Using the online and offline change model to improve efficiency for fast-track patients in an emergency department.

Background: In 1998 the emergency department (ED) Work Group at Johns Hopkins Bayview Medical Center (Baltimore) worked to reinvigorate the fast-track program within the ED to improve throughput for patients with minor illnesses and injuries who present for care. There had been two prior unsuccessful attempts to overhaul the fast-track process.

Methods: The work group used a change model intended to improve both processes and relationships for complex organizational problems that span departments and functional units.