Improving Emergency Department Efficiency Through a Primary-Care-Led Fast Track Model: A High-Volume Hospital Experience

Background

Emergency Departments (EDs) in Greece face persistent challenges related to overcrowding, prolonged waiting times, staff shortages, and limited infrastructure. Many patients seek care in EDs for conditions that could be managed at the primary care level. The General Hospital of Nikaia, among the busiest in Athens, reports more than 107,000 annual ED visits, highlighting the urgency for operational improvements. To mitigate system strain and streamline patient flow, a Fast Track (FT) area staffed by primary care physicians was introduced in 2017.

Methods

The Fast Track intervention targeted low-acuity patients who did not require immediate resuscitation or advanced diagnostic interventions. All ED attendees were screened through a standardized triage process using the Emergency Severity Index (ESI) and National Early Warning Score (NEWS). Eligible Fast Track patients included those classified as ESI 4–5, with NEWSs of 0–3, ambulatory individuals over 16 years of age, and minor trauma cases. Additional specialty pathways were delineated for more specialties. Operational metrics, including Fast Track utilization, referral rates, and admission rates among referred patients, were monitored over time to evaluate effectiveness.

Results

Findings indicate a significant increase in Fast Track utilization across the observation period. Referral rates from Fast Track to the main ED decreased, demonstrating improved case resolution within the FT unit. Simultaneously, the proportion of referrals that resulted in hospital admission increased, suggesting more appropriate and targeted identification of patients requiring higher-level care. The main medical areas, and particularly the internal medicine area, experienced demonstrable relief from patient congestion.

Conclusion

The implementation of a primary-care-led Fast Track area contributed to more efficient triage, optimized resource allocation, and reduced bottlenecks within a high-demand ED environment. The model effectively improved patient flow and represents a viable strategy for enhancing acute care delivery in resource-strained healthcare systems.