Is the fast-track process efficient and safe for older adults admitted to the emergency department?

B Gasperini,G Maracchini,E Espinosa,F Pierri,A Fazi,A Cherubini

doi:10.1186/s12877-020-01536-5

Abstract

BackgroundThe efficiency of the fast-track (FT) process in the management of patients in Emergency Departments is well demonstrated, but there is a lack of research focused on older adults. The aim of our study was to verify whether the FT process is efficient and safe for older adults admitted to ED.MethodsObservational case-control single-centre study.ResultsFive hundred four cases and 504 controls were analysed. The mean age was 75 years, and there was a predominance of women. In total 96% of subjects were classified with a “less-urgent” tag. The length of stay was significantly lower in the fast-track group than in the control group (median 178 min, interquartile range 184 min, and 115 min, interquartile range 69 min, respectively, p < 0.001), as well as the time spent between the ED physician’s visit and patient discharge (median 78 min, interquartile range 120 min, and median 3 min, interquartile range 6 min, respectively, p < 0.001). There weren’t any increases in the number of unplanned readmissions within 48 h, 7 days and 30 days.ConclusionsThe fast-track appears to be an efficient and safe strategy to improve the management of older adults admitted to the ED with minor complaints.

Highlights

The efficiency of the fast-track (FT) process in the management of patients in Emergency Departments is well demonstrated, but there is a lack of research focused on older adults
The literature shows that the advantages of this approach are a shorter waiting time, a shorter Emergency Departments (ED) length of stay (LOS), a decreased rate of patients leaving the ED without being seen and decreased ED overcrowding [2], without increasing unplanned readmissions or mortality [3] as well as affecting waiting times and ED LOS for other ED patients [4]
The first goal of our study was to verify whether the FT process is effective to reduce the ED LOS of older adults

Summary

Introduction

The efficiency of the fast-track (FT) process in the management of patients in Emergency Departments is well demonstrated, but there is a lack of research focused on older adults. Fast-track (FT) is a process developed to manage patients admitted to Emergency Departments (ED) with non-urgent complaints more effectively [1]. It consists of a separate pathway for patients with less serious conditions who can be treated and discharged more quickly. While ED LOS should be kept between four and eight hours for the general population [5], it has been demonstrated that after 6 hrs the risk of older adults developing adverse outcomes is significantly increased [6, 7]

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