What affects time to care in emergency room appendicitis patients?

Med Care. 2008 Apr;46(4):417-22. doi: 10.1097/MLR.0b013e31815c1e66.


Background: Emergency departments (EDs) provide a safety net for seriously ill individuals. Little is known about factors that affect time to diagnosis and treatment of patients with time-sensitive conditions within the ED.

Methods: Retrospective observational study of 236 appendicitis patients examining patient factors and ED characteristics with time to a surgeon's diagnosis of appendicitis and ED length of stay (LOS).

Results: Time to surgeon's diagnosis and ED LOS were slower for nonwhite patients without private insurance (parameter estimate = 0.38, P = 0.002 and 0.31, P < 0.001, respectively) and quicker for patients for whom the ED physician's diagnostic first impression was appendicitis (parameter estimate = -0.29, P = 0.003 and -0.14, P = 0.04, respectively). Greater numbers of physicians staffing the ED had a modest effect on time to surgeon diagnosis and ED LOS (parameter estimate = -0.04, P = 0.01 and -0.04, P = 0.01, respectively), whereas greater numbers of patients had little impact (parameter estimate = -0.005, P = 0.04 and -0.002, P = 0.28, respectively).

Conclusions: Minority patients without private insurance had slower times to specialist consultation and treatment; ED staffing and census had a small effect. To maximize patient safety and ED quality of care, administrators should ensure timely specialist consultation and determine additional mechanisms facilitating white privately insured patients' quicker care.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Appendicitis / diagnosis*
  • Appendicitis / surgery*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Healthcare Disparities*
  • Humans
  • Insurance Coverage
  • Insurance, Health
  • Male
  • Middle Aged
  • Minority Groups
  • Quality of Health Care
  • Retrospective Studies
  • Time Factors