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Fast Track Service Delivery Model

Clinical Excellence Division

Fast track is the allocation of patients into alternate 'streams' of appropriately resourced locations within the emergency department (ED), with emphasis being on dedicated clinical teams commencing care rather than the patient 'waiting to see a doctor'.

Fast track is beneficial when the ED is:

  • at capacity and overcrowding necessitates ambulance diversion
  • not coping with a temporary increase in admissions
  • under pressure to free up ED beds accommodated by inpatient outliers – access block
  • experiencing increased numbers of ‘did not waits’
  • experiencing increased dissatisfaction from patients in the waiting room – formal complaints
  • regularly experiencing verbal abuse and aggression from frustrated patients towards clerical and clinical staff in the ED

Applicability

Many factors determine the structure and work process of implementing this model of care, individual site consideration should be given to the following factors:

  • ED activity and acuity (i.e: more than 30000 presentations per annum, more than 55% of presentations being ATS 4 or 5)
  • Availability of resources to consistently provide a dedicated team (i.e: senior clinician with competence to make discharge decisions/nursing/administration)
  • Availability of physical space/dedicated location away from the main work area in the ED where patients can be assessed, investigations arranged and treatment completed
  • Electronic information systems capable of tracking and reporting on patient flow
  • Cost considerations – staffing profile required/availability of physical space and equipment availability

Key principles

  • Standardising front-end processes to decrease practice variation and improve efficiency
  • Dedication to the continuum of service within this model
  • Sufficient number of experienced non-rotational staff dedicated to the model

Objectives

  • Substantial reduction in the average waiting time, ED length of stay and instances of did not waits
  • Assess each patients ‘presenting problem’ against pre-determined criteria to identify them as ambulatory, non-complex, not likely for admission or with the potential to have their emergency care initiated using nurse-initiated clinical pathways
  • Offer low acuity patients with straightforward presenting problems on-the-spot treatment so that they are in the ED for as short a length of time as possible
  • Provision of an environment where suitable patients can be assessed, investigations arranged and treatment completed separate to the main ED clinical area
  • Provision of protocol-driven treatment plans developed to guide the management of specific presentations

Performance indicators

  • Key performance indicators under the National Emergency Access Target
  • Decreased percent of ‘long wait’ patients across all ATS categories
  • Decreased average ED length of stay
  • Decreased percent of did not waits
  • Improved patient and staff satisfaction
  • Decreased adverse events, complaints

Also known as

  • Streaming
  • See and treat
  • Admit/non-admit
  • Ambulatory care
  • Subacute

Related links

Last updated: 2 December 2013