Background: about 53,300 patients are visited per year at the First Aid service of St. Paul’s Hospital, Milan. The major activity (85%) occurs from 7 a.m. to 9 p.m., encompassing the activities and prolonging the Wait Times before the call. In order to shorten Wait Times we realized that fast nursing paths called “fast-tracks” should be established as implemented in Tuscany and Emilia Romagna. Aim: to measure the impact on efficiency of the fasttrack system in the treatment of patients with ophthalmologic, dermatological and ear, nose and throat health disorders. Methods: comparison of the activity from 8 a.m. to 4 p.m. in the First Aid service of St. Paul hospital, Milan, in the periods September 2010/2011 (fast-tracks activated) and September 2009/2010. Exclusion criteria: patients with major health issues (color code yellow and red) or with preferential access (obstetrics, pediatric, orthopedic and trauma). Data obtained from the SW “first-aid”, and analysed with SW-free OPENEPI. We used the Student’s t-test for independent samples, significance level set at 0.05. Results: analysis per code of access did not register an increasing number of admissions according to color codes, except for patients with white codes (from 214 to 614), and green codes (from 5.606 to 6.508) in the period observed, while yellow and red codes did not vary significantly. Analysis per length of Wait Times: the introduction of the fast-track system, demonstrated on the whole, a reduction of Wait Times. This decrease was statistically significant (200 minutes) for the white codes, despite the increased number of admissions (p <0.001), and for the green codes (55 minutes) (p <0.001). Wait Time was thus reduced by19 minutes for the yellow codes and 4 minutes for the red ones (p= 0.99).Cost Analysis of white codes (paying a ticket): with patients paying a 25 ticket, the mean cost estimated is 11.65 per patient visited in the First Aid service, with the hospital earning about 13.25 per patient. Shorter Wait Times for patients given white codes reduced the number of people leaving the hospital (2,663 vs. 4,043). We estimated net proceeds of 3,174 only during the month of June 2011. Conclusions: the activation of the fast track system has significantly reduced Wait Times for the less severe patients. Further investigations are needed to assess the economic impact in the mid/long-terms. References • Anchisi R, Benci L, Benci A et al. NurseTriage. Milan: Mc Graw- Hill; 2000 • Raimondi M. Triage. In Raimondi M. Prehospital Trauma Care. Arianna Editrice; 2003: 141-50 • Di Pietro G, De Blasio E, Diani A, et al. Prehospital Triage at the poly-emergency and maxi-emergency areas. Prehospital Trauma Care Basic Framework. Prehospital Trauma Approach and Treatment following the Italian Resuscitation Council guidelines. Milan: Italian Resuscitation Council;2003: 81-3 • Benci L. Professional practice in specific operating situations. In Benci L. Juridical Aspects of the Nursing profession. Elements of healthcare legislation. 4th ed. Milan Mc Graw-Hill; 2005: 96-103GFT-Group Triage Training. Nursing Triage. McGraw-Hill Italy, Milan 2005.

NEW FRONTIERS OF TRIAGE: EXPERIMENTATION OF THE “FAST-TRACK” PATHS. ANALYSIS OF ORGANIZATIONAL OUTCOMES, COSTS AND PROCESSES

Cicolini G
2011

Abstract

Background: about 53,300 patients are visited per year at the First Aid service of St. Paul’s Hospital, Milan. The major activity (85%) occurs from 7 a.m. to 9 p.m., encompassing the activities and prolonging the Wait Times before the call. In order to shorten Wait Times we realized that fast nursing paths called “fast-tracks” should be established as implemented in Tuscany and Emilia Romagna. Aim: to measure the impact on efficiency of the fasttrack system in the treatment of patients with ophthalmologic, dermatological and ear, nose and throat health disorders. Methods: comparison of the activity from 8 a.m. to 4 p.m. in the First Aid service of St. Paul hospital, Milan, in the periods September 2010/2011 (fast-tracks activated) and September 2009/2010. Exclusion criteria: patients with major health issues (color code yellow and red) or with preferential access (obstetrics, pediatric, orthopedic and trauma). Data obtained from the SW “first-aid”, and analysed with SW-free OPENEPI. We used the Student’s t-test for independent samples, significance level set at 0.05. Results: analysis per code of access did not register an increasing number of admissions according to color codes, except for patients with white codes (from 214 to 614), and green codes (from 5.606 to 6.508) in the period observed, while yellow and red codes did not vary significantly. Analysis per length of Wait Times: the introduction of the fast-track system, demonstrated on the whole, a reduction of Wait Times. This decrease was statistically significant (200 minutes) for the white codes, despite the increased number of admissions (p <0.001), and for the green codes (55 minutes) (p <0.001). Wait Time was thus reduced by19 minutes for the yellow codes and 4 minutes for the red ones (p= 0.99).Cost Analysis of white codes (paying a ticket): with patients paying a 25 ticket, the mean cost estimated is 11.65 per patient visited in the First Aid service, with the hospital earning about 13.25 per patient. Shorter Wait Times for patients given white codes reduced the number of people leaving the hospital (2,663 vs. 4,043). We estimated net proceeds of 3,174 only during the month of June 2011. Conclusions: the activation of the fast track system has significantly reduced Wait Times for the less severe patients. Further investigations are needed to assess the economic impact in the mid/long-terms. References • Anchisi R, Benci L, Benci A et al. NurseTriage. Milan: Mc Graw- Hill; 2000 • Raimondi M. Triage. In Raimondi M. Prehospital Trauma Care. Arianna Editrice; 2003: 141-50 • Di Pietro G, De Blasio E, Diani A, et al. Prehospital Triage at the poly-emergency and maxi-emergency areas. Prehospital Trauma Care Basic Framework. Prehospital Trauma Approach and Treatment following the Italian Resuscitation Council guidelines. Milan: Italian Resuscitation Council;2003: 81-3 • Benci L. Professional practice in specific operating situations. In Benci L. Juridical Aspects of the Nursing profession. Elements of healthcare legislation. 4th ed. Milan Mc Graw-Hill; 2005: 96-103GFT-Group Triage Training. Nursing Triage. McGraw-Hill Italy, Milan 2005.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11586/258194
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