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Increasing wait times predict increasing mortality for emergency medical admissions
Patrick K Plunkett1, Declan G Byrne, Tomás Breslin
1Department of Emergency Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland. patrick.plunkett@tcd.ie
Summary
Emergency department wait times significantly increase mortality risk for medical admissions. Delays in medical referral and ward bed access independently predict higher 30-day mortality, necessitating timely interventions.
Area of Science:
- Emergency Medicine
- Health Services Research
- Clinical Outcomes
Background:
- The impact of emergency department (ED) wait times on mortality for medical admissions is a persistent debate.
- This study investigates the relationship between ED wait times and 30-day mortality in medical patients over seven years.
Purpose of the Study:
- To evaluate the effect of ED wait times on in-hospital mortality for medical emergency admissions.
- To identify specific time intervals within the ED process that influence patient outcomes.
Main Methods:
- Analysis of 23,114 medical admissions between 2002 and 2008.
- Examined the impact of time to medical referral and time to ward bed on 30-day mortality.
- Utilized multivariate regression, adjusting for comorbidity and illness severity scores.
Main Results:
- ED triage category strongly predicted 30-day mortality (4.8% to 46.1%).
- Both door-to-team time (OR 1.13) and team-to-ward time (OR 1.07) were independent predictors of 30-day mortality.
- These associations remained significant after adjusting for patient acuity and comorbidities.
Conclusions:
- Delays in ED care are independently associated with adverse mortality outcomes.
- Recommended maximal target limits of 4 hours for referral and 6 hours for admission to mitigate mortality risk.
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