{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T09:28:46Z","timestamp":1793698126502,"version":"4.5.1"},"reference-count":51,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","jenonline.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Emergency Nursing"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.jen.2026.07.017","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:40:32Z","timestamp":1791960032000},"update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Fast Care Model and Clinical Leadership in the Emergency Department: A Randomized Clinical Trial"],"prefix":"10.1016","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6196-7797","authenticated-orcid":false,"given":"Annalisa","family":"Gemmano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6236-3283","authenticated-orcid":false,"given":"Valerio","family":"Della Bella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4964-8794","authenticated-orcid":false,"given":"Jacopo","family":"Fiorini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Rogliani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Alivernini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girolamo","family":"De Andreis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Sili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jen.2026.07.017_bib1","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1444951","article-title":"Addressing the overuse of hospital emergency departments in the Portuguese NHS: a new paradigm","volume":"12","author":"Goiana-da-Silva","year":"2025","journal-title":"Front Public Health"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib2","doi-asserted-by":"crossref","first-page":"94","DOI":"10.54996\/anatolianjem.1684632","article-title":"Overcrowding in emergency departments: A scoping literature review","volume":"8","author":"Altun","year":"2025","journal-title":"Anatol J Emerg Med"},{"issue":"9","key":"10.1016\/j.jen.2026.07.017_bib3","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.3390\/healthcare10091625","article-title":"Overcrowding in emergency department: causes, consequences, and solutions-a narrative","volume":"10","author":"Sartini","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"10.1016\/j.jen.2026.07.017_bib4","doi-asserted-by":"crossref","first-page":"973","DOI":"10.2147\/RMHP.S454925","article-title":"Perceived causes and effects of overcrowding among nurses in the emergency departments of tertiary hospitals: a multicenter study","volume":"17","author":"Guerrero","year":"2024","journal-title":"Risk Manag Healthc Policy"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13690-022-00787-5","article-title":"Non-emergent care visits in a Turkish tertiary care emergency department after 2008 health policy changes: review and analysis","volume":"80","author":"Dundar","year":"2022","journal-title":"Arch Public Health"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib6","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.50522","article-title":"Concordance in medical urgency classification of discharge diagnoses and reasons for visit","volume":"7","author":"Giannouchos","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"4","key":"10.1016\/j.jen.2026.07.017_bib7","article-title":"Changes in low-acuity patient volume in an emergency department after launching a walk-in clinic","volume":"4","author":"Kurian","year":"2023","journal-title":"J Am Coll Emerg Physicians Open"},{"issue":"3 suppl 49","key":"10.1016\/j.jen.2026.07.017_bib8","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1016\/j.annemergmed.2025.06.127","article-title":"114 optimizing emergency department flow: the impact of a split flow model on efficiency metrics","volume":"86","author":"Smith","year":"2025","journal-title":"Ann Emerg Med"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12873-024-01163-y","article-title":"Effective strategies for reducing patient length of stay in the emergency department: a systematic review and meta-analysis","volume":"25","author":"Devia Jaramillo","year":"2025","journal-title":"BMC Emerg Med"},{"issue":"6","key":"10.1016\/j.jen.2026.07.017_bib10","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1017\/cem.2020.426","article-title":"Throughput interventions to reduce emergency department crowding: A systematic review","volume":"22","author":"Grant","year":"2020","journal-title":"CJEM"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib11","doi-asserted-by":"crossref","DOI":"10.5001\/omj.2020.22","article-title":"\u201cSee and treat\u201d clinic service evaluation at a Tertiary Care Hospital in Abu Dhabi","volume":"35","author":"Ghaleb","year":"2020","journal-title":"Oman Med J"},{"issue":"5-6","key":"10.1016\/j.jen.2026.07.017_bib12","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00508-019-01596-7","article-title":"Emergency department overcrowding: analysis and strategies to manage an international phenomenon","volume":"133","author":"Lindner","year":"2021","journal-title":"Wien Klin Wochenschr"},{"issue":"4 suppl 7","key":"10.1016\/j.jen.2026.07.017_bib13","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1016\/j.annemergmed.2022.08.036","article-title":"14 The impact of a mixed fast-track and mid-acuity track area with a vertical component on emergency department throughput","volume":"80","author":"Muradian","year":"2022","journal-title":"Ann Emerg Med"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib14","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1186\/s12913-023-09869-8","article-title":"Quality communication can improve patient-centred health outcomes among older patients: a rapid review","volume":"23","author":"Sharkiya","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.auec.2019.01.004","article-title":"Fast track patients\u2019 satisfaction, compliance and confidence with emergency department discharge planning","volume":"22","author":"Stevens","year":"2019","journal-title":"Australas Emerg Care"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib16","doi-asserted-by":"crossref","first-page":"6","DOI":"10.29173\/cjen225","article-title":"Impact of nurse practitioner role in emergency departments: a mixed studies systematic review protocol","volume":"47","author":"Lartey","year":"2024","journal-title":"Can J Emerg Nurs"},{"issue":"4","key":"10.1016\/j.jen.2026.07.017_bib17","doi-asserted-by":"crossref","first-page":"4","DOI":"10.5334\/ijic.5994","article-title":"Continuity of care and healthcare costs among patients with chronic disease: evidence from primary care settings in China","volume":"22","author":"Liang","year":"2022","journal-title":"Int J Integr Care"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib18","doi-asserted-by":"crossref","DOI":"10.4081\/scenario.2025.623","article-title":"Follow-up telefonico infermieristico e outcome degli assistiti con scompenso cardiaco: studio osservazionale retrospettivonursing telephone follow-up and outcomes in heart failure patients: a retrospective observational study","volume":"42","author":"Janjic","year":"2025","journal-title":"SCENARIO"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib19","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s11739-025-04145-5","article-title":"Exploring the implementation of nurses\u2019 advanced competencies in emergency departments: a scoping review","volume":"21","author":"Franchini","year":"2026","journal-title":"Intern Emerg Med"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/01.ASW.0000897444.78712.fb","article-title":"Specialized nurse-led care of chronic wounds during hospitalization and after discharge: A randomized controlled trial","volume":"36","author":"Sili","year":"2023","journal-title":"Adv Skin Wound Care"},{"issue":"8","key":"10.1016\/j.jen.2026.07.017_bib21","doi-asserted-by":"crossref","first-page":"3371","DOI":"10.1111\/jan.16032","article-title":"The role of the clinical nurse specialist in stoma care: a modified Delphi consensus","volume":"80","author":"Burch","year":"2024","journal-title":"J Adv Nurs"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib22","doi-asserted-by":"crossref","first-page":"23","DOI":"10.29173\/cjen44","article-title":"Research to action: nurse practitioners in the emergency department, emergency department transition clinic and intravenous therapy clinic at Strathcona Community Hospital","volume":"43","author":"Shand","year":"2020","journal-title":"Can J Emerg Nurs"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13722-017-0080-2","article-title":"Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options in primary CarE (CHOICE) trial","volume":"12","author":"Bradley","year":"2017","journal-title":"Addict Sci Clin Pract"},{"issue":"suppl 3","key":"10.1016\/j.jen.2026.07.017_bib24","article-title":"Emergency Department waiting-time in the post pandemic era: new organizational models, a challenge for the future","volume":"94","author":"Stirparo","year":"2023","journal-title":"Acta Biomed"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib25","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s11739-023-03477-4","article-title":"Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes","volume":"19","author":"Pearce","year":"2024","journal-title":"Intern Emerg Med"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib26","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.15452\/cejnm.2025.16.0010","article-title":"Empowering educational actions of nurses for patients with long-term health problems: an integrative review","volume":"16","author":"Heinonen","year":"2025","journal-title":"Cent Eur J Nurs Midwif"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib27","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1186\/s12912-025-03040-w","article-title":"Effectiveness of nurse-led transitional care interventions for adult patients discharged from acute care hospitals: a systematic review and meta-analysis","volume":"24","author":"Sakashita","year":"2025","journal-title":"BMC Nurs"},{"issue":"12","key":"10.1016\/j.jen.2026.07.017_bib28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2025-108770","article-title":"Socioeconomic inequality and access to emergency care: understanding the pathways to the emergency department in the UK","volume":"15","author":"Madia","year":"2025","journal-title":"BMJ Open"},{"issue":"10489","key":"10.1016\/j.jen.2026.07.017_bib29","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/S0140-6736(25)00672-5","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials","volume":"405","author":"Hopewell","year":"2025","journal-title":"Lancet"},{"key":"10.1016\/j.jen.2026.07.017_bib30","article-title":"Fast care clinical pathway in the emergency department: a quasi-experimental study","author":"Gemmano","year":"2025","journal-title":"OSF Registries"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib32","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12912-025-02729-2","article-title":"Nurse management of minor problems in primary care emergencies: a non-randomized controlled trial","volume":"24","author":"Estarlich-Corominas","year":"2025","journal-title":"BMC Nurs"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib33","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s12873-024-01080-0","article-title":"Redirection of low-acuity emergency department patients to nearby medical clinics using an electronic medical support system: effects on emergency department performance indicators","volume":"24","author":"Feral-Pierssens","year":"2024","journal-title":"BMC Emerg Med"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib35","article-title":"Strategies to measure and improve emergency department performance: a review","volume":"16","author":"Mostafa","year":"2024","journal-title":"Cureus"},{"issue":"3","key":"10.1016\/j.jen.2026.07.017_bib36","first-page":"4","article-title":"Relative risk analysis of patient return within 72 hours to emergency department","volume":"21","author":"Aishwarya","year":"2022","journal-title":"Online J Health Allied Scs"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib37","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12877-020-01536-5","article-title":"Is the fast-track process efficient and safe for older adults admitted to the emergency department?","volume":"20","author":"Gasperini","year":"2020","journal-title":"BMC Geriatr"},{"key":"10.1016\/j.jen.2026.07.017_bib38","series-title":"Fundamentals of Biostatistics","author":"Rosner","year":"2011"},{"issue":"6","key":"10.1016\/j.jen.2026.07.017_bib40","doi-asserted-by":"crossref","first-page":"531","DOI":"10.4097\/kja.23278","article-title":"Intention-to-treat versus as-treated versus per-protocol approaches to analysis","volume":"76","author":"Ahn","year":"2023","journal-title":"Korean J Anesthesiol"},{"key":"10.1016\/j.jen.2026.07.017_bib41","doi-asserted-by":"crossref","DOI":"10.1891\/RTNP-2024-0116","article-title":"Toward a situation-specific theory of nursing organizational well-being: an early-stage sevelopment","author":"Della Bella","year":"2025","journal-title":"Res Theory Nurs Pract"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib42","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s11739-025-04225-6","article-title":"Supporting emergency departments workers well-being: a systematic review of the literature on interventions","volume":"21","author":"Colaiacovo","year":"2025","journal-title":"Intern Emerg Med"},{"key":"10.1016\/j.jen.2026.07.017_bib43","doi-asserted-by":"crossref","first-page":"311","DOI":"10.2147\/OAEM.S316366","article-title":"Investigating indicators of waiting time and length of stay in emergency departments","volume":"13","author":"Al Nhdi","year":"2021","journal-title":"Open Access Emerg Med"},{"issue":"7","key":"10.1016\/j.jen.2026.07.017_bib44","doi-asserted-by":"crossref","first-page":"3178","DOI":"10.1111\/jonm.13739","article-title":"Nursing leadership in clinical practice, its efficacy and repercussion on nursing-sensitive outcomes: a cross-sectional multicentre protocol study","volume":"30","author":"Fiorini","year":"2022","journal-title":"J Nurs Manag"},{"key":"10.1016\/j.jen.2026.07.017_bib45","article-title":"Association of emergency department waiting times with patient experience in admitted and discharged patients","volume":"8","author":"Nyce","year":"2021","journal-title":"J Patient Exp"},{"issue":"4","key":"10.1016\/j.jen.2026.07.017_bib46","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1007\/s11739-021-02919-1","article-title":"Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)","volume":"17","author":"Otto","year":"2022","journal-title":"Intern Emerg Med"},{"issue":"13","key":"10.1016\/j.jen.2026.07.017_bib47","doi-asserted-by":"crossref","first-page":"7367","DOI":"10.3390\/app15137367","article-title":"Fast track design using process mining: does it improve saturation and times in emergency departments?","volume":"15","author":"Celda-Moret","year":"2025","journal-title":"Appl Sci"},{"issue":"3","key":"10.1016\/j.jen.2026.07.017_bib48","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2020-001058","article-title":"Efficiency measures of emergency departments: an Italian systematic literature review","volume":"10","author":"Di Laura","year":"2021","journal-title":"BMJ Open Qual"},{"issue":"10","key":"10.1016\/j.jen.2026.07.017_bib49","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.ifacol.2022.09.452","article-title":"Relevance of fast-track to manage overcrowding in emergency departments","volume":"55","author":"Viera","year":"2022","journal-title":"IFAC-PapersOnLine"},{"key":"10.1016\/j.jen.2026.07.017_bib50","doi-asserted-by":"crossref","DOI":"10.1155\/emmi\/7199212","article-title":"Reasons and features of patients who leave the emergency department without being seen","volume":"2025","author":"Abuguyan","year":"2025","journal-title":"Emerg Med Int"},{"issue":"46","key":"10.1016\/j.jen.2026.07.017_bib51","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000040543","article-title":"Characteristics of patients leaving the emergency department without being seen by a doctor: the first report from T\u00fcrkiye","volume":"103","author":"\u015eeng\u00fcld\u00fcr","year":"2024","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"10.1016\/j.jen.2026.07.017_bib52","doi-asserted-by":"crossref","DOI":"10.1111\/ijun.70019","article-title":"Nursing care organisational model for patients with bladder diseases: a systematic review","volume":"19","author":"Bann\u00f2","year":"2025","journal-title":"Int J Urol Nurs"},{"issue":"4","key":"10.1016\/j.jen.2026.07.017_bib53","first-page":"245","article-title":"Care complexity factors associated with revisits to an emergency department","volume":"35","author":"Urbina","year":"2023","journal-title":"Emergencias"},{"issue":"1","key":"10.1016\/j.jen.2026.07.017_bib54","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12245-025-00847-x","article-title":"Critical revisits after discharge from the emergency department","volume":"18","author":"Liu","year":"2025","journal-title":"Int J Emerg Med"}],"container-title":["Journal of Emergency Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099176726002552?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0099176726002552?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T09:05:11Z","timestamp":1793696711000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0099176726002552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":51,"alternative-id":["S0099176726002552"],"URL":"https:\/\/doi.org\/10.1016\/j.jen.2026.07.017","relation":{},"ISSN":["0099-1767"],"issn-type":[{"value":"0099-1767","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The Fast Care Model and Clinical Leadership in the Emergency Department: A Randomized Clinical Trial","name":"articletitle","label":"Article Title"},{"value":"Journal of Emergency Nursing","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jen.2026.07.017","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Emergency Nurses Association. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}