Black and Hispanic patients more likely to face inappropriate emergency department delays

August 8, 2023

Source: Sangal, et al JAMA Network Open July 28, 2023 LINK

Emergency departments don’t take patients in the order they arrive. Those with life-threatening illnesses or injuries “jump the queue,” as is appropriate. Those with asthma who can’t breathe, or gunshot wounds need care this instant, while those with mild respiratory infections can wait a bit longer. But line-jumpers should have more urgent issues. Hospitals which established special units to expedite care for big donors or influential politicians have faced backlash; the order in which patients are seen should depend on how severely ill you are, not wealth, social standing, or the color of your skin!

Researchers at Yale reviewed data from over 300,000 visits to two of their emergency departments from 2017-2020 (stopping just before the pandemic) and found, unfortunately, that skin color mattered. Their research was published in JAMA Network Open last week. It showed that Hispanics and Non-Hispanic Blacks were more likely to be taken after other patients with less dangerous conditions. While the differences look small, they are all statistically significant given the large sample size. Those who were taken later were more likely to spend time on gurneys in hallways and to leave the emergency department without being seen by a physician.

Implications for employers:

-        This research adds to the growing evidence of structural racism in clinical practice, which leads to worse care and decrease trust of the medical delivery system in many marginalized communities

-        Employer efforts to obtain reporting from carriers that shows differences in care based on race and ethnicity can help identify other areas of disparities. We can only address disparities when we know where they are!

-        I’m grateful that these researchers overcame barriers to publish research that shows opportunities to improve in their own institutions.

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