title: What affects time to care in emergency room appendicitis patients?
abstract: 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.
authors: Department of Health Policy, Mount Sinai School of Medicine, New York, New York 10029, USA. nina.bickell@mssm.edu
authors: Nina A
authors: NA
authors: Bickell
authors: Ula
authors: U
authors: Hwang
authors: Rebecca M
authors: RM
authors: Anderson
authors: Mary
authors: M
authors: Rojas
authors: Carol L
authors: CL
authors: Barsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors