Factors Related to Emergency Surgery Wait Times in British Columbia
Date
2019-05-23
Authors
Sing, Jaclyn E
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Abstract
Objective: The purpose of this project was to assess the relationships between emergency surgery wait times in British Columbia (BC) and characteristics of the patient’s hospital admission.
Background: The BC Ministry of Health has historically focused on elective surgery wait times. Various clinical decision support tools have been proposed for optimizing emergency wait times; however, little is known about how long patients are waiting for emergency surgery. This project sought to uncover how long patients wait for emergency surgery in BC and to identify whether wait times can be shortened using health information technology such as clinical decision support.
Methods: The research design was a retrospective cohort study. Secondary data from the Discharge Abstract Database (DAD) was statistically examined to identify factors associated with longer wait times. Patients included in this study must have received surgery during an urgent admission between April 1, 2012 – March 31, 2017 for hip fracture repair, appendectomy or cholecystectomy.
Results. When comparing mean wait times by procedure, the results of the one-way ANOVA indicated mean wait times varied significantly between procedures (appendectomy = 13 hours, hip fracture repair = 33 hours, cholecystectomy = 53 hours). In addition, wait times were significantly increased for patients with older age, afterhours admission or admission to hospitals with a trauma level 1 or 2 designation and transplant services. A subsequent analysis to assess which factors impacted wait times was done on a per-procedure basis. Factors affecting appendectomy was compared against a 24 hour benchmark, while hip fracture repair and cholecystectomy were compared against a 48 hour benchmark. Mean wait times for hip fracture repair and appendectomy were within the benchmarks; however, mean wait times for cholecystectomy were greater than the benchmark. In a multivariate analysis, older age had the strongest effect. Older age significantly increased the risk of surgical delay (OR 3.066, 95% CI 2.553 – 3.682, p<.001).
Conclusion: All though surgical wait times varied significantly based on a number of factors, these variations may be strongly related to other prioritization variables not included in the DAD. For this project, patient age was the strongest factor related to surgical delay. Age is not a factor that can improved by implementing clinical decision support. Further research is needed to determine if clinical decision support can be used to reduce emergency surgery wait times in BC.
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Keywords
Wait Time, Retrospective, Emergency Surgery