Disposition Time Research Articles

Predictors of psychiatric boarding in the emergency department.

IntroductionThe emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ubiquitous throughout emergency departments (EDs) nationwide. Boarding is recognized as a major cause of ambulance diversions and ED crowding and has a significant adverse impact on healthcare providers, patient satisfaction, and hospital costs. We sought to identify differences between patients who boarded versus patients who did not board, to identify factors amenable to change and identify interventions that could lead to a decrease in overall psychiatric patient length of stay and improve patient care.MethodsThis study is a retrospective multicenter cohort study of all patients assessed to require inpatient psychiatric hospitalization at two community EDs in Illinois from July 1, 2010 through June 30, 2012. We identified 671 patients and collected insurance status, sex, age, time of arrival, time of disposition and time of transfer.ResultsThere was a statistically significant difference in the insurance status between the cohort of patients boarding in the ED compared to non-boarders prior to inpatient psychiatric admission. Our study identified 95.4% of uninsured patients who were boarded in the ED, compared to 71.8% of Medicare/Medicaid patients and 78.3% of patients with private insurance (χ2=50.6, df=2, p<0.001). We found the length of stay to be longer for patients transferred to publicly funded psychiatric facilities compared to those transferred to private facilities, with a mean time spent in the ED of 1,661 minutes and 705 minutes, respectively (p<0.001). Patients with Medicare/Medicaid were nearly twice as likely to return to the ED for psychiatric emergencies than self-pay and privately insured patients, requiring repeat inpatient psychiatric admission (estimate=0.649, p=0.035, OR=1.914).ConclusionThis study found that unfunded patients boarded significantly longer than Medicare/Medicaid and privately insured patients. Patients with private insurance boarded longer than those with Medicare/Medicaid. Patients transferred to publicly funded facilities had significantly longer ED length of stay than patients transferred to private facilities.

A cross-country analysis of the impact of regulatory quality on commercial case disposition time

Commercial courts around the world encounter prolonged legal procedures, which harms businesses that require dispute resolution through the legal system. This paper, for the first time, tests whether a country’s quality of business regulation impacts the average commercial case disposition time. Panel regression analyses of 133 countries from 2006 to 2011 substantiate the negative association between the perceived regulatory quality and the average duration of commercial legal disputes. Surprisingly, the actual regulatory quality does not affect the average duration of a trial.

Does Distance Matter? Effect of Having a Dedicated CT Scanner in the Emergency Department on Completion of CT Imaging and Final Patient Disposition Times

PurposeTo evaluate whether presence of a CT scanner in the emergency department (ED) improves ED workflow by decreasing time between imaging requisition and completion, and time to final patient disposition. MethodsInstitutional review board approval was obtained for this retrospective study conducted on 2,142 consecutive, acute thoracic, abdomino- pelvic imaging requests from 2 ED hospital campuses affiliated with the same academic institution, August 1 to October 31, 2012. Of these patients, only 1,696 had complete records and were used for analysis. One hospital had a CT scanner in the ED; the other was in the radiology department, 300 meters from the ED. Patients were stratified based on acuity of CT indication, interpreting radiologist training level, and time of day. Time points were compared between hospitals: (1) time of CT requisition receipt to time of scan initiation (2) time from scan initiation to time of preliminary report by resident or fellow, or verbally by staff to the ED; and (3) time of CT requisition receipt to time of final patient disposition. ResultsDecreases in time, favoring the institution with the ED CT scanner, are 16 min (P < .0001); 15 minutes (P < .0001); and 19 minutes (P < .04) for the 3 times, respectively. Significant differences were seen in morning and overnight shifts and for CT reporting times with higher radiology levels of training (20 min, P = .04; and 18 min, P < .0001 for staff and postgraduate year-5 residents, respectively). ConclusionsPresence of an ED CT scanner is associated with decreases in time to CT scan completion, radiologic interpretation, and patient disposition.

Effect of MicroEEG on Clinical Management and Outcomes of Emergency Department Patients With Altered Mental Status: A Randomized Controlled Trial

Altered mental status (AMS) is a common presentation in the emergency department (ED). A previous study revealed 78% electroencephalogram (EEG) abnormalities, including nonconvulsive seizure (NCS; 5%), in ED patients with AMS. The objective of this study was to assess the impact of EEG on clinical management and outcomes of ED patients with AMS. This was a randomized controlled trial at two urban teaching hospitals. Adult patients (≥18 years old) with AMS were included. Excluded patients had immediately correctable AMS (e.g., hypoglycemia) or were admitted before enrollment. Patients were randomized to routine care (control) or routine care plus EEG (intervention). Research assistants used a scalp electrode set with a miniature, wireless EEG device (microEEG) to record standard 30-minute EEGs at presentation, and results were reported to the ED attending physician by an off-site epileptologist within 30 minutes. Primary outcomes included changes in ED management (differential diagnosis, diagnostic work-up, and treatment plan from enrollment to disposition) as determined by surveying the treating physicians. Secondary outcomes were length of ED and hospital stay, intensive care unit (ICU) requirement, and in-hospital mortality. A total of 149 patients were enrolled (76 control and 73 intervention). Patients in the two groups were comparable at baseline. EEG in the intervention group revealed abnormal findings in 93% (95% confidence interval [CI] = 85% to 97%), including NCS in 5% (95% CI = 2% to 13%). Using microEEG was associated with change in diagnostic work-up in 49% (95% CI = 38% to 60%) of cases and therapeutic plan in 42% (95% CI = 31% to 53%) of cases immediately after the release of EEG results. Changes in probabilities of differential diagnoses and the secondary outcomes were not statistically significant between the groups. An EEG can be obtained in the ED with minimal resources and can affect clinical management of AMS patients.

Using Child Advocacy Center Tracking Data to Examine Criminal Disposition Times

Given the difficulty of obtaining criminal justice data on child abuse cases, information from child advocacy centers could be an important resource for answering questions about criminal justice outcomes for child abuse cases. In this exploratory study, we use data from one child advocacy center (N = 632) to examine the feasibility of using NCAtrak, a national computerized, Web-based case tracking system, to examine criminal disposition timeframes in child abuse cases. The system data indicated that the time frame for the cases to be criminally resolved varied widely. About one in four child physical and sexual abuse cases with adult offenders took more than one year to reach a final disposition. About 11% of child sexual abuse cases with juvenile offenders took more than one year to reach a criminal disposition. We encourage child advocacy centers using computer-based data systems to think of additional ways they might use this potentially rich source of data.

Comments in Opposition to the Proposed Amendments to the Federal Rules of Civil Procedure

These are Professor Moore's public comments in opposition to the recent proposed amendments to the Federal Rules of Civil Procedure. The proposed rules amendments are ostensibly intended to address the so-called and of civil litigation. Professor Moore offers four observations. First, the most objective and reliable measure of cost before the Committee is contained in the 2009 closed-case study by the Federal Judicial Center, which shows neither out-of-control costs nor an increase in costs over time. Second, one objective and reliable measure of delay is case disposition time, a statistic maintained by the Administrative Office of the Courts. The AO's statistics show that the median disposition time for a civil case (from case filing to final disposition) has maintained stability for twenty-five years, from 7 months in 1986 to a still-brisk 7.8 months in 2012, a difference of about 24 days. Third, contrary to the Committee's apparent belief, lawyers and judges are well aware of the concept of proportionality in discovery and apply it frequently. Fourth, the federal courts are widely perceived to favor defendants, and the adoption of these proposals will intensify that perception, because the proposals do favor defendants.

Pediatric Early Warning Score at Time of Emergency Department Disposition Is Associated With Level of Care

The objective of this study was to determine the association between the Pediatric Early Warning Score (PEWS) at time of emergency department (ED) disposition and level of care. We conducted a prospective observational study with a convenience sample of patients aged 0 to 21 years in the ED of an urban, tertiary care children's hospital between November 2010 and July 2011. Pediatric Early Warning Score data were obtained at time of ED disposition, and the disposition decision was collected from the electronic medical record. Multinomial logistic regression was used to determine the association between PEWS and disposition. The sample of 383 patients included 239 (62%) who were discharged, 126 (33%) admitted to acute care, and 18 (5%) admitted to intensive care. Assigned scores ranged from 0 to 9. Adjusting for triage level, a 1-point increase in PEWS increased the odds of acute care admission 48% relative to the odds of discharge (odds ratio, 1.48; 95% confidence interval, 1.25-1.76) and increased the odds of intensive care admission 41% relative to the odds of acute care admission (odds ratio, 1.41; 95% confidence interval, 1.13-1.76). Pediatric Early Warning Score of 1 or more had maximum discriminant ability for admission, and PEWS of 3 or greater had maximum discriminant ability for intensive care. Area under the receiver operator characteristic curve was 0.68 to detect need for admission for the entire sample and 0.80 among the 97 patients with respiratory complaints. Pediatric Early Warning Score is associated with the level of care at ED disposition but does not provide adequate sensitivity and specificity to be used in isolation. Performance characteristics are better for patients with respiratory complaints.

Analysis of Waiting Time in Emergency Department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia

Emergency Department (ED) in Alnoor Hospital is considered the pulsating unit in the hospital by facing a daily challenge through a huge exposure to number of patients round between 500 - 700 per day in average. With this busy service in ED, our study emerges to measure the quality of provided services to patients in term of measuring the total length of stay time (LOS) in ED and its influencing factors. This is a prospective study aiming to estimate the average time patients spend in ED of Alnoor Hospital during the month of January (2013). In addition, it inspects factors influencing the LOS. The questionnaire which conducted and filled by emergency team over all patients was consisted of the following data: arrival time to ED, initial time of assessment by nurse, initial time of assessment by doctor, time of arrival to specific area, consultation time, arrival time of consulted specialty, time of laboratory investigation, time of radiological investigation, time of final disposition and time of physical disposition. For the 7604 patient visits analyzed, mean ED LOS was 3.02 hour (SD = 5.03 hour). About half of the patients spent less than 59 minutes (44%), 32.6% spent 1 to 3:59 hour, 15.2% spent 4 to 7:59 hour, and 8.2% of the patients spent more than 8 hours. A priceless such study will offer an opportunity to evaluate the recent ED performance and assist to adapt future optimization strategies to improve the quality of services provided to the patient.

7% Hypertonic Saline in Acute Bronchiolitis: A Randomized Controlled Trial

Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated. We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay. At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant. In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.

Nontechnical skills performance and care processes in the management of the acute trauma patient

Acute trauma management is a complex process, with the effective cooperation among multiple clinicians critical to success. Despite this, the effect of nontechnical skills on performance on outcomes has not been investigated previously in trauma. Trauma calls in an urban, level 1 trauma center were observed directly. Nontechnical performance was measured using T-NOTECHS. Times to disposition and completion of assessment care processes were recorded, as well as any delays or errors. Statistical analysis assessed the effect of T-NOTECHS on performance and outcomes, accounting for Injury Severity Scores (ISS) and time of day as potential confounding factors. Meta-analysis was performed for incidence of delays. Fifty trauma calls were observed, with an ISS of 13 (interquartile range [IQR], 5-25); duration of stay 1 (IQR, 1-8) days; T-NOTECHS, 20.5 (IQR, 18-23); time to disposition, 24 minutes (IQR, 18-42). Trauma calls with low T-NOTECHS scores had a greater time to disposition: 35 minutes (IQR, 23-53) versus 20 (IQR, 16-25; P = .046). ISS showed a significant correlation to duration of stay (r = 0.736; P < .001), but not to T-NOTECHS (r = 0.201; P = .219) or time to disposition (r = 0.113; P = .494). There was no difference between "in-hours" and "out-of-hours" trauma calls for T-NOTECHS scores (21 [IQR, 18-22] vs 20 [IQR, 20-23]; P = .361), or time to disposition (34 minutes [IQR, 24-52] vs 17 [IQR, 15-27]; P = .419). Regression analysis revealed T-NOTECHS as the only factor associated with delays (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.06-0.95). Better teamwork and nontechnical performance are associated with significant decreases in disposition time, an important marker of quality in acute trauma care. Addressing team and nontechnical skills has the potential to improve patient assessment, treatment, and outcomes.

Development of a diagnostic tool: the wastewater collection network odour wheel

The assessment of nuisance odour problems and the application of an effective odour management programme for the associated industrial activity may be achieved using a representative odour wheel and Odour Profile Analysis methodology. The odour wheel is a very useful tool for conducting odour quality control monitoring and developing a constructive dialogue regarding nuisance odours with the public. Previously, odours from wastewater treatment plant activities have been identified and described with a dedicated odour wheel. The oxidation state of the organic chemicals responsible for a given odour depends on multiple parameters specific to the individual wastewater collection networks (residence time of wastewater, topographic disposition and network slope, aeration and on line chemical treatment processes). This is especially important for odorous nitrogen, sulfur and volatile fatty acids. Trained sensory odour panels combined with chemical analyses have been used to study wastewater collection network odours and to adapt the wastewater odour wheel accordingly. The wastewater collection network odour wheel has been produced using the results of five sampling campaigns; eight out of the 11 odour families constituting the wastewater odour wheel have been identified and consequently validated for sewer networks. Different groups of odours have been perceived according to the presence or absence of wastewater effluents at the various sampling points.

Latin Hypercube Sampling and the Identification of the Foreclosure Contagion Threshold

Over the last several years, the U.S. economy has experienced a significant recession brought on by the collapse of the residential real estate market. During this downturn, the number of real estate foreclosures has risen drastically. Recent studies have empirically demonstrated a reduction in real estate values due to neighboring foreclosures, termed the foreclosure contagion effect. The foreclosure contagion effect impacts healthy neighboring properties that surround the foreclosed property as a function of both time and distance. We mathematically specify a precise equation that identifies the foreclosure contagion threshold, that is, the boundary that separates surviving markets from those that crash. Using a new technique to our field known as Latin Hypercube Sampling, we presents the results of a large scale sensitivity analysis to find that beyond the foreclosure discount and disposition time variables, the percentage of adjustable rate mortgages (ARMs) and the foreclosure distance discount weight are the two secondary most contributing causes to a market collapse.

A Prospective Analysis of Lifeguard Medical Team Interventions in Ecuador During 2011 Carnaval

Drowning remains a leading cause of death globally. The true burden is unknown because of underreporting. Carnaval, a large-scale event in Ecuador, draws large sections of the population to the coast and historically is associated with numerous drowning deaths. The purpose of this study was to prospectively quantify preventative, rescue, and first aid interventions by lifeguards protecting the beaches in Ecuador during Carnaval. This was an Institutional Review Board approved, prospective observational study. Inclusion criteria were any rescue, prevention, or first aid encounters by lifeguards. Lifeguards were trained on the 18-item data collection form and dictionary, and completed the form after every intervention. Elements collected included age, gender, time of day, injuries, contributing factors, disposition, and mortality. The primary measure was the proportion of the 3 types of interventions. We secondarily characterize the lifeguard rescues. Data were entered into a database by trained and monitored research assistants. We report descriptive statistics as appropriate. During the 4-day event, lifeguards performed 246 unique interventions: 153 preventative maneuvers on 2141 swimmers, 94 water rescues, and 29 first aid interventions. The mean age was 22.7 years (range 3–60 years). The rescued swimmers were predominantly male, 36 of 52 (69% [95% confidence interval (confidence interval): 55% to 80%]). The time of day analysis revealed a bimodal pattern with peaks during the 11:00 am to 12:00 noon and the 1:00 pm to 2:00 pm periods. Rip current was a factor in 52 of 94 cases (55% [95% CI: 45% to 65%]), and alcohol was a factor in 4 of 47 rescues (9% [95% CI: 3% to 21%]). None of the 94 rescues (0% [95% CI: 0% to 5%]) required resuscitation, and only 2 of 94 (2% [95% CI: 1% to 7%]) required transfer to a hospital. There were no drowning deaths. Study limitations were that beach crowd estimates and number of persons impacted by preventative interventions were not adjudicated. The majority of lifeguard interventions were preventative in nature, and there were no drowning deaths. Most rescues occurred in the late morning or early afternoon, and involved male, nonintoxicated swimmers. Our data may provide insight for others planning large water events in the future.

Emergency focussed assessment with sonography in trauma (FAST) and haemodynamic stability

BackgroundFocussed assessment with sonography in trauma (FAST) has assumed a key role in the rapid non-invasive assessment of thoracoabdominal trauma and assists in decreasing disposition time. This study evaluates FAST's...

Criminal Disposition Time for Child-Sexual-Abuse Cases in a Large Urban Court

This study compared criminal disposition time for child-sexual-abuse cases and other felonies in the Arizona Superior Court for Maricopa County. Of those resolved, the majority of both child-sexual-abuse cases (59 percent) and felony cases (85 percent) were disposed within the target time frame of 180 days. However, nearly one in three child-sexual-abuse cases took more than two years to reach disposition or were pending. The average pending time for child-sexual-abuse cases were two-and-one-half times that for all pending felonies in general.

Bedside Teaching on Time to Disposition Improves Length of Stay for Critically-ill Emergency Departments Patients

Introduction:We tested the effect of a brief disposition process intervention on residents’ time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients.Methods:This was a quasi-experimental study design in a single teaching hospital where ED residents are responsible for administrative bed requests for patients. Enrollment was performed for intervention and control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged as Emergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted the resident to make the disposition immediately after the evaluation of resuscitation patients. In the control group, the attending physicians did not intervene in the disposition process unless more than 2 hours passed without a disposition. Main outcomes were time to disposition and total ED LOS.Results:A total of 104 patients were enrolled; 53 (51%) in the intervention group and 51 (49%) in the control group. After controlling for ESI and resident training year, mean disposition time was significantly shorter in the intervention group by 41.4 minutes (95% CI: 32.6–50.1). LOS was also shorter in the intervention group by 93.3 minutes (95% CI: 41.9–144.6).Conclusion:Prompting residents to enter administrative disposition orders in high acuity patients is associated with significant reduction in both time to disposition and ED LOS.

301 The Financial Benefits of Implementing Cardiac Point of Care Testing of Emergency Department Chest Pain Patients

Study Objectives: Glendale Memorial Hospital implemented point of care testing for cardiac biomarkers in their emergency department (ED) in May of 2010 using a rapid disposition protocol. The goal of the hospital was 2fold: 1) to reduce the turnaround time for these markers which would improve workflow for chest pain patients and decrease patient disposition times; and 2) to reduce unnecessary inpatient admissions by admitting more of these patients to an existing ED Chest Pain Unit (EDCPU). The hypothesis was that more appropriate disposition of patients should lead to reduced costs and increased reimbursements. Methods: The implementation included the use of multiple cardiac biomarkers (TnI, CK-MB, myoglobin, and BNP; Alere™ Triage® CardioProfilER) which were evaluated in a rapid (2 hour) serial draw protocol. The analyses performed were comparisons of laboratory versus point of care test turnaround time during the post-implementation period, comparisons of pre-implementation versus post-implementation patient disposition, and the financial impact of the differences in patient disposition. The statistical analysis used was Student's t-test for equality of means for paired data (Excel® 2007) for all of the analyses except turnaround time which used the Mann-Whitney test for equality of means with unequal variance (MedCalc®). The EDCPU began operation in September of 2009 and the POC implementation process was completed in May of 2010. Allowing at least 2 months as a “start-up” period for these 2 events resulted in a pre-implementation period from November 2009 through April 2010 and a post-implementation period of November 2010 through April 2011 (six months in each period). Results: The turnaround time for biomarker results was significantly less for the point of care tests than for those coming from the central laboratory (p<0.0001). For 1736 test results at the point of care the mean time from order to result was about 42 minutes and the median was 37 minutes. 14.2% of the results took longer than an hour. In contrast, for 2208 tests performed in the central laboratory the mean time from order to result was 94 minutes with a median time of 85 minutes. 77.5% of the results took longer than an hour. There were also significant differences in chest pain patient disposition in the pre- versus post-implementation time frames. Whereas there was no significant difference in disposition to telemetry beds, there were highly significant differences in >24 h admissions (26.7 per month versus 14.5 per month; p<0.003) and EDCPU admissions (19.5 per month versus 33.3 per month; p<0.0004) in the pre- versus post-implementation periods. This translated into an approximate $4500 increase in margin per month (p<0.04) which was about $54,000 in increased revenue per year. Conclusion: Institution of a rapid disposition protocol for chest pain patients increased the use of the EDCPU at Glendale Memorial Hospital which resulted in a net financial gain for the hospital.

The Efficiency of Federal Appellate Decisions: An Examination of Published and Unpublished Opinions

Almost 60 years ago, James Gough, wrote of the “pathologies” of the federal appellate process—particularly institutional characteristics that obstructed swift, meaningful justice. While some researchers have explored these institutional pathologies for published cases, the present piece extends our understanding in two ways. First, we introduce an empirical measure of judicial efficiency, “swift justice,” in terms of adjudicatory disposition time. Second, we examine the impact of particular institutional characteristics—whether a case is orally argued, or whether the decision is published—on judicial efficiency. We analyze the population of published and unpublished U.S. federal appellate decisions from 1976-97, using institutional variables to identify prescriptions that might attenuate pathologies of adjudicatory speed. Our historical analysis provides some baseline evidence that publication status influences the timeliness of appellate decision making.

Impact of Physician Screening in the Emergency Department on Patient Flow

BackgroundPhysician triage is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. Study ObjectiveWe aim to determine the impact of this intervention on some key components of ED patient flow, including time to physician evaluation, treatment order entry, diagnostic order entry, and disposition time for admitted patients. MethodsWe conducted a 2-year before–after analysis of a physician triage system at an urban tertiary academic center with 90,000 annual visits. The goal of the physician in triage was to arrange safe disposition of straightforward patients as well as to initiate work-ups. All medium-acuity patients arriving during the hours of the intervention were impacted and thus included in the analysis. Our primary outcome was the time to disposition decision. In addition to before–after analysis, comparison was made with high-acuity patients, a group not impacted by this intervention. Patient flow data were extracted from the ED information system. Outcomes were summarized with medians and interquartiles. Multivariable regression analysis was performed to investigate the intervention effect controlling for potential confounding variables. ResultsThe median time to disposition decision decreased by 6min, and the time to physician evaluation, analgesia, antiemetic, antibiotic, and radiology order decreased by 16, 70, 66, 36, and 16min, respectively. These findings were all statistically significant. Similar results were observed from the multivariable regression models after controlling for potential confounding factors. ConclusionsPhysician triage led to earlier evaluation, physician orders, and a decrease in the time to disposition decision.

Effects of cognitive age, dispositional time perceptions, and time view manipulations on product attribute evaluations

Researchers manipulate time perceptions in experiments, but the efficacy of such manipulations demands further scrutiny. Two studies test the effects of dispositional time views and time view manipulations on product attribute evaluations, as well as the interaction between cognitive age and manipulated time perceptions and that between dispositional and manipulated time perceptions. The results suggest that time manipulation drives and predicts consumer product evaluations. In addition, cognitive age interacts with time manipulation as a meaningful moderator/predictor, and dispositional time view interacts with time manipulation to influence consumer evaluations. An incongruency effect (i.e., a time manipulation condition that differs from consumers' time perceptions) occurs for hedonic attribute evaluations but not for utilitarian attribute evaluations. The research offers several managerial implications of these findings.