Horwitz Leora I, Bradley Elizabeth H
Department of Internal Medicine, Yale University School of Medicine, PO Box 208093, New Haven, CT 06520-8093, USA.
Arch Intern Med. 2009 Nov 9;169(20):1857-65. doi: 10.1001/archinternmed.2009.336.
The wait time to see a physician in US emergency departments (EDs) is increasing and may differentially affect patients with varied insurance status and racial/ethnic backgrounds.
Using a stratified random sampling of 151 999 visits, representing 539 million ED visits from 1997 to 2006, we examined trends in the percentage of patients seen within the triage target time by triage category (emergent, urgent, semiurgent, and nonurgent), payer type, and race/ethnicity.
The percentage of patients seen within the triage target time declined a mean of 0.8% per year, from 80.0% in 1997 to 75.9% in 2006 (P < .001). The percentage of patients seen within the triage target time declined 2.3% per year for emergent patients (59.2% to 48.0%; P < .001) compared with 0.7% per year for semiurgent patients (90.6% to 84.7%; P < .001). In 2006, the adjusted odds of being seen within the triage target time were 30% lower than in 1997 (odds ratio, 0.70; 95% confidence interval, 0.55-0.89). The adjusted odds of being seen within the triage target time were 87% lower (odds ratio, 0.13; 95% confidence interval, 0.11-0.15) for emergent patients compared with semiurgent patients. Patients of each payment type experienced similar decreases in the percentage seen within the triage target over time (P for interaction = .24), as did patients of each racial/ethnic group (P = .05).
The percentage of patients in the ED who are seen by a physician within the time recommended at triage has been steadily declining and is at its lowest point in at least 10 years. Of all patients in the ED, the most emergent are the least likely to be seen within the triage target time. Patients of all racial/ethnic backgrounds and payer types have been similarly affected.
在美国急诊科就诊时等待看医生的时间正在增加，这可能对具有不同保险状况和种族/族裔背景的患者产生不同影响。
我们采用分层随机抽样法，抽取了151999次就诊病例，代表了1997年至2006年期间的5.39亿次急诊科就诊情况，我们按分诊类别（紧急、加急、半紧急和非紧急）、付款人类型和种族/族裔，研究了在分诊目标时间内就诊的患者百分比的趋势。
在分诊目标时间内就诊的患者百分比平均每年下降0.8%，从1997年的80.0%降至2006年的75.9%（P <.001）。紧急患者在分诊目标时间内就诊的百分比每年下降2.3%（从59.2%降至48.0%；P <.001），而半紧急患者为每年下降0.7%（从90.6%降至84.7%；P <.001）。2006年，在分诊目标时间内就诊的调整后几率比1997年低30%（优势比，0.70；95%置信区间，0.55 - 0.89）。与半紧急患者相比，紧急患者在分诊目标时间内就诊的调整后几率低87%（优势比，0.13；95%置信区间，0.11 - 0.15）。随着时间的推移，每种付款类型的患者在分诊目标时间内就诊的百分比下降情况相似（交互作用P值 =.24），各种族/族裔组的患者也是如此（P =.05）。
在急诊科中，在分诊建议时间内由医生诊治的患者百分比一直在稳步下降，且处于至少10年来的最低点。在所有急诊科患者中，最紧急的患者在分诊目标时间内就诊的可能性最小。所有种族/族裔背景和付款人类型的患者都受到了类似影响。
