title: Association of race/ethnicity with emergency department wait times.
abstract: OBJECTIVE
  To determine whether wait times for children treated in emergency departments (EDs) nationally are associated with patient race/ethnicity.
  
  
  METHODS
  Data were obtained from the National Hospital Ambulatory Medical Care Survey, which collects information on patient visits to EDs throughout the United States. We examined data for patients < or =15 years of age who presented to EDs during the 4-year period of 1997-2000. Sample weights were applied to the identified patient records to yield national estimates. For the purposes of this study, race/ethnicity was analyzed for 3 major groups, ie, non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic white (HW).
  
  
  RESULTS
  During the 4-year study period, 20633 patient visits were surveyed, representing a national sample of 92.9 million children < or =15 years of age. The race/ethnicity distribution included 9019 NHW children (59.5%), 3910 NHB children (23.9%), and 2991 HW children (16.6%). The wait time for all groups was 43.6 +/- 1.7 minutes (mean +/- SEM). There were significant unadjusted intergroup differences in wait times (38.5 +/- 1.6 minutes, 48.7 +/- 0.5 minutes, and 54.5 +/- 0.1 minutes for NHW, NHB, and HW children, respectively). Visit immediacy (triage status), when reported, was categorized as <15 minutes for 2203 children (17.1%), 15 to 60 minutes for 5324 (41.4%), 1 to 2 hours for 3010 (25.1%), and >2 to 24 hours for 1910 (16.4%). There were significant unadjusted differences in triage status according to race, with 14.6% of NHW patients being placed in the >2-hour immediacy range, compared with 18.8% of NHB patients and 20.0% of HW patients. In a linear regression analysis with logarithmically transformed wait time as a dependent variable and with adjustment for potential confounders, including hospital location, geographic region, and payer status, both NHB and HW patients waited longer than NHW patients, although the results were statistically significant only for HW patients.
  
  
  CONCLUSIONS
  These nationally representative data suggest that children who come to EDs have wait times that vary according to race/ethnicity. There are several potential explanations for this observation, including discrimination, cultural incompetence, language barriers, and other social factors. These data and similar data from the National Hospital Ambulatory Medical Care Survey are useful in identifying nonclinical influences on the delivery of pediatric emergency care.
authors.affiliation: Division of Emergency Medicine, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. catherine.james@childrens.harvard.edu
authors.forename: Catherine A
authors.initials: CA
authors.lastname: James
authors.forename: Florence T
authors.initials: FT
authors.lastname: Bourgeois
authors.forename: Michael W
authors.initials: MW
authors.lastname: Shannon
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D019538:Health Care Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D016014:Linear Models; D013997:Time Factors; D014218:Triage; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*