Med study finds racial inequalities in ERs

Black emergency-room patients are likely to wait about an hour longer than other patients to be transferred to a regular hospital bed, according to a recent study by researchers in the School of Medicine.

The study, which drew from data from the National Hospital Ambulatory Medical Care Survey - a nationwide sample of emergency-room visits across the country - also found that critically ill black patients waited approximately an hour longer than other patients to be transferred out of intensive-care units.

In order to identify the cause of the disparity, said Jesse Pines, assistant professor of Emergency Medicine and Epidemiology at the School of Medicine and the study's lead author, the researchers looked at "certain hospital characteristics that might explain the association," such as whether the difference existed within individual hospitals or across hospitals in general.

In the case of emergency department patients who are not critically ill and are moved to in-patient beds, the difference was likely a result of black patients going to emergency departments of large, inefficient inner-city hospitals, Pines explained.

"Hospitals that see a higher proportion of African-Americans are more likely to be inefficient hospitals," he said. "Inner-city hospitals take longer to process patients in their emergency departments than hospitals that see a lower proportion of African-American patients."

But for critically ill patients, the disparity couldn't be fully explained by the above explanation, Pines said, since a disparity in lengths of ICU stays existed within individual hospitals.

"We don't think it's necessarily racial discrimination," he said, adding that other factors the study didn't take into account, like severity of illness or diagnosis, might also play a role in the disparity.

Regardless, he said, the study's results are important because longer lengths of stay in emergency departments are associated with lower survival rates.

Emergency departments are well-suited to provide initial care, Pines explained, but "what the emergency departments are not so good at is providing continuing care for those patients for long periods of time" - a task better handled by the general hospital.

The study, Pines said, pointed to a need for greater external accountability for emergency department boarding times - a step which will likely be taken in the next few years by the National Quality Forum, a group that has approved several measurements of emergency department waiting time.

"Knowing that, we might be able to pinpoint which particular hospitals do have longer boarding times," Pines said, thereby allowing for various interventions to alleviate the problem.

Officials at the Hospital of the University of Pennsylvania, the Children's Hospital of Philadelphia, Temple University Hospital and Thomas Jefferson University Hospitals did not return requests for comment.

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