title: Night admission to the emergency department: a factor delaying time to surgery in patients with head injury.
abstract: OBJECTIVE
  To investigate factors influencing time from patient's arrival at the emergency department to surgery in patients with head injury.
  
  
  BACKGROUND
  A better understanding of factors influencing variation in time from patient's arrival at the emergency department to surgery for patients with head trauma could reduce mortality and morbidity associated with injury.
  
  
  METHODS
  A cross-sectional study of secondary data.
  
  
  METHODS
  The sample represented 493 patients with head injury requiring surgery from the 17 level I and II trauma centres. Data were extracted from the National Trauma Data Bank version 4.0. Two-level hierarchical models were used to analyse data at the patient level while incorporating a unique random effect for each trauma centre. Factors entered in the models included patient characteristics and trauma centre characteristics.
  
  
  RESULTS
  Patients with a Glasgow coma scale score of 3-8 in the first ED assessment had earlier time to surgery compared with those with a Glasgow coma scale of 13-15 (β = -0·31, 95% CI = -0·43-0·18). Patients who arrived at the hospital during the nighttime (6pm-8am) had a significantly delayed time to surgery than those who arrived during the daytime (8am-6pm) (β = -0·15, 95% CI = -0·26 to -0·04).
  
  
  CONCLUSIONS
  The more severely the injured patients were the faster surgery was performed. The time, when patients arrived to the emergency department was found to be a significant factor influencing time to surgery. Patients who arrived at emergency department at night had longer time to surgery than those who arrived during daytime, despite they were more severely head injured than those who arrived during the day.
  
  
  CONCLUSIONS
  When surgical intervention in head-injured patients is anticipated, especially during the night shift, time from patient's arrival at emergency department to surgery should be consistently assessed to identify opportunities for improvement in the structure and process of trauma care.
authors.affiliation: College of Nursing, Sungshin Women's University, Seoul, Korea. yjkim727@sungshin.ac.kr
authors.forename: Young-Ju
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D006259:Craniocerebral Trauma / Q000601:surgery*; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D016529:Emergency Nursing; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009493:Neurosurgery; D024802:Nurse's Role; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States; D000078329:Workforce