title: The impact of race and disease on sickle cell patient wait times in the emergency department.
abstract: OBJECTIVE
  To determine whether patients with sickle cell disease (SCD) experience longer wait times to see a physician after arrival to an emergency department (ED) compared to patients with long bone fracture and patients presenting with all other possible conditions (General Patient Sample), and to attempt to disentangle the effects of race and disease status on any observed differences.
  
  
  METHODS
  A cross-sectional, comparative analysis of year 2003 through 2008 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of nonfederal emergency department visits in the United States. Our primary outcome was wait time (in minutes) to see a physician after arrival to an ED. A generalized linear model was used to examine ratios of wait times comparing SCD visits to the two comparison groups.
  
  
  RESULTS
  SCD patients experienced wait times 25% longer than the General Patient Sample, though this difference was explained by the African-American race of the SCD patients. SCD patients waited 50% longer than did patients with long bone fracture even after accounting for race and assigned triage priority.
  
  
  CONCLUSIONS
  Patients with SCD presenting to an ED for care experience longer wait times than other groups, even after accounting for assigned triage level. The African-American race of the SCD patients, and their status as having SCD itself, both appear to contribute to longer wait times for these patients. These data confirm patient anecdotal reports and are in need of intervention.
authors: Department of Medicine, Division of Hematology, The Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. chaywoodjr@jhu.edu
authors: Carlton
authors: C
authors: Haywood
authors: Paula
authors: P
authors: Tanabe
authors: Rakhi
authors: R
authors: Naik
authors: Mary Catherine
authors: MC
authors: Beach
authors: Sophie
authors: S
authors: Lanzkron
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000628:therapy; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D013997:Time Factors; D014481:United States / Q000453:epidemiology
references: J Hosp Med. 2011 May;6(5):248-55
references: 21661098
references: J Health Soc Policy. 1994;5(3-4):243-59
references: 10138761
references: Pediatr Emerg Care. 2011 Jan;27(1):27-8
references: 21178811
references: Patient Educ Couns. 2009 Aug;76(2):272-8
references: 19233587
references: Health Aff (Millwood). 2008 Mar-Apr;27(2):w84-95
references: 18198184
references: Br J Haematol. 2004 Sep;126(6):878-80
references: 15352993
references: Pediatr Blood Cancer. 2008 Sep;51(3):317
references: 18383149
references: Am J Hematol. 2010 Oct;85(10):797-9
references: 20730795
references: J Emerg Med. 2010 Nov;39(5):691-5
references: 19703740
references: Blood. 2000 Feb 15;95(4):1130-6
references: 10666181
references: JAMA. 1993 Mar 24-31;269(12):1537-9
references: 8445817
references: Pediatr Blood Cancer. 2009 Aug;53(2):174-8
references: 19350642
references: Pediatr Blood Cancer. 2008 Sep;51(3):398-401
references: 18300322
references: J Emerg Nurs. 2013 Nov;39(6):539-46
references: 21937097
references: Med Care. 2002 Jan;40(1 Suppl):I140-51
references: 11789627
references: Acad Emerg Med. 2007 May;14(5):419-25
references: 17389246
references: J Stroke Cerebrovasc Dis. 2011 Jan-Feb;20(1):30-40
references: 20538484
references: Am J Hematol. 2009 Oct;84(10):666-70
references: 19743465
references: Ann Emerg Med. 2000 Jan;35(1):11-6
references: 10613935
references: J Health Care Poor Underserved. 2011 May;22(2):606-20
references: 21551937
references: Pain Med. 2006 Mar-Apr;7(2):119-34
references: 16634725
references: Clin J Pain. 2010 Mar-Apr;26(3):199-205
references: 20173433
references: Acad Emerg Med. 2012 Apr;19(4):430-8
references: 22506947
references: Am J Public Health. 2003 Feb;93(2):248-55
references: 12554578
references: J Gen Intern Med. 2004 Nov;19(11):1154-9
references: 15566446
references: Am J Prev Med. 2010 Apr;38(4 Suppl):S536-41
references: 20331955
references: J Hosp Med. 2011 May;6(5):297-303
references: 21661104
references: J Natl Med Assoc. 2009 Oct;101(10):1022-33
references: 19860302
references: J Pain Symptom Manage. 1997 Sep;14(3):168-74
references: 9291703
references: Haematologica. 2007 Jun;92(6):854-5
references: 17550862
references: Pediatr Blood Cancer. 2008 Jul;51(1):82-5
references: 18383165