Date of Degree
Summer 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Lydia Forsythe
Second Advisor
Corinne Cochran
Abstract
Problem: Overcrowding and prolonged wait times in emergency departments (ED) negatively affect patient safety, outcomes, and satisfaction. Hospital A, a Level 1 trauma center with over 52,000 annual ED visits, consistently exceeded the national ED length of stay (EDLOS) benchmark of 6 hours, averaging 6.7 hours, with left without being seen (LWBS) rates at 2.89%, surpassing the 2% target. Low-acuity Emergency Severity Index (ESI) level 4 and 5 patients contributed to congestion due to inefficient triage processes and lack of alternative care pathways, delaying timely access to care.
Aim of the Project: The project aimed to implement an evidence-based fast-track pathway to reduce EDLOS, door-to-provider times, and LWBS rates for low-acuity ESI level 4 and 5 patients, improving patient throughput and ED efficiency.
Review of the Evidence: A systematic literature review identified fast-track pathways as effective strategies to reduce wait times, LOS, and LWBS among low-acuity patients (Adriani et al., 2021; Faber et al., 2023). Ten high-quality studies, including systematic reviews and quality improvement projects, supported the use of designated care areas, triage redesign, and staff engagement to improve ED throughput and patient outcomes.
Project Design: This quality improvement (QI) project utilized Plan-Do-Study-Act (PDSA) cycles and the OhioHealth Change Management (OHCM) Model to guide iterative process refinements. Stakeholder collaboration, process mapping, and continuous performance monitoring were integral to the intervention's success. Intervention: Over 12 weeks, a fast-track pathway for ESI level 4 and 5 patients was implemented, including dedicated treatment spaces, modified triage processes, role delineation, and real-time data tracking. Staff training emphasized unconscious bias awareness and social determinants of health (SDOH) screening to promote equitable care delivery.
Significant Findings/Outcomes: Post-intervention, EDLOS decreased by 7% and discharge LOS by 8%. LWBS rates reduced from 2.89% to 1.65%, with fast-track LWBS at 0.66%. Door-to-provider times improved by 4.6 minutes. Fast-track utilization averaged 31%, peaking at 41% during high-volume periods.
Implications for Nursing: Nursing leadership is essential in improving ED efficiency, triage accuracy, and equitable care. Fast-track pathways offer a sustainable solution to reduce overcrowding, enhance patient experience, and optimize ED operations.
Recommended Citation
Donaldson, Dawnyel, "Implementing a Fast-Track Pathway for Low Acuity Patients to Reduce Patient Length of Stay in the Emergency Department" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 38.
https://fuse.franklin.edu/dnp-project/38
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