Abstract
Study objective
To determine whether patients with sickle cell disease (SCD) experience longer wait
times to see a physician after arrival to an emergency department (ED) compared to
patients with long bone fracture and patients presenting with all other possible conditions
(General Patient Sample), and to attempt to disentangle the effects of race and disease
status on any observed differences.
Methods
A cross-sectional, comparative analysis of year 2003 through 2008 data from the National
Hospital Ambulatory Medical Care Survey, a nationally representative sample of nonfederal
emergency department visits in the United States. Our primary outcome was wait time
(in minutes) to see a physician after arrival to an ED. A generalized linear model
was used to examine ratios of wait times comparing SCD visits to the two comparison
groups.
Results
SCD patients experienced wait times 25% longer than the General Patient Sample, though
this difference was explained by the African-American race of the SCD patients. SCD
patients waited 50% longer than did patients with long bone fracture even after accounting
for race and assigned triage priority.
Conclusions
Patients with SCD presenting to an ED for care experience longer wait times than other
groups, even after accounting for assigned triage level. The African-American race
of the SCD patients, and their status as having SCD itself, both appear to contribute
to longer wait times for these patients. These data confirm patient anecdotal reports
and are in need of intervention.
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Article Info
Publication History
Published online: February 04, 2013
Accepted:
November 13,
2012
Received:
October 10,
2012
Footnotes
☆This work was presented at the 53rd Annual Meeting of the American Society of Hematology (San Diego, CA; December 2011), as well as at the 2nd National Conference on Blood Disorders in Public Health (Atlanta, GA; March 2012).
☆☆Grant Support: Both Dr. Haywood and Dr. Lanzkron were supported by Career Development Awards from the National Heart, Lung, and Blood Institute (NHLBI) (Haywood #1K01HL108832-01; Lanzkron #5K23HL083089-05). Dr. Beach's effort was supported by NHLBI grant #: 4R01HL088511-03. Dr. Tanabe's effort was supported by AHRQ grant #: 1R18HS019646-01A1.
★Potential Conflicts of Interest: The governmental grant support reported above for Dr. Tanabe is for a project designed to improve the quality of emergency department care for persons with sickle cell disease. Some may perceive this as a potential conflict of interest. We certify that Dr. Tanabe's study sponsors played no role in any aspect of the design of this study, the collection and analysis of data, or the interpretation of the results.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
