• Jaya Aysola, Justin T Clapp, Patricia Sullivan, Patrick J Brennan, Eve J Higginbotham, Matthew D Kearney, Chang Xu, Rosemary Thomas, Sarah Griggs, Mohamed Abdirisak, Alec Hilton, Toluwa Omole, Sean Foster, and Mira Mamtani.
• Penn Medicine Center for Health Equity Advancement, Office of the CMO, University of Pennsylvania Health System, Philadelphia, PA, USA. jaysola@upenn.edu.
• J Gen Intern Med. 2022 Feb 1; 37 (2): 341350341-350.

BackgroundEnsuring equitable care remains a critical issue for healthcare systems. Nationwide evidence highlights the persistence of healthcare disparities and the need for research-informed approaches for reducing them at the local level.ObjectiveTo characterize key contributors in racial/ethnic disparities in emergency department (ED) throughput times.DesignWe conducted a sequential mixed methods analysis to understand variations in ED care throughput times for patients eventually admitted to an emergency department at a single academic medical center from November 2017 to May 2018 (n=3152). We detailed patient progression from ED arrival to decision to admit and compared racial/ethnic differences in time intervals from electronic medical record time-stamp data. We then estimated the relationships between race/ethnicity and ED throughput times, adjusting for several patient-level variables and ED-level covariates. These quantitative analyses informed our qualitative study design, which included observations and semi-structured interviews with patients and physicians.Key ResultsNon-Hispanic Black as compared to non-Hispanic White patients waited significantly longer during the time interval from arrival to the physician's decision to admit, even after adjustment for several ED-level and patient demographic, clinical, and socioeconomic variables (Beta (average minutes) (SE): 16.35 (5.8); p value=.005). Qualitative findings suggest that the manner in which providers communicate, advocate, and prioritize patients may contribute to such disparities. When the race/ethnicity of provider and patient differed, providers were more likely to interrupt patients, ignore their requests, and make less eye contact. Conversely, if the race/ethnicity of provider and patient were similar, providers exhibited a greater level of advocacy, such as tracking down patient labs or consultants. Physicians with no significant ED throughput disparities articulated objective criteria such as triage scores for prioritizing patients.ConclusionsOur findings suggest the importance of (1) understanding how our communication style and care may differ by race/ethnicity; and (2) taking advantage of structured processes designed to equalize care.© 2021. Society of General Internal Medicine.

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