Physician Scientist - American Association of Physicians of Indian ...

SPECIAL ARTICLE
AAPI Journal • June 2009
Fast Track In Memorial
Hermann Emergency Department
by Swati Choudhary, M.D.
Swati Choudhary, M.D.
Houston, TX
Emergency Department (ED)
waiting periods have increased from
1997-2004 by 4.1% 1 with resulting
patient frustration causing loss of
patient satisfaction. To reduce the
waiting time a pilot Fast Track
service labeled “Chair Project” was
started in Emergency Department of
Memorial Hermann Hospital at
University of Texas (UT), Houston
during September 2008.
A separate Fast Track stream was
started where patients were treated
on chairs under supervision of an
attending physician, a resident
physician and two nurses. Less
emergent conditions including
extremity fractures or sprains, minor
injuries, headaches, abdominal
pains, nausea and vomiting, abscess,
etc., not requiring couch for
examination or urgent interventions
were included. All patients were
assessed and triaged by an
experienced ED Nurse or a
Physician and were fast tracked to
an Emergency Room (ER) chair. Time
spent by the patients in ER was
reduced without compromising the
health care standards.
The Fast Track unit was run on 5
random dates in September 2008
from 1300 hrs-1700 hrs. 70 patients
were fast tracked. Patient’s age
varied from 3-67 years (mean 35
years). The following medical
conditions were treated; urinary
tract infection(4), headaches(2),
diarrhea(1), dehydration(1), back
pain(4), abdominal pain(2), rectal
bleeding(1), shingles(1), skin
infections(8), ear pain(1),
syncope(1), anxiety(1), dizziness(2),
viral syndrome(3), bronchitis(1),
asthma(1), anemia(1), otitis
media(1), gynecological
problems(3), obstetric problems(3),
minor surgical problems like
abscesses(5), cyst(1), cellulites(3),
lacerations(4), burns(2), trauma(4),
and orthopedic problems like
contusions(3), sprains(3), pain in
extremities(1) and fractures of
extremities(4).
The study compared time spent
waiting for treatment on days with
and without Fast Track in ED.
Patient’s time from arrival to care
complete for discharge averaged 90
minutes (range 10-300 minutes) on
fast track days. On non-fast track
days average turn around time for
September 2008 was 5.2 hours.
Patient’s time spent in ER was
reduced from 310 minutes to about
90 minutes, an 82.7% reduction.
Patient’s response was graded as
Satisfactory, Unsatisfactory or
Neutral. In patient satisfaction 61
patient’s response was positive, 4
patient’s response was negative and
5 patients had a neutral response, an
87% patient satisfaction
The introduction of a separate Fast
Track stream for minor injuries can
lead to a significant decrease in time
spent by patients in ED while
maintaining the standards of care.
The experience gained by the
Chair Project led us to use this
method during the strike of
Hurricane Ike at Houston and
proved to be of considerable benefit.
References:
(1) White Coat Notes, Cambridge
Health, Harvard University.
Swati Choudhary, MD., Research
Observer, Dept. of Emergency
Medicine, University of Texas,
Houston, TX
Yashwant Chathampally, MD.,
Attending Physician, Dept. of
Emergency Medicine, University of
Texas, Houston, TX
www.aapiusa.org
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