Sociodemographic Disparities in Queue Jumping for Emergency Department Care

Area of Science:

• Emergency Medicine
• Health Services Research
• Health Equity

Background:

• Emergency department (ED) triage aims to prioritize patients based on acuity and arrival time.
• Unexplained queue jumps (UQJ) violate these principles, potentially leading to care access disparities.

Purpose of the Study:

• To characterize disparities in ED care access by examining unexplained queue jumps (UQJ).
• To assess the association of UQJ with ED outcomes, including hallway placement and patients leaving without treatment.

Main Methods:

• Retrospective, cross-sectional study of over 314,000 ED patient visits across two sites.
• Defined UQJ as a patient receiving treatment ahead of higher acuity or earlier arriving patients of same acuity.
• Used regression models to analyze associations between UQJ, patient demographics, and ED outcomes.

Main Results:

• 28.8% of patients experienced a queue jump.
• Medicaid insurance, Black non-Hispanic race, Hispanic/Latino ethnicity, and Spanish as primary language were associated with being passed over.
• Patients passed over by someone of the same triage level had higher odds of hallway placement and leaving before disposition.

Conclusions:

• Significant disparities exist in ED care access, with marginalized populations more likely to experience UQJ.
• UQJ is associated with negative ED outcomes, including hallway placement and patients leaving without treatment.
• Standardizing ED triage processes is crucial to mitigate bias and ensure equitable care access.