Ryan J, Ghani M, Staniforth P, Bryant G, Edwards S
Royal Sussex County Hospital, Brighton: Accident and Emergency Department, UK.
J Accid Emerg Med. 1996 Mar;13(2):108-10. doi: 10.1136/emj.13.2.108.
To assess the management of elderly patients presenting to the accident and emergency (A&E) department with a proximal femoral fracture.
A retrospective audit carried out on 30 patients with proximal femoral fracture showed an unacceptably long waiting time in the A&E department. A new "fast track" system for managing these patients, involving the use of a flow chart for expediting admission, was devised. A prospective study of 100 patients > 60 years of age with proximal femoral fracture admitted by fast track system was then carried out.
Implementation of the fast track system resulted in earlier admission to the ward (median time to admission 2.5 h v 4.5 h in the retrospective audit, P < 0.001). Eighteen patients were not admitted by fast track during the study period, in some cases because of inconclusive diagnosis or because there was no identifiable orthopaedic bed; mean admission time for this group was 4 h 8 min.
The fast track system was of benefit to all involved, including the patient, A&E staff, ward staff, and orthopaedic personnel.
评估因股骨近端骨折前往急诊部就诊的老年患者的管理情况。
对30例股骨近端骨折患者进行的回顾性审计显示，急诊部的等待时间长得令人无法接受。设计了一种新的“快速通道”系统来管理这些患者，该系统使用流程图来加快入院流程。随后对100例年龄>60岁、通过快速通道系统入院的股骨近端骨折患者进行了前瞻性研究。
快速通道系统的实施使患者更早入住病房（回顾性审计中入院中位时间为2.5小时，而快速通道系统为4.5小时，P<0.001）。在研究期间，有18例患者未通过快速通道入院，部分原因是诊断不明确或没有可确定的骨科床位；该组的平均入院时间为4小时8分钟。
快速通道系统对所有相关方都有益，包括患者、急诊部工作人员、病房工作人员和骨科人员。
