Improving Emergency Department Patient Flow through Optimal Fast Track Usage
Jordan Peck and Sang-Gook Kim
Study Objectives: We seek to decrease Emergency Department Crowding by studying the use of a Fast Track and proposing an alternative method for assigning patients to Fast Track.
Methods: Systems analysis tools are used to identify the relevant goals of an Emergency Department with Fast Track: treat those who are most urgent and encourage the patient flow of all levels of acuity. Systems design methods show that the use of Emergency Severity Index for both purposes exemplifies the sub-optimal, coupled design case where only one design parameter is employed to fulfill two goals. A new supplemental patient index, the Park Index (PI), is proposed and assigned to patients strictly based on their expected treatment time. A discrete event simulation model is employed to test the potential improvements from the use of the PI.
Results: There are higher acuity patients that still have low treatment times and low acuity patients that have high treatment times. Simulation results show that by sending the low treatment time high acuity patients to Fast Track and high treatment time low acuity patients to the main Emergency Room using the PI, there is a significant decrease in patient waiting time (~50%) compared to a scenario when FT beds are used as normal ER beds, while the priority care of high acuity patients is maintained.
Conclusion: By introducing a second index built specifically for patient flow, there is potential for decreasing patient waiting times and maximizing resource utilization.
