Lam Daniel, Braund Cortney, Schmidt Sarah, Johnson Bernadette, Spencer Sandra P, Agbim Chisom
From the Division of Pediatric Emergency Medicine, University of California San Francisco, Department of Emergency Medicine, San Francisco, Calif.
Section of Emergency Medicine, Children's Hospital of Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Co.
Pediatr Qual Saf. 2024 Sep 18;9(5):e770. doi: 10.1097/pq9.0000000000000770. eCollection 2024 Sep-Oct.
Fast-track models decrease patient crowding in emergency departments (EDs) by redirecting low-acuity patients to an expedited care pathway. In 2016, this institution's pediatric ED created a fast-track pathway for patients evaluated in a rapid assessment triage area who needed further management in the primary ED. This "Supertrack" designation was intended for patients requiring up to 1 hour of additional care, though means of ensuring these patients were discharged within their anticipated timeframe were lacking.
We aimed to increase the percentage of Supertrack patients discharged within 1 hour of their ED bed assignment from 17% to 50%. Interventions included the creation of objective Supertrack criteria, departmental-wide progress reports, personalized reminders, intake huddles, and documentation prompts. We visualized data from Plan, Do, Study, Act (PDSA) cycles with statistical process control charts to determine special cause variation.
The percentage of Supertrack patients discharged within their anticipated timeframe increased from 17% to 27% without an increase in return ED visits. The average time Supertrack patients spent in the ED decreased from 121 to 103 minutes. Personalized reminders demonstrated a significant but short-lived improvement.
We improved the flow of Supertrack patients by decreasing their length of stay and increasing how many were discharged within their anticipated timeframe. Limitations included an unexpected surge in patients with respiratory complaints and staffing and structural constraints preventing the designation of a discrete Supertrack assessment space with dedicated providers. These findings are helpful for institutions seeking to develop an effective fast-track model with limited space and resources.
快速通道模式通过将低急症患者引导至加速护理途径，减少了急诊科（ED）的患者拥挤情况。2016年，该机构的儿科急诊科为在快速评估分诊区接受评估且需要在主急诊科进一步治疗的患者创建了一条快速通道。这种“超级通道”指定适用于需要长达1小时额外护理的患者，不过缺乏确保这些患者在预期时间内出院的方法。
我们旨在将超级通道患者在分配急诊床位后1小时内出院的比例从17%提高到50%。干预措施包括制定客观的超级通道标准、全科室进度报告、个性化提醒、接诊前碰头会以及记录提示。我们使用统计过程控制图可视化了计划-实施-研究-改进（PDSA）循环中的数据，以确定特殊原因变异。
超级通道患者在预期时间内出院的比例从17%提高到了27%，且再次就诊急诊的情况没有增加。超级通道患者在急诊科花费的平均时间从121分钟减少到了103分钟。个性化提醒显示出显著但短暂的改善。
我们通过缩短超级通道患者的住院时间并增加在预期时间内出院的患者数量，改善了他们的流程。局限性包括呼吸道疾病患者意外激增，以及人员配备和结构限制导致无法指定一个有专门医护人员的独立超级通道评估空间。这些发现对寻求在有限空间和资源条件下开发有效快速通道模式的机构很有帮助。
