Disparities in emergency department wait times for acute gastrointestinal illnesses: results from the National Hospital Ambulatory Medical Care Survey, 1997-2006

Bechien U Wu, Peter A Banks, Darwin L Conwell
American Journal of Gastroenterology 2009, 104 (7): 1668-73

OBJECTIVES: (i) The aims of this study were to report wait times for visits to US emergency departments (EDs) for acute gastrointestinal illnesses, (ii) to identify whether racial/ethnic disparities exist in wait times, and (iii) to characterize factors associated with delays in physician assessment.

METHODS: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1997 to 2006. We studied wait times for acute pancreatitis, appendicitis, cholecystitis, and upper gastrointestinal hemorrhage (UGIH). Diagnosis was based on the International Classification of Diseases, Ninth Revision, Clinical Modification. Racial/ethnic categories were defined as non-Hispanic White (NHW), non-Hispanic Black, and Hispanic White (HW). Wait time was stratified by racial/ethnic group and by study year. We evaluated the association between race/ethnicity and frequency of delay relative to triage assignment. Multivariate logistic regression was used to estimate the impact of age, sex, payment status, and geography on wait time.

RESULTS: There were an estimated 1.6 million ED visits for acute pancreatitis, 2.2 million visits for appendicitis, 1.2 million visits for cholecystitis, and 3.9 million visits for UGIH in the NHAMCS survey during the study period. Average wait time ranged from 48 min (acute pancreatitis) to 61 min (cholecystitis). We identified a delay in clinical assessment in 24% of cases. In multivariate analysis, race/ethnicity was an independent predictor for increased wait time. HW waited longer and had higher frequency of delays compared with NHW for all four disease groups.

CONCLUSIONS: A significant proportion of visits to US EDs for acute gastrointestinal illnesses are associated with a delay in initial clinical assessment. Hispanic patients waited longer and had a higher frequency of delays compared with other racial/ethnic groups. Future policies should be directed at reducing delays in physician assessment and addressing this healthcare disparity.

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