Why use them?
Fast Track zones provide an alternative option for emergency care and provide access to timely care for those with minor injury or illness. Cooke et al (2003) observe that when applying operation research theory, waiting time in a system utilising one queue can be reduced by attending to those with the shortest time requirements. A number of studies have found that Fast Track reduced the total waiting time by 30 per cent and improved patient flow through the system. (Al Darrab, Fan, Fernandez, Zimmerman, Smith, Woster, Smith & O’Connor 2006: Cooke, Wilson & Pearson 2002).
What is Fast Track?
On arrival at Triage patients are assessed against pre-determined criteria that identify them as ambulatory, non-complex, and with the potential to have their emergency care initiated using clinical treatment protocols by the clinical team. These patients are treated in the Fast Track zone.
Fast Track zones increase ED throughput by creating specialised systems designed to:
- expedite the care of ambulatory patients with non-urgent conditions (Al Darrab et al. 2006: Taylor 2004)
- divert the care of patients who meet particular clinical criteria through a separate stream in the ED (Cooke et al. 2003)
- provide a dedicated staffed area with senior clinicians who have the competence to make discharge decisions (Cooke et al. 2003: Taylor 2004: Emergency Service Collaborative p.8, 2002)
- provide care that is protocol driven and directed e.g. for minor illness and injuries.
In Fast Track zones the emphasis is on a clinical team commencing care, rather than ‘waiting to see a doctor’. The aim is discharge within two hours of presentation for non-admitted lower acuity patients.
Advantages
There are a number of advantages of Fast Track zones.
- They have a demonstrable impact on the waiting time for care and the total time in the ED.
- Fast Track zones provide an environment where patients are assessed, investigations are arranged and treatment can be completed away from the main part of the ED.
- The use of treatment protocols promotes patient safety and allows for nurse-initiated management of low acuity patients who meet well-defined criteria.
- A properly designed ambulatory Fast Track area and re-engineering of existing staff roles (including nursing, medical and clinical support roles) facilitates provision of ‘directed care’. That is the provision of protocol driven treatment plans developed to guide the management of specific presentations.
- Patients are seen faster and are more satisfied with their care (Cooke & Fisher, p.83, 2004).
- Prevents excessively long waits, reduces length of stay and reduces ‘walk outs’ (Al Darrab et al. 2006).
- Patients treated by a nurse practitioner may have all their care, including discharge, by one clinician.
