Identifying disparity in emergency department length of stay and admission likelihood

doi:10.5847/wjem.j.1920-8642.2016.02.005

Abstract

Abstract:

BACKGROUND: To assess whether insurance status has an effect on emergency department (ED) length of stay (LOS) and likelihood for admission or transfer to an operating room.
METHODS: This was a retrospective cross-sectional study of all encounters from January 2011 through October 2013 at an urban, academic trauma center. Analysis included multi-variable linear regression for ED LOS and logistic regression for the likelihood of admission.
RESULTS: Overall, 201 535 patients met the inclusion criteria, for which the mean age was 43.8 years, 55.9% were female, 23.4% were uninsured and 8% were of non-black race. Admission rate was 24.5% and operative rate was 1.4%. After adjusting for age, sex, triage acuity and race, the presence of insurance coverage was associated with an increased ED LOS of 575 (95%CI 552-598) vs. 567 (95%CI 543-591) minutes (P<0.01) among admitted patients and a decreased ED LOS of 456 (95%CI 381-531) vs. 499 (95%CI 423-575) minutes (P<0.01) among those transferred to an operating room. Adjusting for these same predictors, insured status remained a predictor for admission (odds ratio 1.24, 95%CI 1.20-1.28, P<0.01) and a negative predictor for transfer to the operating room (odds ratio 0.84, 95%CI 0.77-0.92, P<0.01).
CONCLUSION: The insured experienced a clinically insignificant increase in ED LOS when admitted and a 43-minute decrease in ED LOS when being transferred to the operating room. The insured were more likely to be admitted and less likely to be transferred to an operating room.

Key words: Emergency department, Health disparities, Racial disparities, Insurance

Sean Wilson, Sharmistha Dev, Meredith Mahan, Manu Malhotra, Joseph Miller. Identifying disparity in emergency department length of stay and admission likelihood[J]. World Journal of Emergency Medicine, 2016, 7(2): 111-116.

Figures/Tables 4

Figure 1.

Table 1

Table 2

Table 3

References 28

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Characteristics	Total participants (n=201 535)	Insured patients (n=154 425)	Uninsured patients (n=47 110)
Age, years, mean±SD	43.8±21.1	46.2±22.3	36.0±14.2
Sex, n (%)
Male	88 813 (44.1)	63 589 (41)	25 224 (54)
Race, n (%)
Black	185 423 (92.0)	142 194 (92)	43 229 (92)
Non-black	16 112 (8.0)	12 231 (8)	3 881 (8)
ESI, n (%)
1	15 014 (7.5)	12 522 (8)	2 492 (5)
2	66 813 (33.2)	53 527 (35)	13 286 (28)
3	92 859 (46.1)	69 718 (45)	23 141 (49)
4	23 747 (11.8)	16 570 (11)	7 177 (15)
5	3 102 (1.5)	2 088 (1)	1 014 (2)
Disposition, n (%)
Admitted to GPU/ICU	49 418 (24.5)	42 639 (28)	6 779 (14)
Transferred to OR	2 780 (1.4)	1 976 (1)	804 (2)
Discharged	149 337 (74.1)	109 810 (71)	39 527 (84)

Characteristics	Admitted to GPU/ICU		Transferred to OR
Characteristics	LOS (95%CI)^*	P^#	LOS (95%CI)^*	P^#
Sex
Male	560 (536-583)	<0.01	457 (381-532)	<0.01
Female	583 (559-606)		449 (423-575)
Insurance
Insured	575 (552-598)	<0.01	456 (381-531)	<0.01
Uninsured	567 (543-591)		499 (423-575)
Race
Black	569 (546-592)	<0.01	470 (397-544)	<0.01
Non-black	573 (549-597)		486 (407-565)
ESI
1	474 (467-480)	<0.01	307 (271-343)	<0.01
2	544 (539-550)		527 (503-551)
3	581 (575-588)		545 (519-571)
4	618 (594-641)		518 (445-591)
5	639 (527-749)		493 (137-849)

Characteristics	Disposition	Odds Ratio^# (95%CI)	P
Age^*
Year	Admitted	1.05 (1.04-1.05)	<0.01
	Transferred to operating room	1.00 (1.00-1.00)	0.03
Sex
Female vs. Male	Admitted	0.93 (0.90-0.95)	<0.01
	Transferred to operating room	1.00 (0.92-1.07)	0.90
Insurance
Insured vs. Uninsured	Admitted	1.24 (1.20-1.28)	<0.01
	Transferred to operating room	0.84 (0.77-0.92)	<0.01
Race
Black vs. Non-black	Admitted	0.87 (0.83-0.91)	<0.01
	Transferred to operating room	0.41 (0.37-0.45)	<0.01
ESI
1	Admitted	194.09 (129.40-291.12)	<0.01
	Transferred to operating room	75.31 (28.08-202.03)	<0.01
2	Admitted	33.78 (22.56-50.58)	<0.01
	Transferred to operating room	16.53 (6.18-44.18)	<0.01
3	Admitted	16.20 (10.82-24.26)	<0.01
	Transferred to operating room	11.38 (4.26-30.39)	<0.01
4	Admitted	2.72 (1.80-4.11)	<0.01
	Transferred to operating room	3.26 (1.24-8.87)	0.02

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