Comparison of emergency department throughput and process times between male and female patients: A retrospective cohort investigation by the Reducing Disparities Increasing Equity in Emergency Medicine Study Group

Onal, Ege Gungor; Knier, Kit; Hunt, Alexander W.; Knudsen, John M.; Nestler, David M.; Campbell, Ronna L.; Thompson, Kristine M.; Sunga, Kharmene L.; Walker, Laura E.; Madsen, Bo E.; Sadosty, Annie T.; McGregor, Alyson J.; Mullan, Aidan F.; Jeffery, Molly Moore; Bellamkonda, Venkatesh R.

doi:10.1002/emp2.12792

Cited by 4 publications

(2 citation statements)

References 25 publications

(24 reference statements)

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“…Additionally, this increase is mainly due to the higher use of PM in women (20% of increase), while use of NSAID and opiates seems to be more balanced among sexes. The results obtained in this study are in contrast to those obtained in younger populations, in which a lower frequency of analgesic prescription has been observed in women [16]. Therefore, a line of further investigation specifically designed to address if sex-based inequality in use analgesics in EDs is clearly needed.…”

Section: Discussioncontrasting

confidence: 91%

Sex- and age-related patterns in the use of analgesics in older patients in the emergency department

Miró,

Osorio,

Alquézar-Arbé

et al. 2023

European Journal of Emergency Medicine

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Background Treatment of acute pain in older patients is a common challenge faced in emergency departments (EDs). Despite many studies that have investigated chronic analgesic use in the elderly, data on patterns of acute use, especially in EDs, of analgesics according to patient characteristics is scarce. Objective To investigate sex- and age-related patterns of analgesic use in the Spanish EDs and determine differences in age-related patterns according to patient sex. Design A secondary analysis of the Emergency Department and Elderly Needs (EDEN) multipurpose cohort. Setting Fifty-two Spanish EDs (17% of Spanish EDs covering 25% of Spanish population) Participants All patients’ ≥65 years attending ED during 1 week (April 1–7, 2019). Patient characteristics recorded included age, sex, chronic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and opiates, comorbidity, dependence, dementia, depression, ability to walk and previous falls. Analgesics used in the ED were categorized in three groups: non-NSAID non-opioids (mainly paracetamol and metamizole, PM), NSAIDs, and opiates. Outcome measures Frequency of analgesic use was quantified, and the relationship between sex and age and analgesic use (in general and for each analgesic group) was assessed by unadjusted and adjusted logistic regression and restricted cubic spline models. Interaction between sex and age was explored. Main results We included 24 573 patients, and 6678 (27.2%) received analgesics in the ED: 5551 (22.6%) PM, 1661 (6.8%) NSAIDs and 937 (3.8%) opiates (1312 received combinations). Analgesics were more frequently used in women (adjusted OR = 1.076, 95%CI = 1.014–1.142), as well as with NSAID (1.205, 1.083–1.341). Analgesic use increased with age, increasing PM and decreasing NSAIDs use. Opiate use remained quite constant across age and sex. Interaction of sex with age was present for the use of analgesics in general (P = 0.006), for PM (P < 0.001) and for opiates (P = 0.033), with higher use of all these analgesics in women. Conclusion Use of analgesics in older individuals in EDs is mildly augmented in women and increases with age, with PM use increasing and NSAIDs decreasing with age. Conversely, opiate use is quite constant according to sex and age. Age-related patterns differ according to sex, with age-related curves of women showing higher probabilities than those of men to receive any analgesic, PM or opiates.

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Section: Discussioncontrasting

confidence: 91%

Sex- and age-related patterns in the use of analgesics in older patients in the emergency department

Miró,

Osorio,

Alquézar-Arbé

et al. 2023

European Journal of Emergency Medicine

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“…Previous studies have suggested that the patient's sex influences the access to healthcare and the quality of care provided, from the out-of-hospital environment to specialized inpatient treatments [6]. For instance, significant sex disparities in time-sensitive emergencies such as cardiac care have been reported, suggesting that females are less likely to undergo extensive cardiac workup [7][8][9][10][11][12][13] and to receive cardiac treatment such as aspirin, nitroglycerin and IV access [14] and cardiac catheterization after myocardial infarction [15], resulting in worse outcomes overall [9]. Furthermore, females are less likely than males to be admitted to an intensive care unit [6,8] and to receive intravenous tissue plasminogen activator for a stroke [16].…”

Section: Introductionmentioning

confidence: 99%

Impact of Sex on Completion of Life-Saving Interventions for Severely Injured Patients: A Retrospective Cohort Study

Deloye,

Nadeau,

Barnes-Métras

et al. 2023

Trauma Care

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Sex disparities in access and quality of care are well known for some time-sensitive conditions. However, the impact of sex on early trauma care remains unknown. In this study, we compared delays of completion of life-saving interventions (LSIs) between females and males among severely injured patients. This is a retrospective cohort study of all patients who consulted or were transported by ambulance in the emergency department (ED) of a level-one trauma centre following injury between September 2017 and December 2019 and for whom at least one LSI was performed. The list of LSIs was established by an expert consensus and included trauma team leader (TTL) activation, endotracheal intubation, chest decompression, blood transfusion, massive transfusion protocol, neurosurgery, spinal surgery, intestinal surgery, and spleen, liver and/or kidney angiography. A total of 905 patients were included. No significant statistical differences in the LSI delays were found when comparing females and males brought directly to the ED and transferred from another health care setting. Results of this study suggest that delays before completion of LSIs are similar for severely injured patients at our major trauma centre regardless of their sex.

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Does initiating care in alternate care sites decrease time to disposition in the emergency department?

Mangino,

Balaji,

Stenson

et al. 2024

JACEP Open

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ObjectivesDuring the coronavirus disease 2019 (COVID‐19) pandemic surge, alternate care sites (ACS) such as the waiting room or hospital lobby were created amongst hospitals nationwide to help alleviate emergency department (ED) overflow. Despite the end of the pandemic surge, many of these ACS remain functional given the burden of prolonged ED wait times, with providers now utilizing the waiting room or ACS to initiate care. Therefore, the objective of this study is to evaluate if initiating patient care in ACS helps to decrease time to disposition.MethodsRetrospective data were collected on 61,869 patient encounters presenting to an academic medical center ED. Patients with an emergency severity index (ESI) of 1 were excluded. The “pre‐ACS” or control data consisted of 38,625 patient encounters from September 30, 2018 to October 1, 2019, prior to the development of ACS, in which the patient was seen by a physician after they were brought to an assigned ED room. The “post‐ACS” study cohort consisted of 23,244 patient encounters from September 30, 2022 to October 1, 2023, after the initiation of ACS, during which patients were initially seen by a provider in an ACS. ACS at this institution included the three following areas: waiting room, ambulance waiting area, and a newly constructed ACS that was built next to the ED entrance on the first floor of the hospital. The newly constructed ACS consisted of 16 care spaces each containing an upright exam chair with dividers between each care space. Door‐to‐disposition time (DTD) was calculated by identifying the time when the patient entered the ED and the time when disposition was decided (admission requested or patient discharged). Using regression analysis, we compared the two data sets to determine significant differences among DTD time.ResultsThe largest proportion of encounters were among ESI 3 patients, that is, 56.1%. There was a significant increase in median DTD for ESI 2 and 3 patients who were seen initially in an ACS compared to those who were not seen until they were in an assigned ER room. Specifically, there was a median increase of 40.9 min for ESI 2 patients and 18.8 min for ESI 3 patients who were seen initially in an ACS (p < 0.001). There was a 29‐min decrease in median DTD for ESI 5 patients who were seen in ACS (p = 0.09).ConclusionsInitiating patient care earlier in ACS did not appear to decrease DTD time for patients in the ED. Overall, the benefits of early initiation of care likely lie elsewhere within patient care and the ED throughput process.

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Comparison of emergency department throughput and process times between male and female patients: A retrospective cohort investigation by the Reducing Disparities Increasing Equity in Emergency Medicine Study Group

Cited by 4 publications

References 25 publications

Sex- and age-related patterns in the use of analgesics in older patients in the emergency department

Sex- and age-related patterns in the use of analgesics in older patients in the emergency department

Impact of Sex on Completion of Life-Saving Interventions for Severely Injured Patients: A Retrospective Cohort Study

Does initiating care in alternate care sites decrease time to disposition in the emergency department?

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