Emergency Department Volume and Racial and Ethnic Differences in Waiting Times in the United States

• Published in: Medical care 2012-04, Vol.50 (4), p.335-341
• Main Authors: Sonnenfeld, Nancy, Pitts, Stephen R., Schappert, Susan M., Decker, Sandra L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Ambulances; Black or African American; Black People - statistics & numerical data; Brief Reports; Child health services; Emergency departments; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Ethnicity; Ethnicity - statistics & numerical data; Female; Generalized linear models; Geometric mean; Health Care Surveys; Health care waiting times; Healthcare Disparities - statistics & numerical data; Hispanic or Latino - statistics & numerical data; Hispanics; Humans; Linear Models; Male; Middle Aged; Patients; Pediatrics; Racial differences; Racial Groups - statistics & numerical data; Teaching hospitals; Triage; United States; Waiting Lists; Waiting period; White people; White People - statistics & numerical data; Young Adult
• ISSN: 0025-7079; 1537-1948; 1537-1948
• DOI: 10.1097/MLR.0b013e318245a53c

Background: Racial and ethnic differences in emergency department (ED) waiting times have been observed previously. Objectives: We explored how adjusting for ED attributes, particularly visit volume, affected racial/ethnic differences in waiting time. Research Design: We constructed linear models using generalized estimating equations with 2007—2008 National Hospital Ambulatory Medical Care Survey data. Subjects: We analyzed data from 54,819 visits to 431 US EDs. Measures: Our dependent variable was waiting time, measured from arrival to time seen by physician, and was log transformed because it was skewed. Primary independent variables were individual race/ethnicity (Hispanic and non-Hispanic white, black, other) and ED race/ethnicity composition (covariates for percentages of Hispanics, blacks, and others). Covariates included patient age, triage assessment, arrival by ambulance, payment source, volume, region, and teaching hospital. Results: Geometric mean waiting times were 27.3, 37.7, and 32.7 minutes for visits by white, black, and Hispanic patients. Patients waited significantly longer at EDs serving higher percentages of black patients; per 25 point increase in percent black patients served, waiting times increased by 23% (unadjusted) and 13% (adjusted). Within EDs, black patients waited 9% (unadjusted) and 4% (adjusted) longer than whites. The ED attribute most strongly associated with waiting times was visit volume. Waiting times were about half as long at low-volume compared with high-volume EDs (P < 0.001). For Hispanic patients, differences were smaller and less robust to model choice. Conclusions: Non-Hispanic black patients wait longer for ED care than whites primarily because of where they receive that care. ED volume may explain some across-ED differences.