Sex and Gender
Background: Major determinants of ED patient satisfaction include time to be seen by a healthcare provider (wait time) and total length of stay (LOS). Prior studies have suggested sex and racial/ethnic disparities in delivery of healthcare. We explored patient characteristics associated with ED wait times and LOS to determine whether such disparities currently exist in the ED.
Methods: Data were extracted from the National Hospital Ambulatory Medical Care Survey (NHAMCS) database sponsored by the CDC. Based on weighted sampling, national estimates are calculated for the entire country. Information in this survey includes reasons why the patient visited the ED, physician diagnoses, demographics, comorbidities, vital signs, diagnostic tests, and disposition. Univariate and multivariate analyses were performed to determine the association between patient characteristics and outcomes including wait time and LOS.
Results: In 2015 there were an estimated 137 million ED visits. Mean (SE) age was 37 (0.9), 55% were female, 74% were white. Mean (SE) wait time and LOS were 31 (2.2) and 196 (7.5) minutes respectively. Wait times did not differ by sex, race/ethnicity, residence type, insurance type, or presence of alcohol or substance abuse. ED LOS was significantly longer for patients who were homeless, on Medicare, had a consult, had alcohol or substance abuse, had low pulse oximetry or respiratory rates, or required advanced imaging (P<0.001). Age and number of comorbidities were positively associated with ED LOS (P<0.001 for both). Multivariate analysis showed that older age (1 min increase per year, P<0.001), advanced imaging (154 mins longer for MRI, P=0.004; 69 mins longer for CT, P<0.001; 23 mins longer for X-ray, P<0.001), number of comorbidities (8 mins per comorbidity, P=0.005), residence (180 mins longer for homeless compared to private home, P=0.005), insurance type (60 mins longer for Medicaid and no-charge patients compared to worker’s comp, P<0.001), consultation (increase of 83 minutes, P<0.001), and alcohol abuse (increase of 90 mins, P<0.001) were all associated with increased ED LOS.
Conclusion: There were no disparities in ED wait times based on age, sex, race, substance abuse or homelessness. Increasing age, Medicaid insurance, homelessness, number of comorbidities, having a consult, and advanced imaging were associated with longer ED LOS.