Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before-after study

Objectives We aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators. Design Adjusted before-after analysis. Setting A large hospital in the Champagne-Ardenne region, France. Participants Patients admitted to the ED between 13 January 2015 and 13 January 2017. Intervention Implementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016). Primary and secondary outcome measures Proportion of patients with LOS hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions. Results The ED of the intervention hospital registered 53 768 stays in 2016 and 57965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before after estimator for ED LOS >= 4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before-after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.00/0 to 5.4%. Conclusions The implementation of a fast-track was associated with a decrease in stays lasting >= 4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.