P2.D072: Patient Equity and Overcrowding in the ED

Background: Emergency department (ED) crowding results in patients being seen in ancillary spaces, including hallway beds and waiting rooms where there may be a lack of privacy and less monitoring. Lower acuity and government insurance have been associated with higher likelihood of being seen in an ancillary space. Surges in ED volumes such as during the 2022-2023 viral season resulted in more ED crowding. This study assesses inequities by race, ethnicity, and language of care (REaL) for patients seen in ancillary spaces versus ED rooms.

Methods: Retrospective cohort study of patient encounters in an academic pediatric ED between 11/2022-6/2023. We excluded patients requiring active resuscitation (ESI 1), patients aged 21 years and older and patients who arrived by ambulance. We used logistic regression to explore the association of REaL with being seen in an ancillary space versus ED room, controlling for ED crowding and type of insurance.

Results: 26,901 patient encounters were included; 4,899 were seen in ancillary spaces. For the higher (ESI 2) and lower (ESI 4-5) acuity patients, there were no significant associations between REaL and care in ancillary spaces versus ED rooms. For moderate acuity (ESI 3), Hispanic patients and patients with language other than English (LOE) were more likely to be seen in an ancillary space (p=0.026, p< 0.001), while non-Hispanic White patients and English-speaking patients were more likely to be placed in an ED room (p < 0.001 for both). Patients seen in ancillary spaces with ESI 2, 3, or 4 were less likely to receive medications (all p< 0.001) and undergo laboratory workup (all p< 0.005). Regardless of location, there were no statistically significant differences found for receiving medications or undergoing testing for patients with ESI 5 or undergoing imaging for patients with ESI 3, 4, or 5.

Conclusion: During the study period, for patients with higher or lower acuity, REaL characteristics did not significantly contribute to risk of being seen in ancillary spaces. Patients with moderate acuity were more likely to be seen in ancillary spaces if they were Hispanic or had LOE compared to White and English-speaking patients. Patients of any acuity level other than ESI 5, who were seen in ancillary spaces were less likely to receive labs and medications. These findings suggest that ED room placement and the use of ancillary spaces for patient care during ED surges may be inequitable and may affect patient course, particularly for certain demographics with a moderate acuity level.