A well-implemented fast-track can be a powerful workflow structure tool that takes pressure off of Emergency Department (ED) staff and expedites care for low-acuity patients. However, EDs around the world have seen a rise of low-acuity patients. In turn, during peak hours of demand, EDs end up with congested fast-tracks that slow patient flow and extend patient waiting times. Ultimately, when patients experience prolonged ED waiting times, clinical outcomes and patient satisfaction scores suffer.

To better manage their ED volumes and reduce patient waiting times, Hospital Universitario Austral, a 197-bed teaching hospital based in Buenos Aires, Argentina launched Austral Express— a version of a super fast-track. Austral already had a fast-track in their ED for patients with mild clinical conditions, but they established Austral Express to redirect a group of very low acuity, low complexity patients to a separate facility within the organization.

Austral Express operates Monday through Friday from 8:00am to 3:00pm. ED doctors take one shift per week in the super fast-track—Austral found they really enjoy the change of pace.

After just 14 months of implementation, Austral’s ED redirected 6,163 patients to Austral Express, reducing congestion in their main ED and achieving a six-minute wait time and an average of 20 minutes to treat each patient. This represents an 83% decrease in patient waiting time compared to their main ED fast-track. So, how did they accomplish these outcomes?

Austral’s super fast-track has three main differentiators:

1.    A simplified list of conditions appropriate for fast-track

            Typically, hospitals will triage Emergency Severity Index (ESI) level 3, 4, and 5 to fast-tracks. But             the diversity of conditions and severity even within these low-acuity categorization varies             significantly, causing a wide range of potential time for treatment. Austral’s first step was to             significantly reduce the scope the list of conditions appropriate for Austral Express. They started             by analyzing the most frequent reasons for ED visits; based on the complexity of these conditions             and the resources needed to treat them, they narrowed the super fast-track list down to just seven             overarching symptoms:

            o   Earache

            o   Cough or flu symptoms

            o   Skin diseases

            o   Sore throat

            o   Diarrhea

            o   Back pain

            o   Discomfort when urinating

            Austral Express also excludes elderly, oncology or immunosuppressed patients, and pregnant             women. Further, they set a filter questionnaire for every condition to ensure patient safety. For             instance, if a patient selects “cough or flu symptoms” as their main complaint, the filter questions             will ask if they are experiencing difficulty breathing or have a history of cardiac disease or a COPD             diagnosis.

2.    An online triage system
            Leaning into the power of technology, Austral developed a user-friendly website to triage patients             before they come to the hospital. Patients complete a four-step process to register for the service.             First, the patient fills in personal information. Second, they select their main complaint. After that,             the patient completes the short patient safety screening questionnaire. Lastly, the patient selects             an appointment—which is actually the third differentiator of Austral’s super fast-track.

3.    A nudge to evenly distribute patient flow
            The appointment prompt embedded in Austral’s online triage process is the most crucial             component to avoiding peaks in demand. By directing patients to open slots, Austral ensures that             patient demand spreads evenly across the day. Austral guarantees an appointment to patients             within the next few hours, allowing them to wait at home instead of waiting in the hospital.

Austral Express successfully diverted patients from the ED to their super fast-track, and evenly distributed patient flow across the day, resulting in shorter wait times and increased patient satisfaction scores. Below are their 14-month results:

6163  patients diverted from ED fast-track to super fast-track

6 minute  wait time for super fast-track patients, compared to 34 minutes for fast-track patients

20 minute  average time to see each super fast-track patient, including diagnostic tests

98%  patient satisfaction with speed of service

98%  likelihood of recommending service to others