Assessing the Variability in Time to Treatment in Surgery Final rept. (Oct 1998-Sept 2002)

摘要

The purpose of the repor is to determine the relationship of time to worse health outcomes for 3 potentially timesensitive conditions: appendicitis, ectopic pregnancy and intestinal obstruction and assess system, physician & patient factors affecting time between symptom onset and definitive treatment. We abstracted in- & outpatient records of patients with appendicitis, ectopic pregnancy and intestinal obstruction. Shortly after treatment for these conditions, we surveyed both patients and the physicians who first examined them about their experiences and perceptions. The amount of time to treatment varied depending on the condition. Overall, increasing time between symptom onset and treatment was associated with a greater risk of worse outcomes for patients with appendicitis and intestinal obstruction. Patients with ruptured ectopic pregnancy were more likely to present and be treated within a short time after symptoms began. In general, time to treatment was shorter for patients who went to the Emergency Department first and was longer for patients sent for CT imaging. Some of the CT delay may be due to physician diagnostic uncertainty. Physicians' perceived availability of needed diagnostic and treatment services had little or no impact on time to treatment once patients got into care. Physical signs and symptoms were not helpful in distinguishing patients who were at greater risk of worse health outcomes nor did they contribute to prolonged times between symptom onset and patients' access of medical care; they did have a minimal impact on how quickly patient got treated once accessing care. Patients who perceived their symptoms to be serious and previously had been in good health came to care more quickly. Patient perceived access, insurance, competing demands, ability to handle emergencies and past experience with similar symptoms & with the healthcare system did not affect how quickly patients came to care.