Cut Turnaround Time with Fast Track
With 78,000 adult and pediatric patient visits to its ED annually, Sacred Heart Hospital in Pensacola, FL was highly motivated to increase efficiency of care. And they have. Over the past five months, they've reduced wait time by 60 minutes per patient in the pediatric ED alone.
A 60 minute reduction in turn around time can create room to see an additional 30 patients per day. And if even half of those 30 extra patients are realized, the return on investment is staggering…up to $1.6 million per year.1
Raising Patient Satisfaction
"Several years ago, our fast track patients were penalized and got angry as they waited for hours in the ED because they didn't have lifethreatening emergencies," explains Peter Semczuk, Vice President of Clinical Services at Montefiore Medical Centers' three emergency departments in Bronx, NY. (At 194,000 visits annually, Montefiore's EDs are the busiest on the entire East Coast and seventh largest in the country.) "Now we see them right away and they no longer leave in frustration." Montefiore has reduced its Left without Treatment rate at its Weiler ED (recipient of Press-Ganey's prestigious 2005 Compass award) from 5.2% in 2001 to 1.2% in 2005.
On the west coast in San Diego, Dr. Richard Gwinn, Medical Director of Sharp Rees-Stealy's five urgent cares (affiliated with Sharp HealthCare) concurs. He should know. Sharp's urgent care providers were ranked in the 89th percentile at press time for patient satisfaction nationwide (Press-Ganey). "A patient who waits in pain with a fracture for a half hour is not going to be as happy as one who gets medication immediately," he adds, "even if the outcome is the same."
How to Do It
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Common Mistakes |
Tactics |
Fast track patients are passed over in the triage process or are triaged last. This creates long waits and inefficient use of beds.
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Bypass triage for all fast track patients (e.g. bug bites, sunburns) by putting them in a fast track bed immediately for quick treatment.
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Acute patients are placed in the fast track when the ED is over capacity.
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Fast track only patients you can “treat and street” within one hour. Do not give up fast track beds to non-fast track patients when the ED is over capacity. Otherwise, you lose your ability to turn around patients quickly.
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Treated fast track patients are kept waiting in the bed for bedside registration or discharge instructions.
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Do secondary registration at a discharge desk instead of through bedside registration to clear the bed faster.
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Radiology requests are not prioritized.
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Prioritize radiology tests in three “buckets.” Stat films get first priority. Fast track are second priority. “They’ll be here awhile” (e.g. chest films) are third priority.
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1 Based on an average reimbursement rate for an ED treat/release visit of $300 per patient, this equals $4500 per day or over $1.6 million per year.
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