Secondly, none of the studies were set in a tertiary level, urban Middle Eastern hospital. Thirdly, with a few exceptions, most of the studies had very small and biased samples [7,21]. Finally, only one

study, rigorously evaluated the effect of a fast track system on urgent patients [17]. The aim of this study was to determine if a FTA improved both effectiveness in service delivery (WTs and LOS) and quality measures (LWBS rates and mortality rates) for patients with minor injuries and illnesses classified according to the Canadian Triage Acuity Scale 4 and 5 (CTAS 4/5), without delaying the care of urgent patients (CTAS 2/3). Methods Study Setting and Design This study took place in a 500 bed urban tertiary Inhibitors,research,lifescience,medical care general hospital, BYL719 Sheikh Khalifa Medical City, in the United Arab Emirates (UAE). The public emergency care facility serves residents of Abu Dhabi (capital city of the UAE) and surrounding Inhibitors,research,lifescience,medical areas. In 2005, the ED had an annual census of approximately 70 000 patients. The study

population consisted of adult and pediatric patients (defined as patients less than 12 years old as per hospital policy). The ED included a three-bed resuscitation area, and 15 monitored acute treatment beds (total of 18 ED beds) in the pre-fast track period and 7 additional FTA beds after the intervention (total of 25 Inhibitors,research,lifescience,medical beds). This was a single center study of ED department services at our hospital which provides all Inhibitors,research,lifescience,medical major medical, surgical and pediatric disciplines. The FTA was opened in February 2005. All patients entering the ED were seen by triage nurses and classified according to the Canadian Triage and Acuity Scale (CTAS) [22]. The low acuity patients (CTAS 4 and 5) were then treated, referred or discharged by the

physician from the FTA. Urgent patients (CTAS 2 and 3) were seen in the main ED. The CTAS is a 5 level triage scale Inhibitors,research,lifescience,medical based primarily on the patients presenting complaint and physiologic parameter. The CTAS guidelines are to ensure timely access to physician assessment on the basis of triage acuity level. A patient in CTAS 1 (resuscitation) requires immediate attention. CTAS 2 (emergent) should be seen within 15 minutes. CTAS 3 (urgent) should be seen within 30 minutes PAK6 and the non urgent, CTAS 4 and 5 should be seen within 60 minutes and 120 minutes respectively. The typical patient in CTAS 4 and 5 is ambulatory, does not need extensive investigation and contributes to < 10% of total admissions. The characteristics of our FTA are as follows: It has seven beds, is operational 24 hours a day, is staffed by either one or two Arabic speaking doctors at any time (of which 40% are house-officers and 60% are specialists with ED experience but no formal certification) depending on peak visits, sees only CTAS 4/5 (non-urgent) patients and performs only point of care laboratory testing e.g. pregnancy tests, urine dipsticks, glucose and chest X rays.