The Effectiveness of Fast Track Service in Reducing Waiting Time and Length of Stay for Patients with Minor Injury Attending the Accident and Emergency Department of Tseung Kwan O Hospital

Abstract Description

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Authors (including presenting author) :

Wu HM(1), So JLT(1), Wong KL(1), Lo MT(1), Chan SM(1), Kung SW(1)

Affiliation :

(1) Department of Accident and Emergency, Tseung Kwan O Hospital

Introduction :

Emergency Department (ED) overcrowding has become an issue of growing concern in local EDs. For instance, in our department, the average waiting time of low-acuity (triage category 4) ED patients has steadily increased by 77% over the past three years, from 82 minutes in 2015, to 96 minutes in 2016, and 145 minutes in 2017. The aim of this study was to determine the effectiveness of Fast Track (FT) service in reducing the waiting time and length of stay of low-acuity patients meeting pre-defined FT criteria of minor injury with a view to supplement the current triage criteria, optimise the utilisation of ED resources and reduce ED overcrowding in the context of limited resources, space constraints with an ever increasing patient load.

Objectives :

To reduce the waiting time and length of stay of low-acuity patients meeting pre-defined FT criteria for minor injury through a streamlined ED workflow.

Methodology :

Tseung Kwan O Hospital is a regional hospital with an average ED daily attendance of 309 in 2018. We performed a retrospective study between January 2017 to December 2018 which included 12-month period before and 12-month after the FT service was commenced in January 2018. FT patients were recruited from 8am to 10pm daily at triage. Inclusion criteria include low-acuity (triage category 4) patients presented with acute (< 24 hours) wound, acute minor limb injury, skin abscess, fish bone ingestion and needlestick injury. Exclusion criteria include high-acuity patients (triage category 3 or above). A streamlined workflow had been put in place to enable those patients meeting the pre-defined FT criteria to be rapidly reviewed and treated by the ED team. We compared the mean waiting time and length of stay between FT and non-FT patients; as well as before and after the introduction of FT service. In the 12-month FT period, out of a total of 54,844 low-acuity patients, 3,737 (6.8%) were recruited to the FT service. The mean waiting time for FT patients were 63 minutes compared with 136 minutes for non-FT patients (p< 0.001). The mean length of stay for FT patients were 143 minutes compared with 219 for non-FT patients (p< 0.001). After the introduction of FT service, the mean waiting time of FT patients was reduced by 82 minutes from 145 to 63 minutes (p< 0.001) whereas the mean length of stay was shortened by 86 minutes from 229 to 143 minutes (p< 0.001) when compared to the overall low-acuity patients in the 12-month period preceding the FT service. The majority (83.9%) of FT patients were treated and discharged from the ED. Early wound repair with suturing or tissue adhesive was performed in 935 and 19 patients respectively whereas incision & drainage was performed in 50 patients in the ED. The overall patient satisfaction rate (“very satisfied” and “satisfied”) of the FT service was 93%.

Result & Outcome :

The FT service is effective in reducing the waiting time and length of stay of low-acuity patients with minor injury attending the ED.