O3247: Disparities in Pediatric Emergency Department Arrival-to-Provider Time by Language

Background: Children from minoritized racial and ethnic groups wait longer to see a provider in the emergency department (ED). Even after adjustment for confounders such as illness severity and site of evaluation, disparities persist, particularly for Hispanic children. One potential barrier to timely care may be language, as non-English language is associated with poorer outcomes and patient satisfaction. Studies evaluating the effect of language on ED length of stay have been inconclusive, and no studies have evaluated the effect of language on pediatric ED wait time. In this study, we investigated the association between encounter language and arrival-to-provider time in children presenting to the pediatric ED.

Methods: We conducted a retrospective cohort study of pediatric ED encounters at 3 campuses at a single institution between 2015 and 2023. We excluded patients 18 years of age and older. We excluded patients who, after a medical screening exam, were eligible for outpatient evaluation and left the ED. Our primary outcome measure was arrival-to-provider time. Negative times were coded as missing. Encounter language as indicated in the medical record was the primary independent variable. Multivariable quantile models of increasing complexity included variables for illness acuity, demographics, crowding, and site of evaluation. Covariates reaching significance in bivariate models were included. The natural log of arrival-to-provider time, age, and daily arrivals were used in regression modeling. The exponential of e provided odds ratios with English language as the reference group.

Results: Of the 1.3 million patient arrivals screened, 1.1 million pediatric ED encounters were eligible for analysis. English was the most common encounter language followed by Spanish (Table 1). Most encounters with missing language (n = 2,058; 82.1%) had a disposition of Left Before Treatment Complete. Median arrival-to-provider times were 65.4 min (IQR 23.5-176.5) and 51.1 min (IQR 21.9-141.3) for Spanish and Other language encounters, which were 39% (95% CI 38-40) and 9% (95% CI 5-13) longer than English language encounters (46.9 min [IQR 20.0-128.2]). These differences were attenuated after adjustment for acuity (triage level and disposition acuity), demographics (gender, age, race/ethnicity, insurance status), crowding (time, month, year, daily arrivals), and campus (Table 2). Fully adjusted wait times for Spanish and Other language encounters were 9% (95% CI 8-11) and 6% (95% CI 4-8) longer compared to English language encounters.

Conclusion: In unadjusted analyses, families speaking languages other than English presenting to a single institution’s pediatric ED waited longer to see a provider. In multivariable models, demographics, illness acuity, and crowding had the greatest impact on waiting times. Fully adjusted wait times were still longer for non-English language families. Further analyses of provider-to-disposition, arrival-to-triage, arrival-to-room, and ED length of stay times may provide further insight regarding the stage of care that is most affected by language barriers.