Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Cardiol. 2010 Jan;26(1):e17-21. doi: 10.1016/s0828-282x(10)70337-8.
Wait times for cardiac surgery are well established but may not reflect the total wait time patients experience.
The Maritime Heart Center (Halifax, Nova Scotia) cardiac surgery database was used to identify all consecutive patients who underwent elective coronary artery bypass graft surgery between 2002 and 2005 from a single urgency queue. The provincial physician billing database provided a timeline record of dates, physician visits, and diagnoses or procedures performed for each patient. This information was used to assess total and component wait times leading to cardiac surgery.
A total of 705 consecutive patients were included and stratified based on geographical location: urban Halifax Regional Municipality (HRM; n=222), urban non-HRM (n=220) and rural (n=263). Patients from all regions did not differ in age, sex, comorbidities or ventricular function. Using a traditional definition of wait time (time listed), patients waited a median of 56 days (interquartile range [IQR] 38 to 77 days). In comparison, the total wait times based on the time from presentation to surgery were a median of 109 days (IQR 56 to 184 days) for HRM, a median of 121 days (IQR 77 to 184 days) for urban non-HRM and a median of 123 days (IQR 79 to 169 days) for rural patients (P-value nonsignificant). Two modes of presentation emerged that were not influenced by a patient's geographical location. Patients who presented to the emergency department (n=229) waited a median of 73 days. This was significantly less than patients who presented to their family physician (n=476), who waited a median of 135 days (P<0.001). The difference in overall wait for patients presenting to the emergency room was a result of a shorter wait time for referral to a specialist and from seeing a specialist to catheterization.
The present pilot study demonstrated that total patient wait times for cardiac care and surgery in Nova Scotia are significantly longer (more than twofold) than traditionally reported wait times for surgery alone.
心脏手术的等待时间已经得到很好的确立，但可能无法反映患者实际经历的总等待时间。
利用新斯科舍省哈利法克斯市的海洋之心中心（Maritime Heart Center）心脏手术数据库，从单一紧急队列中确定了在 2002 年至 2005 年间接受择期冠状动脉旁路移植手术的所有连续患者。该省的医师计费数据库为每位患者提供了日期、就诊次数以及诊断或进行的手术的时间记录。该信息用于评估导致心脏手术的总等待时间和各组成部分的等待时间。
共纳入 705 例连续患者，并根据地理位置进行分层：城市哈利法克斯地区自治市（HRM；n=222）、城市非 HRM（n=220）和农村（n=263）。所有地区的患者在年龄、性别、合并症或心室功能方面没有差异。使用传统的等待时间定义（列出的时间），患者的中位等待时间为 56 天（四分位距[IQR] 38 至 77 天）。相比之下，基于从就诊到手术的时间的总等待时间对于 HRM 患者为中位 109 天（IQR 56 至 184 天），对于城市非 HRM 患者为中位 121 天（IQR 77 至 184 天），对于农村患者为中位 123 天（IQR 79 至 169 天）（P 值无统计学意义）。出现了两种就诊模式，不受患者地理位置的影响。就诊于急诊室的患者（n=229）中位等待时间为 73 天。这显著短于就诊于家庭医生的患者（n=476），中位等待时间为 135 天（P<0.001）。急诊就诊患者的整体等待时间差异是由于从转诊给专科医生到进行导管检查的等待时间较短所致。
本试点研究表明，新斯科舍省心脏护理和手术的总患者等待时间明显长（超过两倍）于传统报道的单独手术等待时间。
