Purpose: Research has shown racial/ethnic variability in the quality of pediatric emergency care. Wait time is an important process of care quality measure in the pediatric emergency department (PED) that can affect satisfaction and clinical outcomes. Our objective was to determine if there are racial/ethnic differences in wait time for children presenting to PEDs, and to examine between-site versus within-site differences. Methods: Retrospective cohort study using the Pediatric Emergency Care Applied Research Network (PECARN) Registry, an aggregated de-identified electronic health registry of all encounters to 7 PEDs in 2013. Stepwise multivariable linear regression examined associations between patient-level factors (race/ethnicity, triage, mode of arrival, sex, insurance status) and ED site with logarithmically transformed wait time (time from arrival to first medical evaluation). Results: Our sample included 402,955 visits; of which 121,172 (30%) were non-Hispanic white (NHW), 178,034 (44%) non-Hispanic black (NHB), 67,436 (17%) Hispanic, 29,012 (7%) other races, and 7,341 (2%) missing race/ethnicity. The overall mean unadjusted wait time was 52.6 minutes (95% CI 52.5,52.8). Compared to NHW, NHB children waited 19% longer, Hispanic children waited 32% longer, and children of other races/ethnicities waited 14% longer (Table: Model 1). Racial/ethnic differences in wait times persisted, but were attenuated after adjusting for triage category and mode of arrival (Model 2), and sex and insurance (Model 3). After adjusting for ED site, wait times did not remain significantly longer for NHB and other race children; however, Hispanic children continued to have slightly longer wait times compared to NHW children (Model 4). In analyses by site, Hispanic children at 4 sites had 5-6% longer adjusted wait times compared to white children [1.05 (1.02,1.09), 1.05 (1.02,1.08), 1.05 (1.02, 1.08), 1.06 (1.04, 1.08)]. Conclusion: NHB, Hispanic, and children of other races experience 14-32% longer wait times than NHW children in unadjusted analyses. However, adjusted analyses suggest these differences are due to differences in triage acuity and between-site differences in overall wait times. There are minimal within site differences in wait time by patient race/ethnicity in adjusted analyses. Additional research is needed to better understand the structures and processes of care that underlie higher ED use by minority children for low acuity conditions and affect sites that predominantly treat minority children.
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Section on Emergency Medicine Program| January 01 2018
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Tiffani J. Johnson; Are There Racial Differences in Pediatric Emergency Department Wait Times?. Pediatrics January 2018; 141 (1_MeetingAbstract): 338. 10.1542/peds.141.1MA4.338
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