O'Brien Debra, Williams Aled, Blondell Kerrianne, Jelinek George A
Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Aust Health Rev. 2006 Nov;30(4):525-32. doi: 10.1071/ah060525.
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.
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.
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.
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.
快速通道系统已被广泛引入，用于分流急诊科（ED）中病情较轻的患者，从而缩短了这些患者的等待时间和住院时长。我们旨在前瞻性评估在一家澳大利亚三级成人教学医院的急诊科实施的快速通道系统对患者流量的影响，该医院处理的低病情严重程度患者相对较少。
在为期12周的试验期内，在分诊时识别出澳大利亚分诊量表（ATS）3、4和5类可能出院的患者，并由专门安排在该区域工作的急诊科医护人员在单独的快速通道区域进行评估和治疗。
快速通道区域在其运营时间内管理了所有就诊患者的21.6%。与上一年同期相比，所有出院患者的平均等待时间相对减少了20.3%（-18分钟；95%CI，-26分钟至-10分钟），平均住院时长相对减少了18.0%（-41分钟；95%CI，-52分钟至-30分钟）。与快速通道试验前的12周相比，所有出院患者的平均等待时间相对减少了3.4%（-2.1分钟；95%CI，-8分钟至4分钟），平均住院时长相对减少了9.7%（-20分钟；95%CI，-31分钟至-9分钟）。入院患者的平均等待时间没有增加。尽管在研究期间吞吐量和通道阻塞大幅增加，但情况依然如此。
在一家澳大利亚三级成人教学医院的急诊科对快速通道患者进行分流，可以减少出院患者的等待时间和住院时长，而不会增加入院患者的等待时间，即使在低病情严重程度患者较少的急诊科也是如此。
