C. Sherard1, B. Ochoa2, C. E. Busch3, M. Overstreet2, B. J. Woodhouse3, A. Lesher4 1The Medical University Of South Carolina, College Of Medicine, Charleston, SC, USA 2The Medical University Of South Carolina, Department Of Surgery, Charleston, SC, USA 3The Medical University Of South Carolina, Department Of Pediatric Emergency Medicine, Charleston, SC, USA 4The Medical University Of South Carolina, Division Of Pediatric Surgery, Department Of Surgery, Charleston, SC, USA
Introduction: Increased emergency department (ED) wait times lead to worse surgical outcomes for pediatric patients. This study analyzed wait times of patients who presented to the ED at a single institution and were admitted to the pediatric surgery service. The objective was to determine if demographic factors impacted wait times.
Methods: An institutional database was queried for patients <18 years who presented to the ED between January 1st, 2020 and December 31st, 2022 and were admitted to the pediatric surgery service. Total ED time, ED arrival to ED room time, ED room to admission order time, and admission order to floor arrival time were analyzed. Primary outcomes were wait times based on race and ethnicity. Secondary outcomes included wait time based on insurance, diagnosis, language, day, developmental delay, year, age, and sex. Mann-Whitney U and Kruskal-Wallis analyses were performed.
Results: A total of 306 ED encounters were included in the final analysis. Race was categorized as White (n=174) and non-White (n=132), and ethnicity was analyzed as Hispanic (n=59) and non-Hispanic (n=238). Admission diagnosis was classified as appendicitis (n=150) and all other diagnoses (n=156) while presence of a developmental delay was recorded as yes (n=15) or no (n=291). Hispanic patients experienced longer total ED times (median difference 43 minutes, p=0.008, 95% CI 11-75) and longer times between ED bed receipt and admission order placement (median difference 30 minutes, p=0.015, 95% CI 6-54). Patients presenting in 2022 waited longer for ED beds (median difference 6 minutes, CI 1-11, p=0.013). Patients with appendicitis experienced shorter admission order to floor arrival times (median difference 13 minutes, p=0.002, 95% CI -22 – -5) while patients with developmental delays waited longer (median difference 27 minutes, p=0.041, 95% CI 1-54). While these data encompass the timeframe of the COVID-19 pandemic, differences in treatment groups were present across all years.
Conclusion: Ethnicity, year, diagnosis, and developmental delay impact ED wait times and affect surgical outcomes. Recognition of these differences in care at individual centers and acknowledgment of national trends in health care disparities is necessary to streamline care for affected groups and improve patient outcomes.