Patient Perceptions of Emergency Department Fast Track: A Prospective Pilot Study Comparing Two Models of Care

Australasian Emergency Nursing Journal (2014) 17, 112—118
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/aenj
RESEARCH PAPER
Patient perceptions of emergency

department fast track: A prospective pilot
study comparing two models of care
Matthew Lutze, NP, BN, MN (NP), MN (Critical Care) a,∗
Mark Ross, MBBS, FACEM b,c
Matthew Chu, MBBS, FACEM a
Tim Green, MBBS, FACEM c,d
Michael Dinh, MBBS, FACEM c,d
a
Canterbury Hospital, Emergency Department, Campsie, NSW 2194, Australia
b
CareFlight Northern Operations (NT), PO Box 1932, Darwin, NT 0800, Australia
c
Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
d
Sydney Medical School, Sydney University, Sydney, New South Wales, Australia
Received 12 November 2013; received in revised form 29 April 2014; accepted 5 May 2014
KEYWORDS Summary
Background: Emergency department (ED) fast track has been shown to improve patient flow for
Nurse practitioner;
low complexity presentations.1 The optimal model of care and service delivery for fast track
Emergency
patients has not been established.
department;
Aims: The objective of this pilot study was to compare patient satisfaction using two models
Fast track;
of ED fast track — one in a tertiary hospital emergency department staffed by doctors and
Pilot study;
the other in a nearby urban district hospital staffed by nurse practitioners. We also wanted to
Patient satisfaction
determine the proportion of fast track patients who would prefer to see a General Practitioner
(GP) instead of presenting to the ED. This pilot study was the foundation for subsequent studies
later conducted by Dinh et al.2,3
Methods: This was an observational study using a convenience sample of patients. Eligible fast
track patients were asked to complete a standardised satisfaction survey. Presenting problems
and waiting times of patients were collected using patient information systems. Primary out-
come measure was satisfaction rating using a 5-point Likert scale. Secondary outcomes were
surrogate satisfaction measures encompassing questions on likelihood of returning to ED. A
multivariate analysis was performed to obtain odds ratio for higher satisfaction scores.
∗
Corresponding author. Tel.: +61 297870960; fax: +61 297870311; mobile: +61 401093473.
E-mail addresses: mattlutze@hotmail.com, matthew.lutze@sswahs.nsw.gov.au (M. Lutze), markr@med.usyd.edu.au (M. Ross),
Matthew.Chu@sswahs.nsw.gov.au (M. Chu), tim.green@sswahs.nsw.gov.au (T. Green), dinh.mm@gmail.com (M. Dinh).
http://dx.doi.org/10.1016/j.aenj.2014.05.001
1574-6267/Crown Copyright © 2014 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia Ltd. All rights reserved.
Patient perceptions of emergency department fast track 113
Results: In total, 353 patients were recruited: 212 patients in the doctor treated group (DR)
and 141 were in the nurse practitioner treated group (NP). The two groups had similar baseline
characteristics in terms of age, gender, referral source and waiting times. Overall, 320/353(86%)
patients rated their care as either very good or excellent, with only 0.6% rating their care as poor.
Satisfaction scores in the NP group were higher than those in the DR group (median score 4 vs.
3, p < 0.01). A greater proportion of patients in the NP group reported that they would return to
the ED for a similar problem (99% vs. 91% p < 0.01). Overall, 175/353 (50%) of patients indicated
that they would prefer to see a general practitioner for a similar problem if available nearby.
These numbers were slightly lower in the NP group (43% vs. 53%, p = 0.05).
Conclusions: Most patients were satisfied with ED fast track, irrespective of model of care.
Patient satisfaction was greater in the group of patients using the nurse practitioner model of
care. Around half of the fast track patients would prefer to see a general practitioner for a similar
problem if available nearby.
Crown Copyright © 2014 Published by Elsevier Ltd on behalf of College of Emergency Nursing
Australasia Ltd. All rights reserved.
What is known? Methods
• Fast track models of care are increasingly being Study design

utilised to manage low acuity patients in emergency
departments across Australia. Patient satisfaction Observational study using a convenience sample of patients.
with fast track services has not been well described
within the Australian context. Settings
What this paper adds? The study was undertaken at a large urban tertiary hospital
(Royal Prince Alfred Hospital, RPAH) and an urban district
• This pilot study compared two fast track models of hospital (Canterbury Hospital, TCH) over 4 week period
care and patient satisfaction in both services. Patient between 20/03/09 and 19/04/09.
satisfaction was greater in the Nurse Practitioner
managed Fast Track model of care. Study participants
Participants were enrolled if they presented between the

hours of 0800—2300 at either hospital during the study
Introduction period and qualified under fast track triage criteria. Fast
track inclusion criteria consisted of patients who had mini-
The Emergency Department (ED) triage process aims to mal care requirements based on triage assessment and were
ensure acutely unwell patients are seen before less urgent likely to be discharged home after a brief ED intervention.
cases, meaning the latter are often subjected to prolonged Examples include minor musculoskeletal cases (MSK), minor
waiting times. These prolonged waiting times may con- lacerations and soft tissue infections (Soft tissue), ear nose
tribute to ED overcrowding.4 ‘Fast track’ areas have recently and throat or intraoral problems (ENT/oral), uncomplicated
been implemented in Australian emergency departments as general medical conditions (Gen Med) including urinary tract
a way of ‘‘streaming’’ patients with low complexity presen- infections, deep vein thromboses and upper respiratory tract
tations to reduce overall waiting times. Despite its success infections and simple gynaecological problems (Obs/Gyn).
in reducing waiting times,1 the optimal model of delivering a Fast track patients were identified by triage nurses at RPAH
fast track service has not been established. Many emergency and by Nurse Practitioners (NPs) working in fast track at
departments have begun employing nurse practitioners as an TCH. Fast track patients were generally seen by emergency
alternative to junior doctors, to assess and manage these department senior resident medical officers or registrars at
low complexity patients. Others recommend a coexisting RPAH and by NPs at TCH. NPs could consult with senior
General Practice (GP) service to reduce ED patient load.5 medical staff as required. Fast track presentations were
prospectively recorded by the patient information system at
Objectives RPAH and total numbers could therefore be reported. Fast
track presentations were not contemporaneously tracked at
The present study aimed to compare patient satisfaction TCH and so a post hoc estimation of potential fast track
between two different models of ED fast track: one in a presentations was made by the nurse practitioner at TCH.
tertiary hospital emergency department staffed by doctors Exclusion criteria for fast track at both hospitals included
and the other in a smaller urban district hospital staffed those patients older than 70 years of age, haemodynamically
by nurse practitioners. We also attempted to examine fast unstable, confused/agitated, had a history of significant
track patient attitudes towards a co-located GP service. comorbidities, were currently taking >3 medications or
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Australasian Emergency Nursing Journal (2014) 17, 112—118

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/aenj

Patient perceptions of emergency

What is known? Methods

• Fast track models of care are increasingly being Study design

Participants were enrolled if they presented between the

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