Hospital emergency departments can cut waiting times and treatment times by turning the traditional triage model on its head, a Sydney hospital has shown.

Instead of basing triage on urgency and need for admission, the Bankstown Hospital has trialled a new model based on streaming patients into either a non-complex Fast Track area or a complex standard care treatment stream.

The key was to have a separate area where non-complex patients were treated by nurse practitioners under a senior clinician, and making sure staff were not moved into other areas at times of stress..

Using this method, the hospital ED cut waiting times to almost half (55 to 32 min) and the mean treatment time was reduced by 20% (209 to 191 min). At the same time, the percentage of patients who treated within the waiting-time benchmarks increased from 59% to 77%.

Writing in Emergency Medicine Australasia (Online 6 May, link here), the study authors say the introduction of Fast Track system for low-complexity patients did not disadvantage the more complex patients, whose waiting treatments time remained the same or were lower than previously.

“Most diagnosed fractures, and cases such as miscarriage requiring dilatation and curettage, were managed through Fast Track, with the nurse practitioners sharing the caseload with the doctors, and liaising directly with the inpatient teams. This process likely reduced patients' frustration and duplication of work for patients who knew that they required admission, but who previously would have waited behind more complex cases,” the study authors say.

The department says the improvement s were noticed immediately after adopting the new model and have been maintained ever since

They said the new model also improved work satisfaction and helped the department recruit full time staff rather than rely on locums.

“Emergency departments aiming to improve their patient waiting times and throughput should consider using case complexity as a key criterion for triaging patients into separate streams,” they conclude.