The effects on length of stay of introducing a fast track patient pathway for myocardial infarction: a before and after evaluation.

The aim was to assess whether the implementation of a fast-track patient pathway (FTPP) at an invasive treatment ward (ITW) could reduce the length of hospital stay (LOHS), among patients with non-ST Elevation Myocardial Infarction (NSTEMI). A before-and-after study was carried out, based on historical data from a total of 202 patients with NSTEMI admitted to a coronary ITW during two inclusion periods each lasting 100 days (Period I, 2004, no fast track, 95 consecutive patients; Period II, 2005, fast track implemented, 107 consecutive patients). Patients were followed during 180 days as concerns the total LOHS. A total of 33 patients passed through the FTPP. Their mean total LOHS was significantly shorter (3.3 days reduction; 95% CI 1.7, 5.5 days) as compared with all Period II patients. In total, Period II patients, however, spent significantly more days (mean, 1.7 days more; 95% CI 0.2, 3.3 days) in hospital than Period I patients. Thus, the implementation of FTPP reduced the mean LOHS for patients selected for the FTPP, but the mean LOHS for other patients rose and so the overall mean LOHS turned out to be significantly prolonged. The implementation of FTPP appears a complicated matter; changing one component has consequences for the wider health-care system.