When should a doctor see me when I get sick? A study of the time of day acutely ill medical patients present and the time they wait to see a doctor in Ireland

• Reconfiguration of the Irish acute hospital care has created delayed access to care
• We examined the time patients waited to see a doctor after hospital admission
• Patients who waited more than 80 min had an increased mortality
• Delay increased mortality more in low risk patients than in high risk ones
• It may be safer to be seen quickly by any doctor than wait to see a better one.

BackgroundReconfiguration of the Irish Health Service has diverted of large numbers of acutely ill medical patients to a reduced number of hospitals and may have caused in delays in treatment. Although prompt care improves outcomes for patients with acute myocardial infarction, stroke, infection and shock, there is surprisingly little evidence for its value in other conditions.MethodsThe time of admission and time patients waited to be seen and clerked by a doctor was reviewed on all medical patients admitted to Nenagh Hospital prior to service reconfiguration (i.e. from 17 February 2000 to 6 March 2004).ResultsOver the study period of 1442, days 9435 patients were admitted (i.e. 6.5 patients per day or 0.3 per hour) and waited 37.6 SD 53.1 min after admission before they were seen by a doctor. The peak time of admission is in the late afternoon and early evening and there was a liner correlation between the delay before seeing a doctor and the time of admission. The 1095 patients who waited 80 min or more to be seen and clerked by a doctor (median delay 120 min) were more likely to die (odds ratio 1.36 95% CI 1.03–1.81, p < 0.03).ConclusionWaiting to be seen by a doctor may increase the risk of death to some patients. For these patients it is probably safer to be seen quickly by any doctor, rather than travel many miles and wait several hours to see a better one.