Berger-von Orelli Franziska G, Hertzog Rebecca A-B, Sauter Thomas C, Seiler Michelle, Spigariol Fabian, Tomaske Maren, Gualco Gianluca, Donas Alex, von Vigier Rodo O, Keller Dagmar I, Keitel Kristina
Division of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
BMC Health Serv Res. 2025 Mar 18;25(1):395. doi: 10.1186/s12913-025-12570-7.
In response to the challenges faced by emergency departments (ED), including overcrowding and high patient volumes, Fast Track (FT) systems are designed to optimize patient flow, yet their implementation and impact in Switzerland remain understudied. Our study provides a comprehensive description of Fast Track (FT) processes across both pediatric and adult settings in Switzerland and compares challenges.
We conducted a cross-sectional online survey of ED leadership in Switzerland from May to September 2023, using the WHO SARA framework to explore FT processes. The survey included 28 pediatric EDs and their corresponding adult EDs, with questions addressing FT availability, staffing, infrastructure, and operational challenges. Results were analyzed descriptively, providing insights into FT organization and highlighting barriers to implementation and expansion.
The survey achieved a response rate of 93% (52/56 EDs). Overall, 68% of surveyed hospitals have implemented a FT system, with a higher prevalence in adult EDs (88%) than in pediatric EDs (59%). The absence of FTs in certain pediatric departments was primarily due to structural and personnel constraints. Most FTs are managed internally by hospitals, employing emergency team members, and occasionally general practitioners, reflecting a tailored approach to staffing based on departmental needs. Despite the strategic organization of FTs, operational challenges persist; 45% of respondents identified staff shortages as a major challenge, particularly in pediatric FTs (63%) compared to adult FTs (32%). Financial barriers, including disparities in external physician compensation, remain significant obstacles to FT expansion. Satisfaction levels among EDs with their FT systems were generally high, with improvements in personnel resource allocation and patient flow frequently reported.
While FT systems in Swiss EDs have enhanced patient care and operational efficiency, their expansion and effectiveness are hampered by staffing and financial limitations. Addressing these barriers requires a collaborative effort to reform health system policies and financial frameworks, ensuring the sustainable implementation of FTs to meet the growing demands of emergency care.
为应对急诊科面临的挑战，包括过度拥挤和高患者量，快速通道（FT）系统旨在优化患者流程，但其在瑞士的实施情况和影响仍未得到充分研究。我们的研究全面描述了瑞士儿科和成人急诊科的快速通道（FT）流程，并比较了挑战。
我们于2023年5月至9月对瑞士急诊科领导进行了横断面在线调查，使用世界卫生组织的SARA框架来探索FT流程。该调查包括28个儿科急诊科及其相应的成人急诊科，问题涉及FT的可用性、人员配备、基础设施和运营挑战。对结果进行了描述性分析，深入了解了FT的组织情况，并突出了实施和扩展的障碍。
调查的回复率为93%（52/56个急诊科）。总体而言，68%的受访医院实施了FT系统，成人急诊科的患病率（88%）高于儿科急诊科（59%）。某些儿科科室没有FT主要是由于结构和人员限制。大多数FT由医院内部管理，雇佣急诊团队成员，偶尔也有全科医生，这反映了根据科室需求进行人员配备的定制方法。尽管FT进行了战略组织，但运营挑战仍然存在；45% 的受访者认为人员短缺是一个主要挑战，儿科FT（63%）尤其如此，而成人FT（32%）相对较低。包括外部医生薪酬差异在内的财务障碍仍然是FT扩展的重大障碍。急诊科对其FT系统的满意度普遍较高，经常报告人员资源分配和患者流程有所改善。
虽然瑞士急诊科的FT系统提高了患者护理和运营效率，但其扩展和有效性受到人员配备和财务限制的阻碍。解决这些障碍需要共同努力改革卫生系统政策和财务框架，确保FT的可持续实施，以满足急诊护理不断增长的需求。
