title: Factors associated with delays to emergency care for bowel obstruction.
abstract: BACKGROUND
  Our objective was to determine factors associated with delays to first treatment for emergency department (ED) patients diagnosed with small-bowel obstruction (SBO).
  
  
  METHODS
  This was a retrospective study of ED patients with SBO. Data were collected from medical records, administrative databases, and staffing schedules at an urban, tertiary care medical center from June 1, 2001, to November 30, 2002. Patient-related characteristics and processes of ED and hospital care were evaluated. Outcomes studied were time to first treatment (nasogastric tube or surgery) and risk of surgical resection.
  
  
  RESULTS
  A total of 193 patients were diagnosed with confirmed intestinal obstruction. Patients with longer times to first treatment arrived during ED clinician hand-offs (adjusted hazard ratio, .40; 95% confidence interval, .17-.98). Patients with longer times to surgery consult (ref. first quartile) had greater odds of surgical resection (second quartile adjusted odds ratio, 6.91; 95% confidence interval, 1.85-24.80).
  
  
  CONCLUSIONS
  Remediable ED and hospital factors were associated with longer times to treatment for patients with bowel obstruction.
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. ula.hwang@mountsinai.org
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Aufses
authors.forename: Nina A
authors.initials: NA
authors.lastname: Bickell
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care; D057210:Delayed Diagnosis; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000628:therapy*; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors