.

Website in Korean. Report of Korean Emergency Medical Center Evaluation of 2012. [accessed 19 Jan 2015]. Available from: http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=282862&page=–1

15.

Combs

, Chapman

, Bushby

Evaluation of Fast Track.

Accid Emerg Nurs 2007; 15(1): 40–7.

16.

Considine

, Kropman

, Stergiou

H.E.

Effect of clinician designation on emergency department fast track performance.

Emerg Med J 2010; 27(11): 838–42.

17.

Simon

H.K.

, Ledbetter

D.A.

, Wright

Societal savings by “fast tracking” lower acuity patients in an urban pediatric emergency department.

Am J Emerg Med 1997; 15(6): 551–4.

18.

Rehmani

, Norain

Trends in emergency department utilization in a hospital in the Eastern region of Saudi Arabia.

Saudi Med J 2007; 28(2): 236–40.

19.

Holden

Fast track in the field: another option to ease ED overcrowding.

JAAPA 2005; 18(6): 60–1.