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Arch Hellen Med, 31(3), May-June 2014, 336-341


Crowding in emergency departments: The role of a fast track clinic

C. Lydakis,1 J. Patramanis,1 K. Lavredaki,1 M. Karavitaki,1 G. Neofotistos2
1"Venizeleion" General Hospital of Crete, Heraklion,
2Seventh Regional Health Authority of Crete, Heraklion, Greece

OBJECTIVE The problem of overcrowding in emergency departments (ED) is common in hospitals worldwide. In Greece, especially, this problem is exacerbated by the presence of a large proportion of patients who attend for minor medical problems. In order to manage these patients more efficiently in the ED of the "Venizeleion" General Hospital in Crete a "fast track" clinic was established, the "Clinic for Rapid Management of Low Emergency Cases". The aim of this study was to investigate the potential benefits from the "fast track" clinic in the overall operation of the ED.

METHOD Comparison was made between the total number of visits to all ED clinics in the period January−May 2012 (before operation of the "fast track" clinic) and the period January−May 2013 (during which the "fast track" clinic was in operation). An hourly record was kept of the number of visits and the waiting time during five consecutive 24 hour on-call periods in order to determine a possible 24-hour fluctuation pattern in the presentation of patients.

RESULTS Despite a 15.3% increase in the total number of ED visits during the first five months of 2013 over the corresponding period of 2012, a decrease was recorded in visits to the individual specialty clinics of the ED (i.e., medical, surgical, etc.) of 5.5% to 33.1%. The largest decrease (33.1%) was observed in the ED medical clinic, which was attributed to examination of the majority of low-risk cases in the "fast track" clinic. The total number of laboratory examinations ordered by the ED did not increase in the second study period. Analysis of the hourly variation showed a drop in demand during the noon time zone. The time available per visit in the "fast track" clinic (from 12.8 to 20.4 min) was considered satisfactory in terms of patient safety and overall waiting time.

CONCLUSIONS The establishment of a "fast track" low emergency clinic in the ED had beneficial effects on the management of both patients with minor health problems and those with more serious problems. The "fast track" clinic also helped to keep the cost of emergency services at a low level. The extension of such an establishment to other hospitals would contribute to improving the quality of care provided to patients presenting with acute health problems.

Key words: Crowding, Emergency department, Organization/administration.

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