Dedicating Staff and Resources to Improve Fast Track Operations

Goal:

Reduce turnaround time for low-acuity “fast track” patients to 90 minutes.

Innovation:

Improved their fast track process, including designating a dedicated staff and identifying a supply inventory and physical space in the emergency department that could not be tapped for other things, ensuring that that low-acuity patients receive timely care.

Result:

The fast track is now established as a distinct service line within the emergency department (ED). The median throughput time for fast track patients is now under 90 minutes from arrival to departure.

Institution:

Thomas Jefferson University Hospital Department of Emergency Department 1020 Sansom Street 329 Thompson Building Philadelphia, PA 19107 P: (215) 955-6844

From the Experts:

The improvement to our fast track system reduced turnaround time so that we can get patients with minor or quickly treatable injuries help while the rest of the ED devotes more needed attention to sicker patients. This intervention has had an enormously wide-ranging impact on operations in the ED and the whole hospital.

Rex Mathew, M.D. Vice President, Emergency Medicine Clinical Operations Thomas Jefferson University Hospital

Profile:

Location: Philadelphia, Pa Number of emergency department visits annually: approximately 55,000 Number of beds: 724 Affiliations: Thomas Jefferson University Ownership: non-government, not-for-profit Teaching status: Yes Thomas Jefferson University Hospital is an academic medical center with 724 licensed acute care beds and major programs in a wide range of clinical specialties.

Clinical areas affected:

  • Emergency department

Staff involved:

  • Nurses
  • Physicians
  • Registration staff
  • Technicians

Timeline:

The entire process of revising the fast-track procedure took about one year. The ED operations committee first decided to do it after a two week deliberation, which was followed by 12 months of implementation, data collection and fine-tuning.

Contact: Linda Davis-Moon, M.S.N., C.R.N.P., A.P.R.N., B.C. Executive Director for Strategic Initiatives Thomas Jefferson University Hospital P: (215) 955-6844 ldavismoon@gmail.com

Innovation implementation:

For patients with minor or quickly treatable injuries, unnecessary long waits in the ED can be frustrating and lead to dissatisfaction and, in some instances, worse outcomes for the patient. The delays also contribute to crowding in the ED and divert valuable resources and attention from ED staff. While the team at Thomas Jefferson University Hospital had a “fast track” procedure in place for streamlining treatment of low-acuity patients, like at many hospitals, it was often squandered because of poor practices and operations.

Patients qualified for the fast track were often crowded in with other patients, stuck in line at registration and triage or, worse, simply put last in line because of the uncritical nature of their injuries while staff was too busy to handle them in a timely manner. Furthermore, a trend had developed where triage nurses were classifying patients as fast track qualified when they really were not (meaning they had to be able to leave the ED within 90 minutes or less). This miscategorization resulted in an overloaded fast track system, hampering its ability to meet these goals.

Identifying the fast track system as an area needing improvement that could have a wide-ranging impact, the ED operations committee met and decided to provide it with the operational and practice resources needed to make fast track a success. The hospital answered by dedicating staff, supply inventory and physical space in the ED that could not be tapped for other things, ensuring that that low-acuity patients receive timely care.

The ED administrators also engaged in an education campaign with triage nurses as to what exactly constituted a fast track patient, ensuring that those entering the fast track system were appropriately classified and could be effectively served. The result of the improved fast track system has been reduced turnaround time, improved patient and staff satisfaction and wide-ranging improvement of operations both within the ED and the entire hospital.

Advice and lessons learned:

  1. Have dedicated staff. In order for the fast track program to succeed, you need fast track nurses with increased training and specialization dedicated to servicing those patients. Otherwise the demands of a busy ED will move these resources elsewhere negating the benefit of having a fast track.
  2. Have a measurable goal. In order to track where you were, where you want to be and your progress in between, it is important to use performance measures to establish goals and then monitor progress throughout.
  3. Foster staff ownership of this project. While it is important to have the support of senior administration, for this project to succeed, it is more important that those who are managing this program feel like this is their project. Make the successes and failures of the fast track program be the successes and failures of the nurses.

Cost/benefit estimate:

By simply refocusing resources and operations, and without the need for additional staff or equipment, the fast track improvements have the potential to generate a million-plus dollars in revenue each year by significantly reducing the losses associated with patients who leave without being seen.

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