SOCIETAL SAVINGS BY FAST TRACKING LOWER ACUITY PATIENTS IN AN URBAN PEDIATRIC EMERGENCY DEPARTMENT

To evaluate the cost-effectiveness of a ''fast track'' system for dive rting lower acuity patients away from the pediatric emergency departme nt (ED), 4,060 patients triaged to the fast track area of an urban ped iatric ED with the 10 most common discharge diagnoses from 1/1/94 thro ugh 12/31/94 were retrospectively evaluated. Patients triaged as havin g nonurgent concerns qualified for treatment in a separate fast track area for 8 hours per day (fast track patients). These patients were co mpared with 5,199 seen in the main pediatric ED for the same concerns during the remaining hours when the fast track was not in operation (E D patients). Computer records were reviewed for demographics, acuity l evels, diagno sis, and collection ratios (revenues/charges). The socie tal savings was calculated as Sigma $ [(Delta mean revenue of diagnosi s(1-10) in the main ED - mean revenue of diagnosis(1-10) in the fast t rack) x the number of patients seen in fast track for diagnosis(1-10)] stratified by acuity, Collection ratios were comparable between group s (57% v 62%), but the average charges (physician and facility) were s ignificantly less for patients seen in the fast track by a ratio of 1: 2.4(P<.0001), The average net revenue was also significantly less for all patients seen in the fast track by a ratio of 1:2.6 (P<.0001). Whe n stratified by diagnosis and acuity, the savings to society was $101, 313, or an average of $25/patient seen in the fast track (S101,313 per 4,060). A fast track is an effective system for maintaining patient f low at a cost savings to society. It can help the hospital in its nego tiations with payers because it curtails charges. It is also a potenti al means for maintaining overall departmental revenues as payers incre as ingly deny traditional pediatric ED visits for patients with lower acuity concerns. Copyright (C) 1997 by W.B. Saunders Company.