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Increasing wait times predict increasing mortality foremergency medical admissions.
MedLine Citation:
PMID:  21317786     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The actual impact of emergency department (ED) 'wait' time on hospital mortality in patients admitted as a medical emergency has often been debated. We have evaluated the impact of such waits on 30-day mortality, for all medical patients over a 7-year period. METHODS: All patients admitted as medical emergencies by the ED between 2002 and 2008 were studied; we looked at the impact of time to medical referral and subsequent time to a ward bed on any inhospital death within 30 days. Significant univariate predictors of outcome, including Charlson's comorbidity and acute illness severity score, were entered into a multivariate regression model, adjusting the univariate estimates of the readmission status on mortality. RESULTS: We studied 23 114 consecutive acute medical admissions between 2002 and 2008. The triage category inthe ED was highly predictive of subsequent 30-day mortality ranging from 4.8 (category 5) to 46.1% (category1). After adjustment for all outcome predictors,including comorbidity and illness severity, bothdoor-to-team and team-to-ward times were independent predictors of death within 30 days with respective odds ratios of 1.13 (95%confidence interval 1.07-1.18), and 1.07 (95% confidence interval 1.02-1.13). CONCLUSION: Delay to admission have been shown to be independently adversely related to mortality outcome. We recommend maximal target limits of 4 and 6 h for referrals and admissions, respectively, based on these mortality observations.
Authors:
Patrick K Plunkett; Declan G Byrne; Tomás Breslin; Kathleen Bennett; Bernard Silke
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-11
Journal Detail:
Title:  European journal of emergency medicine : official journal of the European Society for Emergency Medicine     Volume:  -     ISSN:  1473-5695     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442482     Medline TA:  Eur J Emerg Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aDepartment of Emergency Medicine bDivision of Internal Medicine cDepartment of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
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