For emergency departments seeing medium to high volumes of patients, the concept of patient segmentation is becoming popular as a flow strategy.^1-3 Patient segmentation means grouping patients requiring similar levels of care and having similar anticipated lengths of stay (LOS) into a geographic area with dedicated staff and resources. The earliest example of patient segmentation is Fast Track, which now has a very compelling body of literature behind it.^3-6 Other newer examples of patient segmentation include:

• Geriatric ED
• Chest pain center
• Pediatric ED
• Critical decision unit
• Observation unit
• SuperTrack

SuperTrack was pioneered by Jody Crane, MD, in the Mary Washington Hospital Emergency Department in Fredericksburg, Virginia, as part of a complete patient-flow makeover.⁷ The Mary Washington ED was seeing more than 100,000 visits when it opened its new doors in 2006 and was plagued with front-end waits and delays. As part of a complete overhaul of its ED patient flow, Crane and his colleagues assigned patients to different patient streams in geographic zones based on their acuity. This included a so-called SuperTrack for the lowest-acuity patients. They saw a reduction in LOS, improvement in patient and staff satisfaction, and dramatic reductions in patients leaving without being seen (LWBS).

Similarly, Parkland Urgent Care ED (UCED), part of the Parkland Health & Hospital System in Dallas, tackled its patient-flow issues by employing a variation of SuperTrack in December 2012. Parkland representatives presented its findings at the ED Innovations 2014 Conference held in Las Vegas in Feb. 2014. The team reported experiencing staggering arrival surges. These arrivals were overwhelming existing processes, causing high LWBS rates (7.8 percent) and door-to-provider times (158 minutes) in Dec. 2012. The team decided to revamp both intake processes and the streaming of patients. It created processes and designated space for focusing on the lowest-acuity patients (Emergency Severity Index Level 5). It dedicated six rooms as SuperTrack from 8 a.m. to 6 p.m., where identified patients would be seen by a patient care team consisting of nurses and technicians. Patients had already undergone a medical screening exam by an advanced practice provider in triage. SuperTrack was also populated by other low-acuity patients who had protocol-driven orders. The SuperTrack chief complaints and criteria were very specific and included:

• Cold symptoms/congestion
• Headache, under 50 years of age
• Purified protein derivative placement or reading
• Suture/staple removal
• Dental pain
• Dysuria with positive urinalysis results
• Asymptomatic hypertension
• Sore throat
• Hemorrhoids
• Medication refill (with labs resulted)
• Cough less than two weeks’ duration
• Earache
• Pinkeye
• Sinus congestion

Once patients were found to meet the SuperTrack criteria, they were quickly placed in a room, and a patient care tech (PCT) would expedite this process and alert the provider. This pull-to-full system for expediting SuperTrack patients was owned by the PCT and was an important feature of the new process. Providers can always reroute a patient if they feel that other information indicates a higher level of care is required. Providers simply place additional orders and communicate with the main ED team.