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Related Experiment Video

Updated: Jul 6, 2025

Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
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Homelessness and Emergency Department Use: Wait Time Disparities Across Triage Acuity Levels.

Swarna S Weerasinghe1, Samuel G Campbell2

  • 1Department of Community Health and Epidemiology, Dalhousie University, Halifax, CAN.

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|January 1, 2024
PubMed
Summary
This summary is machine-generated.

Homeless individuals face longer emergency department (ED) wait times, particularly for non-urgent care, suggesting primary care access barriers. Older homeless females experience the longest waits, but overall, discrimination is not indicated.

Keywords:
canadian triage acuity scale-based ed visitsdisparities across demographic subgroupshomelessnesswait timewait time benchmarks

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Area of Science:

  • Health Services Research
  • Emergency Medicine
  • Health Equity

Background:

  • Certain patient groups encounter barriers to primary care access, leading to increased emergency department (ED) utilization for non-emergency conditions.
  • Evidence suggests homeless populations may face differential treatment in accessing emergency services.
  • Analyzing ED wait times by demographic characteristics can identify subgroups disproportionately affected by access blockages and treatment delays.

Purpose of the Study:

  • To examine emergency department (ED) wait times for homeless versus domiciled patients.
  • To identify demographic subgroups contributing to wait time disparities across Canadian Triage and Acuity Scale (CTAS) levels.
  • To assess whether homeless individuals experience discrimination in ED wait times.

Main Methods:

  • Analysis of five years of Emergency Department Information System (EDIS) visit records from a tertiary care center in Atlantic Canada.
  • Quantile regressions to assess the influence of housing status on meeting Canadian Association of Emergency Physicians (CAEP) wait time benchmarks for each CTAS level.
  • Classification and regression tree method to identify demographic subgroups associated with wait time disparities across CTAS levels.

Main Results:

  • Homeless visits exceeding the 3-hour CAEP benchmark had significantly longer median wait times for urgent (40 min), semi-urgent (31 min), and non-urgent (57 min) care compared to domiciled patients.
  • Homeless females over 40 experienced the longest waits for non-urgent care (173 min), 82 minutes longer than matched domiciled patients.
  • Homelessness was the primary classifier for non-urgent ED visit wait times, with CTAS-5 patients waiting 30 minutes longer.
  • Homeless emergent-level visits were, on average, 28 minutes shorter than those for domiciled patients.

Conclusions:

  • Wait time disparities for homeless individuals are most pronounced in low-acuity, non-urgent ED visits, supporting the hypothesis that lack of primary care access drives ED use in this group.
  • Older homeless females experience longer waits for low-acuity presentations compared to their domiciled counterparts.
  • The study did not find evidence of discrimination, as homeless patients with emergent needs were seen earlier or similarly to domiciled patients, and younger homeless males had the shortest wait times.