Variation in Emergency Department Wait Times Among Mental Health Patients

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Research Objective: The issue of overcrowding in Emergency Departments (ED) in the United States has received significant national attention in recent years. Between 2004 and 2011, the number of ED visits increased by almost 25% from 110 million to 136.3 million visits. Almost half of all EDs are overcrowded several times in a week. Overcrowding of EDs often results in prolonged wait times and disproportionately affects vulnerable populations, including persons with mental health disorders. This study seeks to examine the variation in ED wait times for mental health patients by race/ethnicity and payment source.

Study Design: A retrospective, observational study was conducted using data from the National Hospital Ambulatory Care Survey on a sample of persons presenting to the ED between 2009 and 2011. Persons were identified as having a mental health disorder if they met any one of the following three criteria: DSM-IV-TR-based, major mental health problems (ICD-9-CM diagnoses 290.0 to 305, 307 to 310, or 311 to 319.0 or V codes 61.1 to 71.02); National Center for Health Statistics (NCHS)-assigned reason-for-visit classification codes related to mental health (25) (1100.0 to 1199.9); or injury E codes related to suicide (E950.0 to E959.9). (Larkin et al 2005). A multilevel mixed-effect generalized linear model was used to analyze the association between race/ethnicity, payment source and ED wait times in a pooled cross-sectional study design. Coefficients were converted into percentage difference by exponentiating the coefficients, subtracting one and multiplying by 100. The study adjusted for patient’s age, gender and hospital location. Statistical analyses were weighted to generate nationally representative estimates.

Population Studied: Adult patients (18 years or older) presenting to the ED with mental health disorders between 2009 and 2011. After eliminating observations without information on wait times (N = 515), the weighted total number of visits for the study was 22,770,702.

Principal Findings: The unadjusted mean ED wait time for patients presenting to the ED with mental health disorders was 51.4 minutes. The adjusted difference in ED wait times was 21.8 percent longer for non-Hispanic Blacks (p=0.001) compared to non-Hispanic Whites. Compared to patients seen at non-for profit hospitals, the wait times at for-profit hospitals was 32.1 percent shorter (p=0.005). The wait time was 13 percent shorter on weekends (p=0.002) compared to weekdays. Notably, a temporal decline in wait times for mental health disorders was observed in 2010 and 2011, when compared to 2009 (13.6 percent decline; p=0.037 and 25 percent decline; p<0.001 respectively). There were no statistically significant differences in wait times based on payer.

Conclusions: Racial and ethnic disparities in ED wait times was observed for patients presenting to the ED with mental health disorders. These differences persisted after accounting for age and gender of patient; hospital location; hospital ownership type; immediacy of condition; time of day seen; number of previous visits and; day and month of visit.

Implications for Policy or Practice: The findings draw attention to the need for policies and interventions to enhance access to mental health services, particularly for minority and underserved populations.


Academy Health Annual Research Meeting (ARM)


Boston, MA