Appendicitis Research Today is a free monthly online journal that collates and summarizes the latest research about Appendicitis, including details on symptoms, surgery, causes, treatment. | ||||||||
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What affects time to care in emergency room appendicitis patients?Bickell NA, Hwang U, Anderson RM, Rojas M, Barsky CL Department of Health Policy, Mount Sinai School of Medicine, New York, New York 10029, USA. nina.bickell@mssm.edu BACKGROUND: Emergency departments (EDs) provide a safety net for seriously ill individuals. Little is known about factors that affect time to diagnosis and treatment of patients with time-sensitive conditions within the ED. METHODS: Retrospective observational study of 236 appendicitis patients examining patient factors and ED characteristics with time to a surgeon's diagnosis of appendicitis and ED length of stay (LOS). RESULTS: Time to surgeon's diagnosis and ED LOS were slower for nonwhite patients without private insurance (parameter estimate = 0.38, P = 0.002 and 0.31, P < 0.001, respectively) and quicker for patients for whom the ED physician's diagnostic first impression was appendicitis (parameter estimate = -0.29, P = 0.003 and -0.14, P = 0.04, respectively). Greater numbers of physicians staffing the ED had a modest effect on time to surgeon diagnosis and ED LOS (parameter estimate = -0.04, P = 0.01 and -0.04, P = 0.01, respectively), whereas greater numbers of patients had little impact (parameter estimate = -0.005, P = 0.04 and -0.002, P = 0.28, respectively). CONCLUSIONS: Minority patients without private insurance had slower times to specialist consultation and treatment; ED staffing and census had a small effect. To maximize patient safety and ED quality of care, administrators should ensure timely specialist consultation and determine additional mechanisms facilitating white privately insured patients' quicker care. Published 25 March 2008 in Med Care, 46(4): 417-22.
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