Fast track keeps everyone moving through your ED

The fast track in the ED at Onslow Memorial Hospital in Jacksonville, NC, is designed to keep everyone in the ED moving, not just those seen in the minor emergency care unit (MECU), says Pat Stark, RN, BSN, nurse manager for the ED. When those with relatively minor needs are funneled out of the regular ED system, they receive faster care, and so does everyone else in the ED.

The MECU is an eight-bed unit, staffed with two nurse practitioners and three licensed personnel, that is adjacent to the normal ED at Onslow. The unit is open from 11 a.m. to 11 p.m., but its success and the ever-growing number of ED patients has the hospital considering longer hours.

All patients enter through the main ED and are triaged normally, but those with the lowest priority triage are sent to the MECU instead of waiting at the end of the line in the main ED. The MECU patients immediately are sent to the MECU, which has its own waiting area. "We didn’t want patients from the two services arguing about who was there first and why the minor injury is getting faster care," Stark says. "The MECU typically sees things like sore throats and flu; but on some days, we might step it up to the next level and send over patients with minor lacerations that aren’t bleeding."

Most of the nurse practitioners can suture minor wounds in the MECU. If the patient needs to see a physician, the patient can be taken back to the other side or the physician can come to the MECU.

When the ED is short staffed, the nurse practitioners may be pulled from the MECU to help out. The MECU is proving to be more successful and more helpful in relieving the main ED’s overcrowding than the off-site urgent care center that the hospital formerly had.

The left-without-being-seen rates have plummeted from 14% to 2%, but the number of patients coming to the ED keeps rising, Stark says. That increase may be one unintended result of the MECU, she adds.

"A potential downside is that you encourage people to come to the ED with nonemergency needs. It’s amazing how word gets around in the community," Stark says. "I’ve heard patients say they came here instead of another hospital because we move faster," she states.


For more information, contact:

  • Annie T. Sadosty, MD, Department of Emergency Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905. Telephone: (507) 284-2511.
  • Matthew Rice, MD, JD, Senior Vice President and Chief Medical Officer, Northwest Emergency Physicians, 3455 S. 344th Way, Suite 210, Federal Way, WA 98001. Tele-phone: (800) 336-8614.
  • Pat Stark, RN, BSN, Nurse Manager, Emergency Department, Onslow Memorial Hospital, 317 Western Blvd., Jacksonville, NC 28541. Telephone: (910) 577-2345.