Increase In Waiting Time Research Articles

Pattern of Treatment Initiation and Outcomes for Patients With Metastatic Non-small Cell Lung Cancer in Ontario.

Introduction: The impact of diagnosis and treatment delay on outcomes in advanced non-small cell lung carcinoma (NSCLC) is not well understood. In this study, we examined the effect of the length of time to the first chemotherapy treatment initiation and the other factors affecting overall survival.Methods: This retrospective study used data from the Institute of Clinical Evaluative Sciences and identified 4520 patients in Ontario who were diagnosed with stage IV NSCLC between 2007 and 2016, treated using chemotherapy. We adjusted the analysis for location (rural vs urban), gender, distance from the nearest cancer center, first chemotherapy treatment used, income, and age. Results: Type of the chemotherapy, length of time to the first treatment, and distance from the nearest cancer center had a statistically significant impact on survival. Paclitaxel was associated with decreased risk of death compared to vinorelbine (Hazard Ratio (HR)=0.835, 95%CI 0.753-0.925), gemcitabine (HR=0.916, 95%CI 0.998-0.826), and docetaxel (HR=0.771, 95%CI 0.994-0.513). Every additional 10 km distance from the nearest cancer center was associated with a 0.5% increased risk of death (HR=1.005, 95%CI 1.000-1.010). A longer time to the first treatment was associated with increased survival. In fact, every 10 days increase in wait time was associated with a 0.5% decrease in the risk of death (HR=0.995, 95%CI 0.993-0.998). Conclusion: Chemotherapy treatment using paclitaxel and living closer to the cancer center is associated with better survival. A longer time between diagnosis and treatment leading to better survival could perhaps be explained by patients on the "sicker" end of the spectrum receiving treatment sooner.

The first wave of COVID-19 did not cause longer wait times in head and neck cancer. Experience of a French expert center

BackgroundHead and neck cancers (HNC) have poor survival prognosis, as tumors are often diagnosed at advanced stages in patients consulting late. The first lockdown linked to the 1st wave of COVID-19 (Coronavirus Disease 2019) disrupted consultation schedules in France. ObjectiveThe principal aim of the present study was to analyze consultation wait time in HNC during and after lockdown, in our university expert oncology reference center, to disclose any increase in treatment wait time. MethodsA single-center retrospective study included patients with a first diagnosis of HNC. Three groups were distinguished: “lockdown”, “post-lockdown”, and a “control” group (corresponding to a reference period 1 year earlier). Intervals between first oncologic consultation and multidisciplinary tumor board (FC-MTB) and between MTB and first treatment (MTB-T) were assessed. ResultsOne hundred and seven patients were included in the control group, 60 in the lockdown group and 74 in the post-lockdown group. There was no increase in median FC-MTB interval (respectively 35, 29 and 28 days) between the lockdown and post-lockdown groups compared to the control group (respectively P=0.2298 and P=0.0153). Likewise, there was no increase in MTB-T interval (27, 20 and 26 days respectively) (P=0.4203). ConclusionNo increase in wait times was observed during the lockdown and post-lockdown periods in our center.

Dually-enrolled patients choose providers with lower wait times: Budgetary implications for the VHA.

To estimate the effect of wait times on patients' choice of provider and simulate changes in choice of provider due to compliance with VA MISSION Act wait time targets. We use nationwide administrative data (2014-2017) on Veterans who are enrolled in Medicare and the Veterans Health Administration (VHA), the Survey of VHA Enrollees, Area Health Resource Files, and other data provided by the Centers for Medicare & Medicaid Services. We use an instrumental variables approach to identify the effect of VHA wait times on the proportion of total (Medicare and VHA) services that are paid for by the VHA ("reliance"). We exploit shocks to VHA provider supply to isolate supply-driven changes in wait times and estimate the effect on VHA reliance. We control for market and time fixed effects and local demand factors. We use monthly aggregated data on 140 markets (groups of counties). VHA reliance is computed among patients aged 65 years or older who are dually enrolled in VHA and Medicare. VHA wait times and reliance are calculated for multiple specialties: cardiology, gastroenterology, orthopedics, urology, dermatology, and ophthalmology/optometry. A 10% increase in the mean wait time (+2.8 days) reduces VHA reliance by 2.3 percentage points (95% CI: 2.3, 2.7), or 7.9% of the sample mean. This implies that meeting the MISSION Act wait time targets may have multi-billion-dollar budgetary impacts. Effects vary across specialties. For example, a 10% increase in the mean wait time for cardiology services (+2.0 days) reduces reliance by 1.8 percentage points (95% CI: 1.6, 2.1), or 6.3% of the sample mean for cardiology services. Meeting statutory wait time targets may have substantial unforeseen impacts on federal health care spending as patients sort to providers who have lower wait times.

Evaluation of factors impacting patient satisfaction in a pediatric otolaryngology clinic

ObjectivesWith an emphasis on patient-centered care and provider transparency, patient satisfaction measures have become a key indicator of healthcare quality. Using the Press Ganey Outpatient Medical Practice Survey (PGOMPS), we sought to determine key factors that impact patient satisfaction. MethodsWe conducted a retrospective review of new pediatric (<18 years old) outpatient otolaryngology visits between January 1, 2014 and December 31, 2018 at a children's hospital clinic and satellite clinics. Univariate and multivariate binary logistic regression analysis were used to determine factors correlated with patient satisfaction for both the PGOMPS Total Score and Provider Sub-Score. ResultsA total of 1,050 patient or parent responses were included. The mean patient age was 5.6 ± 5.0 years with 54.7% identified as male. Univariate analysis demonstrated that for each 10-min increase in Total Wait Time, the odds of being satisfied were significantly decreased on both the Total Score (odds ratio [OR] 0.5; P < 0.001) and Provider Sub-Score (OR 0.8; P < 0.001). Furthermore, for each additional 5-year increase in patient age, patients were significantly more likely to report satisfaction on Total Score (OR 1.21; P = 0.011). Multivariate analysis revealed that the odds of achieving satisfaction for each decile increase in Total Wait Time were 0.5 for Total Score (P < 0.001) and 0.8 for Provider Sub-Score (P < 0.001), independent of patient age, sex, insurance category, socioeconomic disadvantage level, and patient community type. ConclusionsWait time is a significant factor impacting patients’ likelihood of being satisfied with their overall care in a pediatric otolaryngology clinic setting.

Orthopaedic trauma on the weekend: Longer surgical wait times, and increased after-hours surgery

IntroductionOrthopaedic trauma does not present in a linear fashion. Fluctuations in trauma volumes, after-hours surgery and surgical wait times impact orthopaedic surgeons and patients. There is little research focussing on how surgical trauma volumes change throughout the week. This study investigated the relationship between day of the week and surgical orthopaedic trauma volumes, after-hours surgery, and wait times for orthopaedic trauma patients. MethodsAll unscheduled surgical orthopaedic trauma cases presenting to one level I and three level IV urban adult trauma centers between 2008 and 2018 were retrospectively reviewed. Fluctuations in orthopaedic trauma volumes and amount of after-hours surgeries completed were investigated using Multivariable Poisson regression. Fluctuations in patient wait times were investigated using linear regression. ResultsWeekends were associated with increased surgical wait times (8.9%, p<0.001) despite decreased surgical trauma volumes (9.1%, p<0.001). Surgical orthopaedic trauma volumes were elevated on weekdays and decreased on weekends. More after-hours surgeries were performed from Thursday to Saturday with most performed on Friday night (26.6%, p<0.001). Surgical wait times increased midweek and remained high until Saturday. ConclusionWith a lack of dedicated trauma resources on the weekend, a significant increase in after-hours surgery and surgical wait times was identified following surgical volumes peaking on Thursday and Friday. We suggest adapting resource allocation to reflect surgical volumes. Dedicated weekend orthopaedic trauma resources or an adaptable schedule during increased orthopaedic trauma have the potential to ease this bottleneck, improve patient care, and decrease hospital costs.

Clinical practice recommendations for prehabilitation and post-operative rehabilitation for arthroplasty: A scoping review.

The rising need for arthroplasty (joint replacement) has resulted in a significant increase in wait-times. Longer surgical wait-times may further exacerbate functional decline in adults with osteoarthritis as well as delay postoperative functional recovery. This review aims to better inform rehabilitation care provision before (prehabilitation) and after (post-rehabilitation) hip or knee arthroplasty based on recommendations from clinical practice guidelines (CPGs). This scoping review used a three-stage process to screen and extract articles, which resulted in 123 articles reviewed for analysis. Included CPGs were in the English language and focussed on rehabilitation interventions or practices involving adult patients preparing for or recuperating from hip and knee arthroplasty (published 2009-2020). Patient assessments, use of assistive devices, as well as self-management and education programs were recommended before and after arthroplasty. Physiotherapy was recommended to support post-operative rehabilitation. Conversely, there was limited evidence supporting recommendations for or against physiotherapy during the prehabilitation phase of the arthroplasty care journey. The findings from this review highlight the current gap in high-quality evidence supporting hip and knee arthroplasty rehabilitation CPGs before and after surgery. Findings warrant additional research to ensure patients are best prepared for surgery and supported for optimal recovery.

Impact of Universal Suicide Risk Screening in a Pediatric Emergency Department: A Discrete Event Simulation Approach.

ObjectivesThe aim of this study was to use discrete event simulation (DES) to model the impact of two universal suicide risk screening scenarios (emergency department [ED] and hospital-wide) on mean length of stay (LOS), wait times, and overflow of our secure patient care unit for patients being evaluated for a behavioral health complaint (BHC) in the ED of a large, academic children’s hospital.MethodsWe developed a conceptual model of BHC patient flow through the ED, incorporating anticipated system changes with both universal suicide risk screening scenarios. Retrospective site-specific patient tracking data from 2017 were used to generate model parameters and validate model output metrics with a random 50/50 split for derivation and validation data.ResultsThe model predicted small increases (less than 1 hour) in LOS and wait times for our BHC patients in both universal screening scenarios. However, the days per year in which the ED experienced secure unit overflow increased (existing system: 52.9 days; 95% CI, 51.5–54.3 days; ED: 94.4 days; 95% CI, 92.6–96.2 days; and hospital-wide: 276.9 days; 95% CI, 274.8–279.0 days).ConclusionsThe DES model predicted that implementation of either universal suicide risk screening scenario would not severely impact LOS or wait times for BHC patients in our ED. However, universal screening would greatly stress our existing ED capacity to care for BHC patients in secure, dedicated patient areas by creating more overflow.

Timely After-Sales Service and Technology Adoption: Evidence from the Off-Grid Solar Market in Uganda

Problem definition: Adoption and continued use of novel technologies have the potential to significantly accelerate social and economic development in emerging markets. In this paper, we examine to what extent timely after-sales service—that is, faster resolution of repair tasks—impacts technology adoption. In particular, we empirically assess the impact of service wait times on the adoption of solar home systems by first-time users (i.e., adopters of the technology) in off-grid Uganda. Academic/practical relevance: Our study sheds light on a previously understudied driver of technology adoption—customers’ postpurchase experience related to after-sales service. We also provide evidence on how negative word-of-mouth stemming from long service wait times hampers customer acquisition. Methodology: We address our research question using detailed customer-level sales and service data from a leading assembler and distributor of solar home systems in Uganda. We develop a fixed-effects base specification and two instrumental variables specifications that leverage different sources of exogenous geospatial variation—in service-task locations, weather, and road quality. Results: We find that timely after-sales service experienced by existing customers is a strong driver of adoption by first-time users. A one-week increase in average wait time for service decreases adoption by up to 32.4%. The relationship between wait times and adoptions is heterogeneous and depends on the types of pending service cases. We also find that the number of customers acquired through referrals from an existing customer depends on the referring customer’s service wait time. This provides evidence of a strong word-of-mouth channel of information sharing. Managerial implications: Our findings have direct implications for the customer-acquisition strategies of technology firms and for technology investors in emerging markets. Our results are also relevant for policy makers who aim to harness technology to improve the socioeconomic lives of people living in these regions. Importantly, we provide empirical evidence of a direct link between after-sales service and technology adoption, which is of relevance to managers outside of emerging markets as well.

Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery.

BackgroundAlthough insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. Novel coronavirus disease 2019 (COVID-19) negatively impacted access to care, while simultaneously widening pre-existing health-care disparities. The purpose of the present study was to document this phenomena within orthopedics.MethodsPatients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California, were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center, and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients who underwent arthroplasty before the pandemic (March 2020) and those after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared.ResultsTwo-hundred sixty-nine (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher body mass index, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. A comparison of case volumes showed a larger decrease at ZSFGH than at UCSF after COVID. Wait times between the two sites before and after COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH before COVID were more than double the wait times at UCSF after COVID.ConclusionsCOVID-19 worsened access to primary hip and knee arthroplasties at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with nonprivate insurance were affected the most.

Hazard-based duration approach for understanding pedestrian crossing risk exposure at signalised intersection crosswalks – A case study of Kolkata, India

Pedestrian signal violation is a significant concern among policymakers and traffic engineers as this leads to a pedestrian-vehicle crash. The waiting time for a pedestrian at intersections is crucial in street-crossing decision-making. Once pedestrians terminate their waiting behaviour during the red-light period, they would cross in the red light and put themselves in danger. A total of 2089 red-light arriving pedestrian observations were made at eight intersection crosswalks across Kolkata city (India). With the help of hazard-based duration models, the waiting duration till signal violation has been analysed. Kaplan–Meier curve has been plotted to understand the survival probabilities. A semi-parametric Cox Proportional Hazard model was used to understand the different factors influencing signal violation behaviour. However, the proportional hazard assumption was not satisfied. Therefore, a parametric Accelerated Failure Time (AFT) model was used to understand the various covariates that affect the waiting duration. The results highlighted that 49.5% of pedestrians crossed immediately after arriving at the intersection in the red-light phase. A pedestrian’s probability of crossing the road when it is unsafe, i.e., motor vehicles still have green or yellow, varies with the waiting time. As waiting time increases, pedestrians get impatient and violate the traffic signal. This violation places them at an increased risk of being struck by a motor vehicle. The covariate analysis using the AFT model showed that pedestrian glance/looking behaviour, different types of distractions, signal cycle length, carrying luggage, and traffic plying on the road impacted signal violation behaviour. Signal modifications by reducing red-light phase length for pedestrians might be the most efficient means of reducing the likelihood of signal violation and being hit by a motor vehicle.

The Impact of COVID-19 on the Surgical Wait Times for Plastic and Reconstructive Surgery in Ontario.

Purpose: The aim of this study was to assess the impact of COVID-19 on surgical wait times for Plastic and Reconstructive Surgery (PRS) in Ontario, Canada. Methods: Ontario's wait time data has fourteen reporting categories for PRS. For each category, the mean wait time for consultation and for surgery were reported. Each category was given a priority ranging from 1 to 4. Two periods, three-month and six-month, were selected and compared to the same calendar months of the previous year. Wait times, surgical volume and percent change to the provincial wait time target were reported and compared to the baseline data. Results: This study reviewed 9563 consults and 15,000 operative cases. There was a 50% reduction in the volume of surgical consults during the study period compared to the baseline period (P = 0.004). The reduction ranged from 46% to 75% based on the reporting category. The volume of surgical cases decreased by 43% during the study period compared to the baseline period (P = 0.005). A statistically significant increase in the mean wait times for surgery was observed, involving priorities 2 to 4 (overall mean = 32 days, P ≤ 0.01). There was a 15% decrease in the percentage of surgeries meeting the provincial target times (P < 0.0001). Conclusion: COVID-19 has caused a significant reduction in the volume of cases performed in the majority of PRS categories with an overall increase in the wait times for consultation and for surgery. Recovery following COVID-19 will require strategies to address the growing volume of cases and wait times for surgery across all PRS categories.

Evaluation of the palliative radiotherapy pathway in a single institute: Can an MR Linac improve efficiency?

BackgroundPalliative radiotherapy (RT) is effectively used to relieve cancer related symptoms. The demand for these services is increasing worldwide. Rapid response clinics have been developed as a means to streamline the palliative RT radiotherapy process and increase efficiency and improve patient experiences. Key components to successful rapid response palliative RT are access to care, streamlined services and innovation. To successfully implement a rapid response RT programme, it is essential to identify gaps between currently provided care and ideal or enhanced care. The aims of this work are to audit the current palliative RT workflow at our institution both prior to and during the coronavirus pandemic. This work reports the impact of covid-19 on rate of palliative RT referrals and proposes a radiographer led, MR guided rapid response workflow to reduce wait times MethodsA retrospective audit of palliative radiotherapy booking forms was completed over a two yearperiod (2019-2020) to assess the current pathway both prior to and during the covid-19 pandemic. This audit identified patients who had received urgent/emergency spinal RT in the specified timeframe. Further data on these patients was collected using departmental oncology information systems to form a detailed analysis of the pathway and wait times. Data was recorded and analysed using Microsoft Excel. ResultsA total of 813 patients met the inclusion criteria for this audit. Data was reported for 2019 and 2020 separately to determine any significant impact caused by the covid-19 pandemic. In 2020 there was an 11.5% increase in referrals for palliative radiotherapy with an equal portion (81%) of total referrals in each year being for single fractions. Timelines from referral to treatment delivery were reported, with those patients receiving same day single fraction RT palliative radiotherapy undergoing further analysis to determine the amount of time spent in the department. Mean wait time for these patients was 5 hours and 20 minutes in 2019 but increased by 20.9% in 2020. ConclusionsThe increasing demand for palliative RT due to rising global cancer rates and extended life expectancy due to advanced systemic treatments may lead to increased wait times. An increase in both referrals and mean wait time was seen during the covid-19 pandemic. Improving efficiency and access to care is essential for this population. The MR Linac could play a role in streamlining palliative RT workflows due to its ability to employ a scan, plan and treat model in a single session. This work forms preliminary support for the development of a trial one stop palliative program on the MR Linac.

Trends in mental health presentations in a south Australian tertiary emergency department.

Limited recent interstate evidence suggests an increase in paediatric mental health presentations to emergency departments in Australia. We set out to confirm this and whether any specific diagnosis was responsible for this increase. We identified all patients with mental health presentations aged 6-18 years who attended our tertiary emergency department from January 2006 to June 2019 using our emergency department patient record system. Patients were determined to have a mental health presentation if they had a discharge diagnosis or presenting complaint code that corresponded to a mental health disorder or were referred to the mental health team. For analysis, we divided the 13.5-year duration of our study into three periods of 4.5 years. Comparing the first and last time periods, there was a 156% increase in mental health presentations over 9 years. This was out of proportion to the increase in combined general and mental health presentations of 11.9%. There was an increase in the proportion of patients who were diagnosed with an adjustment disorder (14-26.6%) or a childhood emotional disorder (8.5-20.8%). Additionally, there was an increase in median wait time and a reduction in the proportion of patients seen within their recommended triage time. There is a large increase in the number of paediatric mental health presentations to our emergency department. Further resources may need to be allocated to mental health services in the community and in the emergency department.

The impact of Medicaid expansion on emergency department wait times.

To estimate the impact of Medicaid expansion on emergency department (ED) wait times. We used 2012-2017 hospital-level secondary data from the CMS Hospital Compare data warehouse. We used a state-level difference-in-differences approach to identify the impact of Medicaid expansion on four measures of ED wait times: time before being seen by a provider; time before being sent home after being seen by a provider; boarding time spent in the ED waiting to be discharged to an inpatient room; and the percentage of patients who left without being seen. We compared outcomes in states that expanded Medicaid with those in states that did not expand Medicaid. Our sample included all US acute care hospitals with EDs in states that did not ever expand Medicaid or that fully expanded Medicaid in January of 2014. Medicaid expansion was associated with a 3.1-min increase (SE: 0.994, baseline mean: 30.8min) in the time spent waiting to see an ED provider, a relative increase of 10%. Patients who were eventually sent home after being seen by a provider experienced a 7.5-min increase (SE: 1.8, baseline mean 142.1min) in wait time. Boarding time rose by 3.8min (SE 1.9, baseline mean 111.4min). The percentage of patients who left without being seen rose by 0.3 percentage points (SE: 0.09, baseline mean 2.0), a relative increase of 15.3%. This study provides multistate evidence that Medicaid expansion increased ED wait times for patients, indicating that ED crowding may have worsened post-expansion. Future work should aim to uncover the mechanisms through which insurance expansion increased ED wait times to provide policy direction.

S1208 Improving Bone Health Screening Among Chronic Liver Disease Patients in a Digestive Health Liver Clinic, Quality Improvement Initiative

Introduction: Hepatic osteodystrophy affects a substantial proportion of patients with chronic liver disease with 30% developing osteoporosis and up to 40% developing an osteoporotic fracture resulting in a decrease in quality of life and life expectancy. Our aim is to improve screening for hepatic osteodystrophy in digestive health liver clinics among patients with chronic liver disease by increasing vitamin D and DEXA scan orders from a baseline average of 11% and 29% respectively to >75% within 9 month duration. Methods: Hepatology clinics in Fairview Digestive Health at the University of Missouri-Columbia was the site of intervention. We performed root cause analysis and created a process flow map to find areas for intervention. Using the STEEEP Model of Institute of Medicine, Plan Do Study Act (PDSA) Model was used to execute the project. The outcome measures were percentage of patients with vitamin D measurements, DEXA scans completed and referrals to endocrinology clinics for those with osteoporosis. The process measures include Vitamin D, DEXA scan order and completion rates. Balancing measures included potential increase in wait times at the clinic.The intervention included education of fellows and residents in the hepatology clinic and patient education about bone health. PDSA 1: Baseline data collection PDSA 2: Fellow and resident education using PowerPoint and flyers PDSA 3: Medication reconciliation and tracking visits with physicians PDSA 4: Re-education of fellows with flyers in the fellows’ room PDSA 5: Analyzing data Results: In 9 months, we performed 609 patient encounters with chronic liver disease/cholestatic liver disease with mean age 59.4 years and 48.6% male patients. Of them, 11% had a history of fractures. Pre-intervention baseline average vitamin D order rate was 11% and DEXA order rate was 7%. Percentage of patients with vitamin D measurements and DEXA scan at the end of the study period was 77% (469/609) and 34.1% (208/609) respectively. Linkage to subsequent care with endocrinology was 83.3% (35/42) with osteoporosis. Vitamin D and DEXA order rate monthly variation was plotted on a run chart. No significant increase in wait times were noted by this intervention. Conclusion: We noted significant improvement in screening patients for hepatic osteodystrophy and increase in subsequent care of patients with osteoporosis. Sustainability, better medication reconciliation and measurement of osteoporotic fractures are future plans.Figure 1.: Presentation images.Table 1.: Confusion Matrix for VNT Detected by EVEndo Score (VNT: varices needing treatment; VNNT: varices not needing treatment).

The effect of TiB2 ceramic particles on Portevin–Le Chatelier behavior of TiB2/AlMg metal matrix composites

Metal matrix composites (MMCs) have attracted extensive attention due to their excellent mechanical properties. However, the Portevin–Le Chatelier (PLC) behavior of MMCs considering the interaction of reinforced particles and dislocations is rarely reported. In the present study, the influence of TiB2 ceramic particles on PLC behavior is systematically investigated in a TiB2/AlMg composite. It is found that particles decrease the critical strain of PLC at high strain rate (>0.01 s−1) compared with AlMg alloy, but their difference becomes small with the decrease of strain rate. The dual effects of particles are discussed in terms of dislocation waiting time based on experimental characterizations and theoretical modeling. It is shown that with the presence of particles, the waiting time increases at high strain rate, leading to the decrease of critical strain, but the proportion of additional waiting time induced by particles in overall waiting time gradually decreases with the decrease of strain rate, leading to the weakening of the effect of particles.

Can we talk? The association between language and preoperative wait times for gynecologic oncologic patients

<h3>Objectives:</h3> The literature shows that non-English speakers have challenges in the perioperative setting when compared to English speaking patients. There is a lack of research within the field of gynecologic oncology regarding how patients' preoperative wait time and preoperative experience is influenced by their primary spoken language. The purpose of this study is to compare perioperative wait times in gynecologic oncology for English and non-English speaking patients at large public and private institutions. <h3>Methods:</h3> This is a retrospective review of women who underwent elective surgery for a gynecologic malignancy at both a large public safety-net hospital or a large private hospital between January 2018 and September 2019. Data collection included demographic data, baseline health characteristics, pre-operative information including dates of outpatient visits and surgical date. Statistical analysis included two-tailed T tests and chi-square tests. <h3>Results:</h3> 211 charts were reviewed, with 184 patients included in the final analysis. Charlson comorbidity indices were similar for English and non-English speaking patients (p=0.39). The most common non-English spoken languages were Spanish (55%), Mandarin (8%), Cantonese (8%), Polish (7%), and Russian (4%). Overall, the mean wait time from booking appointment to surgery for English speaking patients was 25.5 days compared to 33.6 days in non-English speaking patients (p=0.12). The majority (90%) of the non-English speaking patients included in the analysis received their care at the public hospital (p<0.001). When the analysis was restricted to public hospital patients, mean wait times from booking appointment to surgery were 33.7 and 36.7 days for English and non-English speaking patients, respectively (p=0.7). At the private hospital, wait times from booking appointment to surgery were 19.0 and 14.7 days for English and non-English speaking patients, respectively (p=0.5). When comparing wait times for non-English speaking patients at the two institutions, patients waited significantly longer at the public hospital (p=0.008). <h3>Conclusions:</h3> Non-English speaking patients had an 8 day increase in perioperative wait times compared to English speaking patients. This increase is largely attributable to the increased wait time for all patients in the public hospital system when compared to the private hospital. Further investigation of the structural differences between the public and university hospital systems is warranted.

Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children.

To compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children; validate home T2PSG in children with suspected OSA. Eighty-one participants (ages 6-18) with suspected OSA had simultaneous T1PSG and T2PSG in the sleep laboratory, 47 participants (ages 5-16) had T1PSG in the sleep laboratory and T2PSG performed at home. Sleep scientists staged and scored polysomnography data, and pediatric sleep physicians assigned a diagnosis of normal or OSA. Participant demographics, polysomnography variables, and diagnoses were compared using chi-square and Fisher's exact tests for nominal variables, t test for continuous variables and Cohen's kappa to assess concordance. Acceptable recordings were obtained for every home T2PSG. When T1PSG and T2PSG were simultaneous, correlation between the number of arousals, respiratory disturbance index, and sleep stages was excellent. T2PSG at home demonstrated less stage 2 sleep, more rapid eye movement sleep, and higher sleep efficiency. Comparison of home T2PSG to T1PSG for diagnosing OSA showed a false-positive rate of 6.6% and false-negative rate of 3% for those performed at home. T2PSG in the home is feasible with excellent concordance with T1PSG for the purposes of diagnosing OSA in children aged 5-18 years. Home T2PSG may be more representative of a "normal" night for children and could benefit those suspected of having OSA by reducing waiting times for laboratory PSG, improving access to PSG and possibly reducing costs of investigating and treating OSA. Withers A, Maul J, Rosenheim E, O'Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. J Clin Sleep Med. 2022;18(2):393-402.

Do Patients Respond to Posted Emergency Department Wait Times: Time-Series Evidence From the Implementation of a Wait Time Publication System in Hamilton, Canada

One proposed solution to prolonged emergency department (ED) wait times is a publicly available website that displays estimated ED wait times. This could provide information to patients so that they may choose sites with low wait times, which has the potential to smooth the overall wait times in EDs across a health system. We describe the effect of a novel city-wide ED wait time website on patient volume distributions throughout the city of Hamilton, Ontario, Canada. We compared the number of new patients arriving every 15 minutes during 2 separate time periods-before and after a publicly viewable wait time website was made available. For each ED site, the effect of the posted wait time was measured by assessing its association with the total number of patient arrivals in the subsequent hour at the same site and at all other sites in Hamilton. Linear models showed clinically modest changes in patient volumes when wait times changed. However, nonlinear models showed that a 60-minute increase in wait time at a site was associated with 10% fewer patients presenting over the next hour. Larger negative associations were observed at community hospitals and urgent care centers. Increases in wait times at a given site were also associated with increased patient volumes at other sites in the system. After the implementation of a public wait time website, elevated wait times led to fewer patients at the same site but more patient visits at other sites. This may be consistent with the wait time tracker inducing patients to avoid sites with high wait times and instead visit alternate sites in Hamilton, but only when wait times were very high.

Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis

BackgroundHealth care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery.MethodsThis was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends.ResultsThe difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy.ConclusionsWe found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform.