The Fast Care Model and Clinical Leadership in the Emergency Department: A Randomized Clinical Trial.

INTRODUCTION

The increasing use of emergency departments for the management of minor emergencies represents a major global challenge, with negative implications for organizational efficiency and patient flow. Despite the adoption of different throughput models, prolonged waiting times and incomplete care pathways remain common. This study aimed to evaluate the effectiveness of a nurse-led Fast Care model, based on early assessment and continuity of care, in improving the management of minor emergencies and patient flow within the emergency department.

METHODS

A randomized clinical trial was conducted in a university emergency department. Adult patients presenting with minor emergencies were randomized in a 1:1 ratio to Fast Care or usual care. The primary outcomes were waiting time and overall length of stay. Secondary outcomes included the number of patients who left without being seen and 72-hour emergency department readmission rates. Data were analyzed using descriptive and inferential statistics.

RESULTS

A total of 801 patients were enrolled. Compared with usual care, participants in the Fast Care group experienced reductions of 77.6 minutes in waiting time, 156.9 minutes in treatment time, and 178.1 minutes in overall length of stay. In the Fast Care group, the care pathway was completed in nearly all cases, with early departures (patients leaving before clinical evaluation) occurring in 2.5% of participants, compared with 32.2% in the usual care group.

DISCUSSION: The nurse-led Fast Care model improved patient flow and reduced delays in the management of minor emergencies, supporting a more efficient and appropriate emergency department care pathway.