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Racial disparities in emergency department length of stay for admitted patients in the United States.
Acad Emerg Med. 2009 May; 16(5):403-10.AE

Abstract

OBJECTIVES

Recent studies have demonstrated the adverse effects of prolonged emergency department (ED) boarding times on outcomes. The authors sought to examine racial disparities across U.S. hospitals in ED length of stay (LOS) for admitted patients, which may serve as a proxy for boarding time in data sets where the actual time of admission is unavailable. Specifically, the study estimated both the within- and among-hospital effects of black versus non-black race on LOS for admitted patients.

METHODS

The authors studied 14,516 intensive care unit (ICU) and non-ICU admissions in 408 EDs in the National Hospital Ambulatory Medical Care Survey (NHAMCS; 2003-2005). The main outcomes were ED LOS (triage to transfer to inpatient bed) and proportion of patients with prolonged LOS (>6 hours). The effects of black versus non-black race on LOS were decomposed to distinguish racial disparities between patients at the same hospital (within-hospital component) and between hospitals that serve higher proportions of black patients (among-hospital component).

RESULTS

In the unadjusted analyses, ED LOS was significantly longer for black patients admitted to ICU beds (367 minutes vs. 290 minutes) and non-ICU beds (397 minutes vs. 345 minutes). For admissions to ICU beds, the within-hospital estimates suggested that blacks were at higher risk for ED LOS of >6 hours (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.01 to 2.01), while the among-hospital differences were not significant (OR = 1.08 for each 10% increase in the proportion of black patients, 95% CI = 0.96 to 1.23). By contrast, for non-ICU admissions, the within-hospital racial disparities were not significant (OR = 1.12, 95% CI = 0.94 to 1.23), but the among-hospital differences were significant (OR = 1.13, 95% CI = 1.04 to 1.22) per 10% point increase in the percentage of blacks admitted to a hospital.

CONCLUSIONS

Black patients who are admitted to the hospital through the ED have longer ED LOS compared to non-blacks, indicating that racial disparities may exist across U.S. hospitals. The disparity for non-ICU patients might be accounted for by among-hospital differences, where hospitals with a higher proportion of blacks have longer waits. The disparity for ICU patients is better explained by within-hospital differences, where blacks have longer wait times than non-blacks in the same hospital. However, there may be additional unmeasured clinical or socioeconomic factors that explain these results.

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Authors+Show Affiliations

Pines JM
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. pinesjes@uphs.upenn.edu
Russell Localio A
No affiliation info available
Hollander JE
No affiliation info available

MeSH

AdolescentAdultAfrican AmericansAge FactorsAgedAged, 80 and overCrowdingEmergency Service, HospitalFemaleHealthcare DisparitiesHumansIntensive Care UnitsLength of StayMaleMiddle AgedOutcome Assessment, Health CarePatient AdmissionPatient TransferSex FactorsTime FactorsUnited StatesYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19245372

Citation

Pines, Jesse M., et al. "Racial Disparities in Emergency Department Length of Stay for Admitted Patients in the United States." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 16, no. 5, 2009, pp. 403-10.
Pines JM, Russell Localio A, Hollander JE. Racial disparities in emergency department length of stay for admitted patients in the United States. Acad Emerg Med. 2009;16(5):403-10.
Pines, J. M., Russell Localio, A., & Hollander, J. E. (2009). Racial disparities in emergency department length of stay for admitted patients in the United States. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16(5), 403-10. https://doi.org/10.1111/j.1553-2712.2009.00381.x
Pines JM, Russell Localio A, Hollander JE. Racial Disparities in Emergency Department Length of Stay for Admitted Patients in the United States. Acad Emerg Med. 2009;16(5):403-10. PubMed PMID: 19245372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial disparities in emergency department length of stay for admitted patients in the United States. AU - Pines,Jesse M, AU - Russell Localio,A, AU - Hollander,Judd E, Y1 - 2009/02/24/ PY - 2009/2/28/entrez PY - 2009/2/28/pubmed PY - 2009/10/22/medline SP - 403 EP - 10 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 16 IS - 5 N2 - OBJECTIVES: Recent studies have demonstrated the adverse effects of prolonged emergency department (ED) boarding times on outcomes. The authors sought to examine racial disparities across U.S. hospitals in ED length of stay (LOS) for admitted patients, which may serve as a proxy for boarding time in data sets where the actual time of admission is unavailable. Specifically, the study estimated both the within- and among-hospital effects of black versus non-black race on LOS for admitted patients. METHODS: The authors studied 14,516 intensive care unit (ICU) and non-ICU admissions in 408 EDs in the National Hospital Ambulatory Medical Care Survey (NHAMCS; 2003-2005). The main outcomes were ED LOS (triage to transfer to inpatient bed) and proportion of patients with prolonged LOS (>6 hours). The effects of black versus non-black race on LOS were decomposed to distinguish racial disparities between patients at the same hospital (within-hospital component) and between hospitals that serve higher proportions of black patients (among-hospital component). RESULTS: In the unadjusted analyses, ED LOS was significantly longer for black patients admitted to ICU beds (367 minutes vs. 290 minutes) and non-ICU beds (397 minutes vs. 345 minutes). For admissions to ICU beds, the within-hospital estimates suggested that blacks were at higher risk for ED LOS of >6 hours (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.01 to 2.01), while the among-hospital differences were not significant (OR = 1.08 for each 10% increase in the proportion of black patients, 95% CI = 0.96 to 1.23). By contrast, for non-ICU admissions, the within-hospital racial disparities were not significant (OR = 1.12, 95% CI = 0.94 to 1.23), but the among-hospital differences were significant (OR = 1.13, 95% CI = 1.04 to 1.22) per 10% point increase in the percentage of blacks admitted to a hospital. CONCLUSIONS: Black patients who are admitted to the hospital through the ED have longer ED LOS compared to non-blacks, indicating that racial disparities may exist across U.S. hospitals. The disparity for non-ICU patients might be accounted for by among-hospital differences, where hospitals with a higher proportion of blacks have longer waits. The disparity for ICU patients is better explained by within-hospital differences, where blacks have longer wait times than non-blacks in the same hospital. However, there may be additional unmeasured clinical or socioeconomic factors that explain these results. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/19245372/Racial_disparities_in_emergency_department_length_of_stay_for_admitted_patients_in_the_United_States_ L2 - https://doi.org/10.1111/j.1553-2712.2009.00381.x DB - PRIME DP - Unbound Medicine ER -