title: When should a doctor see me when I get sick? A study of the time of day acutely ill medical patients present and the time they wait to see a doctor in Ireland.
abstract: BACKGROUND
  Reconfiguration of the Irish Health Service has diverted of large numbers of acutely ill medical patients to a reduced number of hospitals and may have caused in delays in treatment. Although prompt care improves outcomes for patients with acute myocardial infarction, stroke, infection and shock, there is surprisingly little evidence for its value in other conditions.
  
  
  METHODS
  The time of admission and time patients waited to be seen and clerked by a doctor was reviewed on all medical patients admitted to Nenagh Hospital prior to service reconfiguration (i.e. from 17 February 2000 to 6 March 2004).
  
  
  RESULTS
  Over the study period of 1442,days 9435 patients were admitted (i.e. 6.5 patients per day or 0.3 per hour) and waited 37.6 SD 53.1min after admission before they were seen by a doctor. The peak time of admission is in the late afternoon and early evening and there was a liner correlation between the delay before seeing a doctor and the time of admission. The 1095 patients who waited 80min or more to be seen and clerked by a doctor (median delay 120min) were more likely to die (odds ratio 1.36 95% CI 1.03-1.81, p <0.03).
  
  
  CONCLUSIONS
  Waiting to be seen by a doctor may increase the risk of death to some patients. For these patients it is probably safer to be seen quickly by any doctor, rather than travel many miles and wait several hours to see a better one.
authors.forename: John
authors.initials: J
authors.lastname: Kellett
authors.forename: Breda
authors.initials: B
authors.lastname: Deane
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D057210:Delayed Diagnosis / Q000401:mortality*; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Acute medicine; Outcomes; Quality improvement; Treatment delay