Supplementary Files
Keywords
Fast Track
Emergency Department
Population Characteristics
How to Cite
Abstract
Introduction: Implementing a Fast-Track solution and optimizing processes for selected patient groups can significantly enhance throughput in an emergency department (ED). Due to limited knowledge about Fast-Track solutions in a Danish context, this study aimed to investigate the patient population and throughput in a newly established Fast-Track zone. Furthermore, the study aimed to investigate differences in patient- and admission-related characteristics among patients with medical conditions or abdominal symptoms.
Methods: This prospective observational cohort study included all patients aged 16 years or older with low-acuity medical conditions or abdominal symptoms, who were referred to the ED and examined in the Fast-Track zone from September 1st, 2022, to April 30th, 2023. Data collection involved detailed recording of patient demographics, referral reasons, and Post-Fast-Track destinations, with validation by medical professionals to ensure accuracy.
Results: During the study period, 2045 patients entered the Fast-Track zone, including 1301 with medical conditions and 744 with abdominal symptoms. Patients with medical conditions were significantly older (median age 62 vs. 49 years; p < 0.001) and more likely to be male (55% vs. 47%). Although their length of stay was shorter, they were more likely to revisit the Fast-Track zone compared to those with abdominal symptoms (50% vs. 20%). Ninety-three percent of the patients were discharged home the same day, some after treatment elsewhere, and some requiring follow-up, while 7% required admission.
Conclusion: The Fast-Track zone for low-acuity medical conditions and abdominal symptoms has significantly streamlined throughput in the ED, allowing most patients to be discharged on the same day without extending the length of stay for the entire group of patients with medical conditions or abdominal symptoms. The Fast-Track criteria effectively differentiated patients with varying treatment needs. While one-third of contacts related to abdominal symptoms affected all age groups and genders equally, two-thirds involved older, predominantly male patients with various medical conditions and higher frequencies of ED visits.
References
Baier N, Geissler A, Bech M, Bernstein D, Cowling TE, Jackson T, et al. Emergency and urgent care systems in Australia, Denmark, England, France, Germany and the Netherlands – Analyzing organization, payment and reforms. Health Policy. 2019;123(1):1-10. https://doi.org/10.1016/j.healthpol.2018.11.001
Lindner G, Woitok BK. Emergency department overcrowding : Analysis and strategies to manage an international phenomenon. Wien Klin Wochenschr. 2021;133(5-6):229-33. https://doi.org/10.1007/s00508-019-01596-7
Oredsson S, Jonsson H, Rognes J, Lind L, Göransson KE, Ehrenberg A, et al. A systematic review of triage-related interventions to improve patient flow in emergency departments. Scand J Trauma Resusc Emerg Med. 2011;19:43. https://doi.org/10.1186/1757-7241-19-434
Grant KL, Bayley CJ, Premji Z, Lang E, Innes G. Throughput interventions to reduce emergency department crowding: A systematic review. CJEM. 2020;22(6):864-74. https://doi.org/10.1017/cem.2020.4265
Larsen JJ, Lauridsen H, Gundersen LW, Riecke BF, Schmidt TA. Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel. BMC Emerg Med. 2024;24(1):147. https://doi.org/10.1186/s12873-024-01069-9
O’Brien D, Williams A, Blondell K, Jelinek GA. Impact of streaming “fast track” emergency department patients. Aust Health Rev. 2006;30(4):525-32. https://doi.org/10.1071/ah060525
Lutze M, Ross M, Chu M, Green T, Dinh M. Patient perceptions of emergency department fast track: a prospective pilot study comparing two models of care. Australas Emerg Nurs J. 2014;17(3):112-8. https://doi.org/10.1016/j.aenj.2014.05.001
Stevens L, Fry M, Browne M, Barnes A. Fast track patients’ satisfaction, compliance and confidence with emergency department discharge planning. Australas Emerg Care. 2019;22(2):87-91. https://doi.org/10.1016/j.auec.2019.01.004
Hwang CE, Lipman GS, Kane M. Effect of an emergency department fast track on Press-Ganey patient satisfaction scores. West J Emerg Med. 2015;16(1):34-8. https://doi.org/10.5811/westjem.2014.11.21768
Aksel G, Bildik F, Demircan A, Keles A, Kilicaslan I, Guler S, et al. Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study. J Pak Med Assoc. 2014;64(7):791-7.
Gasperini B, Pierri F, Espinosa E, Fazi A, Maracchini G, Cherubini A. Is the fast-track process efficient and safe for older adults admitted to the emergency department? BMC Geriatr. 2020;20(1):154. https://doi.org/10.1186/s12877-020-01536-5
De Freitas L, Goodacre S, O’Hara R, Thokala P, Hariharan S. Interventions to improve patient flow in emergency departments: an umbrella review. Emerg Med J. 2018;35(10):626-37. https://doi.org/10.1136/emermed-2017-207263
Considine J, Kropman M, Kelly E, Winter C. Effect of emergency department fast track on emergency department length of stay: a case–control study. Emerg Med J. 2008;25(12):815-9. https://doi.org/10.1136/emj.2008.057919
Chrusciel J, Fontaine X, Devillard A, Cordonnier A, Kanagaratnam L, Laplanche D, et al. Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before-after study. BMJ Open. 2019;9(6):e026200. https://doi.org/10.1136/bmjopen-2018-026200
Ieraci S, Digiusto E, Sonntag P, Dann L, Fox D. Streaming by case complexity: evaluation of a model for emergency department fast track. Emerg Med Australas. 2008;20(3):241-9. https://doi.org/10.1111/j.1742-6723.2008.01087.x
Kongensgaard FT, Fløjstrup M, Lassen A, Dahlin J, Brabrand M. Are 5-level triage systems improved by using a symptom based approach? – a Danish cohort study. Scand J Trauma Resusc Emerg Med. 2022;30(1):31. https://doi.org/10.1186/s13049-022-01016-2
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Ditte Orbesen, Mohamad El-Faramawi, Gitte Sparke, Anne Friesgaard Christensen, Charlotte Abrahamsen