Safety and Effectiveness of Fast-Track Systems in Pediatric Urgent Care Units: A Systematic Review

Emergency department (ED) overcrowding and prolonged waiting times remain major challenges in pediatric emergency care. This systematic review evaluated the effectiveness and safety of fast-track systems implemented in pediatric urgent care and emergency department settings. A systematic search of PubMed/MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials was conducted for studies published between 2014 and 2024. Screening and selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A total of 1,038 records were identified, of which 251 were screened after duplicate removal, and 14 studies met the inclusion criteria. The included studies were conducted primarily in North America, Europe, Asia, and Australia and consisted mainly of before-and-after quality improvement (QI) studies and retrospective cohort designs. Across the included studies, fast-track implementation was associated with improvements in operational efficiency. Reported reductions in length of stay (LOS) ranged from 8.9% to 36%, while waiting times decreased in several studies, including reductions in arrival-to-provider time from 62 to 39 minutes in redesigned triage systems. Improvements in patient flow metrics, including reduced left-without-being-seen (LWBS) rates and decreased short-stay admissions, were also observed. Safety outcomes were reported in a subset of studies and generally included 72-hour return visits or 30-day readmissions, with no statistically significant increases observed following fast-track implementation. Four studies also reported improvements in caregiver satisfaction. Fast-track systems in pediatric emergency settings are associated with improved operational performance, particularly reductions in length of stay and waiting times, while maintaining stable safety outcomes. The effectiveness of these systems appears to depend on implementation characteristics such as dedicated clinical space, appropriate staffing models, and standardized clinical protocols. Further research is needed to evaluate long-term safety outcomes, sustainability, and applicability in diverse healthcare settings.