Association between waiting times and short term mortality

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Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011;342:d2983.

As the authors noted, “long waiting times can delay every stage of the visit, from initial assessment to treatment to final decision making to admission or discharge (patient disposition) and can alter clinicians’ routines and decision making. For patients, the frustration with long waits can cause up to 10% to leave without being seen (that is, before seeing a physician, without a diagnosis or treatment). Hence long waiting times can alter the behaviours of both staff and patients and lead to potentially adverse consequences.”

While long waits can expect to delay time-sensitive treatments for patients requiring, admission, this study found there is also adverse effects for the 85% of patients who are discharged from the emergency department or who leave without being seen. In examining more than 14 million visits to 125 departments from 2003 to 2007, the authors found that “In all patients rates of death and admission to hospital increased with increasing length of stay in an emergency department. In multivariable analyses, the risk of death increased incrementally with each additional hour of mean waiting time per shift.”

As they conclude, “Patients presenting to emergency departments during shifts with long mean waiting times might be at increased risk of death and admission in the subsequent seven days, regardless of acuity on presentation. As mean length of stay increases, so does the risk of subsequent adverse events.”

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