Key result
Highest ED access block occupancy linked to ~43% more surgical delays vs lowest quartile.
Why the study?
Does high emergency department access block occupancy predict delay to surgery in patients with fractured neck of femur?
Cohort (n=369)
Single-blind
No
Does high emergency department access block occupancy predict delay to surgery in patients with fractured neck of femur?
Emergency department access block occupancy at the time of arrival directly predicts delay to surgery for patients with fractured neck of femur, serving as a marker of hospital dysfunction.
High access block occupancy may flag hip fracture patients at risk for surgical delay; leaves open whether system interventions reduce delays.
OBJECTIVE: The present study aimed to identify any relationship between existing access block occupancy (ABO) at the time of patient presentation and delay to definitive procedure. METHODS: Retrospective descriptive cohort study of all patients aged over 50 years with an ED diagnosis of fractured neck of femur admitted through a tertiary ED over 2 years. The independent variable was the ABO at the start of the hour in which the patient presented, derived from existing ED records, and expressed as the quartile for that hour of the day. The dependent variable was start of surgery more than 24 h after arrival without a documented reason for delay. The data abstractor was blinded to the ABO. RESULTS: All 442 diagnoses of fractured neck of femur recorded in the ED were reviewed, 73 were excluded (16 age, 5 misdiagnosis, 31 no surgery, 21 documented medical reasons for delay). There was a significant relationship between ABO quartile and the rate of delay to surgery ranging from 54% (95% CI 43-63%) for those presenting in the lowest ABO quartile to 77% (68-85%) in the highest (P= 0.006, chi(2)). Subgroup analysis showed that arrival ABO predicted patient access block, and that patient access block was associated with delay to surgery and longer postoperative length of stay (geometric mean 12.9 vs 9.9 days, P < 0.01, t-test). CONCLUSIONS: The number of access block patients at the time of arrival directly predicts delay to operation in this setting. This suggests that access block occupancy is a marker of hospital dysfunction.
No takes yet. Share an insight, caveat, or question.
Richardson et al. (2009) conducted a cohort in Fractured neck of femur (n=369). Highest access block occupancy (ABO) quartile vs. Lowest access block occupancy (ABO) quartile was evaluated on Start of surgery more than 24 h after arrival without a documented reason for delay (p=0.006). Presenting to the emergency department during the highest quartile of access block occupancy increased the rate of delay to surgery compared to the lowest quartile (77% vs 54%; P=0.006).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: