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Prolonged Boarding and Racial Discrimination and Dissatisfaction Among Emergency Department Patients.

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Prolonged emergency department (ED) boarding times are linked to increased patient discrimination and dissatisfaction. These effects may disproportionately impact marginalized racial and ethnic groups, highlighting the need for health equity solutions.

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Area of Science:

  • Health Services Research
  • Health Equity
  • Emergency Medicine

Background:

  • Emergency department (ED) boarding times have significantly increased.
  • The impact of prolonged ED boarding on health equity outcomes remains largely unknown.
  • Understanding these disparities is crucial for addressing systemic inequities in healthcare.

Purpose of the Study:

  • To investigate the association between prolonged ED boarding and perceived racial discrimination and dissatisfaction.
  • To examine if these associations differ between marginalized racial/ethnic groups and non-Hispanic White patients.
  • To identify potential exacerbation of health inequities due to ED boarding.

Main Methods:

  • Cross-sectional study of hospitalized adults in an urban hospital ED.
  • Inclusion of equal proportions of non-Hispanic White and marginalized racial/ethnic groups.
  • Data collection via Discrimination in Medical Settings scale and Picker Patient Experience-15 questionnaire.
  • Multivariable logistic regression analysis adjusting for demographic and insurance factors.

Main Results:

  • Boarding 24 hours or longer was associated with increased perceived discrimination (OR, 1.84) and dissatisfaction (OR, 1.77) compared to less than 4 hours.
  • A stronger association between prolonged boarding and discrimination was observed in marginalized groups (OR, 2.36).
  • Effect modification by race/ethnicity was not statistically significant for discrimination or dissatisfaction.

Conclusions:

  • Hospitalized patients experiencing prolonged ED boarding report higher levels of discrimination and dissatisfaction.
  • These findings suggest that extended ED boarding may worsen health inequities, particularly for marginalized populations.
  • Urgent, equity-focused interventions are needed to mitigate the negative impacts of increasing ED boarding times.