A research report presented to the Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand In partial fulfilment of the degree Master of Science in Medicine (Emergency Medicine) / Background: Private health care emergency departments (EDs) are vital components of health care systems and have become increasingly popular due to their accessibility, convenience and proficiency. This popularity has led to overcrowding which in turn has led to increased patient waiting times. Lengthy waiting times have been shown to be a common cause of patient dissatisfaction. Patients, however, often overestimate the passage of time which results in unwarranted dissatisfaction. Study objectives: The purpose of this study was to establish the actual waiting times experienced by patients from the time of triage to first doctor contact at the Dogwood Hospital Emergency Department. Design: A retrospective cross-sectional descriptive study was undertaken at the Dogwood Hospital Emergency Department from 1 st January 2009 to the 30th August 2009. All patients (adults and children) of all priority who sought medical attention at the Dogwood Hospital ED were included in the study. Main Results: Priority 3 patients waited the longest out of all patients, particularly on weekday mornings. Overall this study revealed that for 70% of patients the triage-to-doctor waiting time was less than 1 hour. Almost 24% of patients waited between one and two hours and about six percent waited more than two hours. Conclusions: Most patients in this study were seen by a doctor within the target times set by the South African Triage Group (SATG). Numerous studies suggest that patients believe that the acceptable triage-to-doctor waiting time is approximately one hour. In this study 30% of patients waited longer than one hour.

The primary purpose of this dissertation was to understand if emergency department utilization patterns are associated with subsequent drug overdose death. Specifically, it was hypothesized that that increasing emergency department (ED) utilization (as measured by such indices as two or more visits in 72-hours, two or more visits in a 30-day period, four or more visits in a 365-day period) was associated with increasing risk of fatal unintentional drug overdose compared with patients without two or more visits in a given time frame. Using ED data from the New York State Department of Health's (NYSDOH) Statewide Planning and Research Cooperative System (SPARCS) for the years 2006-2010 linked with unintentional fatal prescription drug overdose data from death certificates and medical examiner case files from the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the NYSDOH for the years 2006-2010, a retrospective dynamic cohort of ED encounter data was conducted. In the first study, the patient population consisted of 1,755,734 New York State residents who were 18-64 years of age and had selected diagnoses on their entry visit. Extended Cox proportional hazards regression models were conducted to estimate the association of ED utilization patterns and subsequent drug overdose death. Compared to time periods in which patients had no visits within a year, patients who had 3, 4-10, or > 10 visits in a year had elevated risks of prescription drug overdose death after adjustment for demographic characteristics: 3 visits (adjusted hazard ratio (aHR 4.77, 95% CI 3.60, 6.15)), 4 - 10 (aHR 7.39, 95%CI 5.81, 9.41), and > 10 ED (aHR 18.37, 95% CI 13.38, 25.23). ED utilization patterns are strong predictors of subsequent overdose death. Understanding the timing of overdose death in relation to ED utilization is essential to recognizing which patients to target with overdose prevention interventions. Identifying time-periods of increased risk may be used as an indicator for developing prediction tools to classify patients at increased risk for overdose.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, September 2009. / Thesis Advisor(s): Richter, Anke ; Bergin, Richard. "September 2009." Description based on title screen as viewed on November 5, 2009. Author(s) subject terms: Patient Tracking, Public Health, Emergency Medical Services, Patient Movement, Evacuation, Public Health Preparedness. Includes bibliographical references (p. 139-140). Also available in print.

Thesis--Columbia University. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 157-165).

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2000. / Includes bibliographical references.

Thesis--Columbia University. / Includes bibliographical references (leaves 157-165).

No description available.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy