Exploration of the needs and barriers of organizational change involving the implementation of a fast track in an emergency department and the motivational theories necessary to overcome those barriers will occur. Identification and description of the organizational change with the fast track implementation will occur. We will examine organizational and individual barriers to the change as well as find other factors possibly influencing the process.
The purpose of implementing a fast track is to make the length of stay (LOS) one-hour or less. LOS is time of presentation to time of discharge. The benefits of a fast track are reduction in the turnaround times for patients fitting into the fast track triage criteria, increase in patient satisfaction because of the expedited care, enhancement of the hospital's image in the community, and increase ED staff morale. This group of patients typically has a payer mix that yields substantially higher collections than that of the ED average. This is turn affords many of them the luxury of acquiring an alternative to the ED if the ED is not meeting their service expectations. Because patients falling into the categories of nonemergent comprise a minimum of 35% of the total ED patient volume, they are also the patients who typically pay a disproportionate share of the emergency physician's total compensation (Considine, Kropman, Kelly, & Winter, 2008).
To accomplish the goal of LOS of one hour, ED must have certain items in place. A dedicated fast track area, minimum of three chairs, appropriate signage, dedicated physician assistant or RNP, dedicated or designated registration, a dedicated nurse assigned to fast track as his or her sole responsibility. The triage nurse initially will select the fast track patient candidates based on ED guidelines as well as experience and critical, thinking skills.
With the implementation of internal and external resources, fast tracks allow rapid intake processing, diagnosis, treatment, and discharge without sacrificing quality of care. Not only does a fast track project need excellent leadership team, but it also needs broad range of employees from different levels, a motivated implementation team, and an excellent communication plan.
Many barriers exist when considering implementation. Financial constraints are a barrier to any organizational change. Budgeting for a fast track's implementation needs to include funds for preliminary research, consultation, and administrative meetings to plan implementation. The cost of the program itself will be added to the cost of training staff and purchasing necessary equipment and supplies. Other unexpected costs will include increased staffing needs and decreased practitioner productivity during implementation (Zandieh, Yoon-Flanner, Kuperman, Langsum, Hyman, and Kaushal, 2007).