title: Emergency Department access block occupancy predicts delay to surgery in patients with fractured neck of femur.
abstract: OBJECTIVE
  The present study aimed to identify any relationship between existing access block occupancy (ABO) at the time of patient presentation and delay to definitive procedure.
  
  
  METHODS
  Retrospective descriptive cohort study of all patients aged over 50 years with an ED diagnosis of fractured neck of femur admitted through a tertiary ED over 2 years. The independent variable was the ABO at the start of the hour in which the patient presented, derived from existing ED records, and expressed as the quartile for that hour of the day. The dependent variable was start of surgery more than 24 h after arrival without a documented reason for delay. The data abstractor was blinded to the ABO.
  
  
  RESULTS
  All 442 diagnoses of fractured neck of femur recorded in the ED were reviewed, 73 were excluded (16 age, 5 misdiagnosis, 31 no surgery, 21 documented medical reasons for delay). There was a significant relationship between ABO quartile and the rate of delay to surgery ranging from 54% (95% CI 43-63%) for those presenting in the lowest ABO quartile to 77% (68-85%) in the highest (P= 0.006, chi(2)). Subgroup analysis showed that arrival ABO predicted patient access block, and that patient access block was associated with delay to surgery and longer postoperative length of stay (geometric mean 12.9 vs 9.9 days, P < 0.01, t-test).
  
  
  CONCLUSIONS
  The number of access block patients at the time of arrival directly predicts delay to operation in this setting. This suggests that access block occupancy is a marker of hospital dysfunction.
authors.affiliation: Medical School, Australian National University, Australian Capital Territory, Australia. drew.richardson@act.gov.au
authors.forename: Drew
authors.initials: D
authors.lastname: Richardson
authors.forename: Kristin L H
authors.initials: KL
authors.lastname: McMahon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044362:Australasia; D001509:Bed Occupancy / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome