Introduction: Black and Hispanic patients, and patients with a preferred language other than English experience longer emergency department (ED) wait times and delays in treatment. We aimed to evaluate racial, ethnic, and language-based differences in wait times to see a physician and get a disposition, as well as in the rates of objective vs subjective urgent evaluations.
\nMethods: This was a retrospective study of all ED visits in our tertiary-care, academic medical center from July 2021–June 2023. Using electronic health record data, we compared time-to- physician, physician-to-decision times, and frequency of triggers (urgent evaluations based on objective criteria) and priority assessments (urgent evaluations that can be based on subjective perception of patient acuity) by race, ethnicity, and preferred language. We used logistic regression, controlling for age, Emergency Severity Index, and sex to compare differences in trigger rates.
\nResults: We included 93,728 patient encounters in this study. Black patients had a median time-to-physician of 31 minutes compared to 24 minutes for White patients (adjusted median difference (aMD) 3.2, 95% CI 2.4-3.9]) and a median physician-to-decision time of 228 minutes compared to 213 for White patients (aMD 15.0, 95% CI 12.0-17.9). Hispanic patients had a median time to physician of 31 (aMD compared to White patients = 3.4, 95% CI 2.4-3.9) and a median physician-to-decision time of 233 minutes (aMD compared to White patients 21.3, 95% CI 17.5-25.2). Patients with a preferred language other than English had a median time-to-physician of 33 minutes compared to 25 in English-preferring patients (aMD 4.6, 95% CI 3.7-5.6) and a median physician-to-decision time of 234 compared to 214 minutes for English-preferring patients (aMD 17.1, 95% CI 13.6-20.7). Black patients were less likely to have a trigger activated relative to White patients (adjusted odds ratio [aOR] 0.88, 95% CI 0.82-0.95). Black patients (aOR 0.72, 95% CI 0.67-0.77), Hispanic/Latino patients (aOR 0.78, 95% CI 0.71-0.86), and non-English-preferring patients (aOR 0.85, 95%CI 0.78-0.92) were less likely to have a priority assessment called compared to White patients.
\nConclusion: Black, Hispanic, and patients who prefer non-English language experience delays in time-to-physician and physician-to-decision time. Black patients are less likely to have triggers activated. Black, Hispanic, and patients who prefer non-English language are less likely to have priority assessments activated compared to White patients. These findings underscore the need to develop additional mechanisms for mitigating biases in the triage process.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"racial disparities"},{"word":"language disparities"},{"word":"Social EM"},{"word":"triage disparities"},{"word":"implicit bias"},{"word":"wait times"}],"section":"Health Equity","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2q98n7vr","frozenauthors":[{"first_name":"Jossie","middle_name":"A.","last_name":"Carreras Tartak","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Anne","middle_name":"V.","last_name":"Grossestreuer","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"David","middle_name":"","last_name":"Chiu","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Bryan","middle_name":"","last_name":"Stenson","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""}],"date_submitted":"2025-02-12T04:19:17.385000Z","date_accepted":"2025-05-30T19:27:44.970000Z","date_published":"2025-09-20T16:12:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/43480/galley/39998/download/"}]}