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. 2024 Sep 18;9(5):e770.
doi: 10.1097/pq9.0000000000000770. eCollection 2024 Sep-Oct.

How Super Is Supertrack? Expediting Care of Fast-track Patients through a Pediatric Emergency Department

Daniel Lam  1 , Cortney Braund  2 , Sarah Schmidt  2 , Bernadette Johnson  2 , Sandra P Spencer  2 , Chisom Agbim  3
Affiliations

How Super Is Supertrack? Expediting Care of Fast-track Patients through a Pediatric Emergency Department

Daniel Lam et al. Pediatr Qual Saf. .

Abstract

Background: Fast-track models decrease patient crowding in emergency departments (EDs) by redirecting low-acuity patients to an expedited care pathway. In 2016, this institution's pediatric ED created a fast-track pathway for patients evaluated in a rapid assessment triage area who needed further management in the primary ED. This "Supertrack" designation was intended for patients requiring up to 1 hour of additional care, though means of ensuring these patients were discharged within their anticipated timeframe were lacking.

Methods: We aimed to increase the percentage of Supertrack patients discharged within 1 hour of their ED bed assignment from 17% to 50%. Interventions included the creation of objective Supertrack criteria, departmental-wide progress reports, personalized reminders, intake huddles, and documentation prompts. We visualized data from Plan, Do, Study, Act (PDSA) cycles with statistical process control charts to determine special cause variation.

Results: The percentage of Supertrack patients discharged within their anticipated timeframe increased from 17% to 27% without an increase in return ED visits. The average time Supertrack patients spent in the ED decreased from 121 to 103 minutes. Personalized reminders demonstrated a significant but short-lived improvement.

Conclusions: We improved the flow of Supertrack patients by decreasing their length of stay and increasing how many were discharged within their anticipated timeframe. Limitations included an unexpected surge in patients with respiratory complaints and staffing and structural constraints preventing the designation of a discrete Supertrack assessment space with dedicated providers. These findings are helpful for institutions seeking to develop an effective fast-track model with limited space and resources.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. Funding for this project was provided by the Clinical Effectiveness and Patient Safety Grant Program from the Institute for Healthcare Quality, Safety and Efficiency and University of Colorado School of Medicine. Additional funding was provided by the Graduate Medical Education Quality and Safety Bonus Program.

Figures

Fig. 1.
Fig. 1.
Key driver diagram. *These interventions were not implemented due to external factors.
Fig. 2.
Fig. 2.
Supertrack patients discharged within 1 hour of ED bed assignment (p-chart).
Fig. 3.
Fig. 3.
A and B. Duration of time Supertrack patients spent in ED (Xbar S chart).
Fig. 4.
Fig. 4.
Percentage of Supertrack patients who met Supertrack criteria (p-chart).
Fig. 5.
Fig. 5.
Percentage of Supertrack patients with a return ED visit within 72 hours/percentage of ED patients with a return visit within 72 hours (p-chart).
See this image and copyright information in PMC

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