Mohanty Sarita A, Washington Donna L, Lambe Susan, Fink Arlene, Asch Steven M
Department of Medicine and Emergency Medicine, Keck School of Medicine, University of Southern California 90033, USA.
Acad Emerg Med. 2006 May;13(5):505-12. doi: 10.1197/j.aem.2005.12.018. Epub 2006 Apr 11.
To assess waiting times in emergency departments (EDs) for on-call specialist response and how these might vary by facility or neighborhood characteristics. Limited availability of on-call specialists is thought to contribute to ED overcrowding.
Direct observational data from a random sample of 1,798 patients visiting 30 California EDs during a six-month period provided specialist waiting times. The authors used multivariate logistic regression and survival analysis to analyze predictors of time to on-call specialists' telephone response.
Eighty-six percent of on-call specialists who were paged responded by telephone within 30 minutes. Ten percent of specialists did not respond at all. After controlling for the annual percentage of nonurgent ED patients at each facility, near closure status, and hospital ownership status, for every 10,000 dollars increase in hospital zip code income, the odds of on-call specialist response within 30 minutes increased by 123% (adjusted odds ratio = 2.23; 95% confidence interval = 1.24 to 4.02; p = 0.01).
Although the majority of on-call specialists met the federal recommendation of a 30-minute response, those in poor neighborhoods were less likely to do so. One in ten on-call specialists did not respond at all. State and federal policies should focus on making more funding available for on-call specialist panels in poor areas.
评估急诊科呼叫专科医生响应的等待时间，以及这些时间如何因机构或社区特征而有所不同。人们认为随叫随到的专科医生数量有限是导致急诊科过度拥挤的原因之一。
在六个月期间，对加利福尼亚州30家急诊科的1798名就诊患者进行随机抽样，直接观察数据提供了专科医生等待时间。作者使用多元逻辑回归和生存分析来分析呼叫专科医生电话响应时间的预测因素。
接到传呼的随叫随到专科医生中有86%在30分钟内通过电话做出了响应。10%的专科医生根本没有回应。在控制了每个机构非紧急急诊科患者的年度百分比、接近关闭状态和医院所有权状态后，如果医院邮政编码收入每增加10000美元，随叫随到专科医生在30分钟内做出响应的几率就会增加123%（调整后的优势比=2.23；95%置信区间=1.24至4.02；p=0.01）。
尽管大多数随叫随到的专科医生达到了联邦建议的30分钟响应时间，但贫困社区的专科医生做到这一点的可能性较小。十分之一的随叫随到专科医生根本没有回应。州和联邦政策应侧重于为贫困地区的随叫随到专科医生小组提供更多资金。
