The effect of a 'fast-track' unit on the performance of a cardiothoracic department

Objective: The objective of this study was to describe the impact of a 'fas t-track' unit, combined with a computerised system for information collecti on and analysis, on the clinical practice and finance of a cardiothoracic d epartment over the first 12 month period of its application. Methods: Within 12 months, starting December 1996, 642 major cardiothoracic cases were performed at the Cardiothoracic Department, St Mary's Hospital, London, after the establishment of a 3-bed 'fast-track' unit, which was su pported by a computerised system for admission planning and a pre-admission clinic. The main outcome measures were operating numbers, financial income , patient recovery and operative mortality. Results: The 'fast-track' unit resulted in an increase of the operating num bers (11.3% increase in major cardiac cases) and income (38%), as compared with the year before. Some 525 patients out of 642 (81.8%) were scheduled f or the 'fast-track' unit and 492 (93.7%) were successfully 'fast-tracked'. Coronary artery bypass grafting operations had the lowest 'fast-track' fail ure and mortality rates. Re-do operations and complex coronary procedures p resented a high 'fast-track' failure rate of approximately 20-25%. Low card iac output, postoperative bleeding and respiratory problems were the most f requent causes for 'fast-track' failure. Conclusions: The development of a 'fast-track' unit, supported by a compute rised system for information collection and analysis and a pre-admission cl inic, has resulted in a substantial improvement of operating numbers and fi nancial income, without adversely affecting the clinical results. This task demanded close collaboration between a dedicated list manager and a design ated member of the medical team. Patient selection with appropriate 'fast-t rack' criteria may improve further the efficiency of 'fast-track' units in the future.