title: Increasing wait times predict increasing mortality for emergency medical admissions.
abstract: 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 in the ED was highly predictive of subsequent 30-day mortality ranging from 4.8 (category 5) to 46.1% (category 1). After adjustment for all outcome predictors, including comorbidity and illness severity, both door-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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Emergency Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland. patrick.plunkett@tcd.ie
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Plunkett
authors.forename: Declan G
authors.initials: DG
authors.lastname: Byrne
authors.forename: Tomás
authors.initials: T
authors.lastname: Breslin
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Bernard
authors.initials: B
authors.lastname: Silke
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration*; D017052:Hospital Mortality; D006801:Humans; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013997:Time Factors; D014218:Triage / Q000458:organization & administration