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. 2019 Jun 19;9(6):e026200.
doi: 10.1136/bmjopen-2018-026200.

Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before-after study

Jan Chrusciel  1   2 , Xavier Fontaine  3 , Arnaud Devillard  4 , Aurélien Cordonnier  5 , Lukshe Kanagaratnam  2   6 , David Laplanche  1 , Stéphane Sanchez  1
Affiliations

Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before-after study

Jan Chrusciel et al. BMJ Open. .

Abstract

Objectives: We aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators.

Design: Adjusted before-after analysis.

Setting: A large hospital in the Champagne-Ardenne region, France.

Participants: Patients admitted to the ED between 13 January 2015 and 13 January 2017.

Intervention: Implementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016).

Primary and secondary outcome measures: Proportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions.

Results: The ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before-after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before-after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%.

Conclusions: The implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.

Keywords: emergency department; fast-track; healthcare quality; hospital readmissions; length of stay.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Daily median emergency department length of stay during the study period (trends obtained by locally weighted regression).
Figure 3
Figure 3
Proportion of emergency department 7-day and 30-day readmissions during the study period.
See this image and copyright information in PMC

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