Investigation of Fast-Track Routing Decisions and Its Impact in Hospital Emergency Departments

Project: Research

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Upon arrival at emergency departments (EDs), patients first seen by triage nurses in general. Triage nurses make two decisions after their assessment: assign triage scores to patients, indicating their urgency; and route patients into either the main area where patients of higher acuity are treated or the fast-track. Fast-track (FT) is a separated ED area with designated medical teams, providing path-ways aimed towards fast care delivery and rapid discharge for patients with mild conditions. FT has been highlighted as one of the high-impact initiatives to regulate patient flow and address ED congestion. FT has become more prevalent in recent years. However, to the best of our knowledge, there is no universal guideline as to which patients should go to FT. Recent studies find that ED census and system workload have an impact on the behaviors of healthcare practitioners in their decision making. Our study aims to shed some light on whether FT routing decisions are affected by healthcare professional's behaviors, what are the clinical and operational impacts, and identify opportunities to improve ED operations and patient outcome. This proposed study is enabled by our access to patient data from three urban hospitals in Canada. To understand the fast-track routing decisions of triage nurses, we carried out a preliminary study using a biprobit model and a latent variable model to develop our hypotheses. Based on the preliminary results, we conjecture that triage nurses tend to route more patients to FT when the main area is highly crowded, which reduces the overall length of stay and does not impact the patient revisit significantly. However, through subgroup analysis, we find the 48-hour revisit rate for certain patients can increase as much as 22%. Our hypotheses imply that the FT routing decisions at EDs are not purely clinical driven but also take ED census into account, which has a significant impact on the outcome of a subgroup of patients. While there have been behavioral studies on medical decision making, the patient routing decisions to FT has not been investigated. This proposed study aims to shed light on this problem. Our objective is to test our hypotheses through econometric models and investigate the impact of FT routing decisions on ED operational performances. We will propose new routing policies to improve ED patient flow and patient outcomes. In this proposal, we present our preliminary results and describe a set of tasks for achieving our goals. 


Project number9043243
Grant typeGRF
Effective start/end date1/01/22 → …