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Factors linked to being passed over include Medicaid insurance, Black non-Hispanic race, Hispanic or Latino ethnicity.

Minority and disadvantaged patients presenting to the emergency department are more likely to be passed over and less likely to receive care over others with the same triage acuity, according to a study published online July 28 in JAMA Network Open.

Rohit B. Sangal, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues characterized disparities in emergency department care access as unexplained queue jumps or instances in which acuity and first come, first served principles are violated in a retrospective, cross-sectional study involving 314,763 emergency department visits.

The researchers found that 28.8 percent of patients experienced a queue jump and 24.8 and 14.2 percent were passed over by a patient of the same or lower acuity, respectively. Overall, 16.8 and 7.6 percent of patients received care ahead of a patient of the same or higher acuity, respectively. Independent social factors associated with being passed over included Medicaid insurance, Black non-Hispanic race, Hispanic or Latino ethnicity, and Spanish as a primary language (incident rate ratios, 1.11, 1.05, 1.05, and 1.06, respectively). Lower odds of a patient receiving care ahead of others were seen for emergency department visits by Medicare-insured, Medicaid-insured, Black non-Hispanic, and Hispanic or Latino ethnicity (odds ratios, 0.92, 0.81, 0.94, and 0.87, respectively). Higher odds of hallway bed placement and leaving before disposition were seen for patients who were passed over by someone of the same triage severity level (odds ratios, 1.01 and 1.02, respectively).

“Emergency departments should seek to standardize triage processes and protocols to mitigate conscious and unconscious biases that may be associated with patient access to emergency care,” the authors write.

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