Disparities in emergency department prioritization and rooming of patients with similar triage acuity score

Background: We identify patient demographic and emergency department (ED) characteristics associated with rooming prioritization decisions among ED patients who are assigned the same triage acuity score.

Methods: We performed a retrospective analysis of adult ED patients with similar triage acuity, as defined as an Emergency Severity Index (ESI) of 3, at a large academic medical center, during 2019. Violations of a first-come-first-served (FCFS) policy for rooming are identified and used to create weighted multiple logistic regression models and 1:M matched case-control conditional logistic regression models to determine how rooming prioritization is affected by individual patient age, sex, race, and ethnicity after adjusting for patient clinical and time-varying ED operational characteristics.

Results: A total of 15,781 ED encounters were analyzed, with 1612 (10.2%) ED encounters having a rooming prioritization in violation of a FCFS policy. Patient age and race were found to be significantly associated with being prioritized in violation of FCFS in both logistic regression models. The 1:M matched model showed a statistically significant relationship between violation of rooming prioritization with increasing age in years (adjusted odds ratio [aOR] 1.009, 95% confidence interval [CI] 1.005-1.013) and among African American patients compared to Caucasians (aOR 0.636, 95% CI 0.545-0.743).

Conclusions: Among ED patients with a similar triage acuity (ESI 3), we identified patient age and patient race as characteristics that were associated with deviation from a FCFS prioritization in ED rooming decisions. These findings suggest that there may be patient demographic disparities in ED rooming decisions after adjusting for clinical and ED operational characteristics.