SHM Converge Scientific Abstract ePoster Gallery-Emergency Department Boarding Increases Racial Discrimination and Patient Dissatisfaction

Pdf Summary

This single-center cross-sectional study examined whether prolonged emergency department (ED) boarding is linked to perceived racial discrimination and patient dissatisfaction among hospitalized internal medicine patients. Researchers conducted random-sample surveys at a large urban academic hospital from June 2023 to January 2024, enrolling 525 patients in a 1:1 ratio of non-Hispanic White patients and racial/ethnic marginalized patients.<br /><br />ED boarding time was grouped into three categories: 4 hours (reference), 4 to 24 hours, and 24 hours or more. Outcomes included binary measures of racial discrimination and patient dissatisfaction. Multivariable logistic regression adjusted for age, sex, primary language, and insurance payor, and analyses tested whether effects differed by race/ethnicity.<br /><br />Key findings showed that boarding for 24 hours or longer was associated with higher odds of reporting discrimination (OR 1.84, 95% CI 1.05–3.24) and dissatisfaction with care (OR 1.77, 95% CI 1.02–3.08). Shorter boarding times were not significantly associated with discrimination. The association with discrimination was driven primarily by marginalized racial/ethnic patients (OR 2.18, 95% CI 1.04–4.57), while the result was not significant among non-Hispanic White patients. Boarding time itself did not differ meaningfully between the two racial/ethnic groups.<br /><br />The authors conclude that prolonged ED boarding, especially 24 hours or more, is associated with increased perceived discrimination and dissatisfaction, with stronger effects among marginalized patients. Limitations include the single-center design, cross-sectional data, a binary race/ethnicity measure, and inability to adjust for all potential confounders such as provider-level factors. Suggested next steps include qualitative work to identify drivers of discrimination and retrospective chart review to examine other boarding-related quality metrics.

Asset Subtitle

Rose McKeon Olson

Meta Tag

Author List Andrea Fleurant, Bram Wispelwey, Jeffrey Schnipper, Marie Plaisime, Regan Marsh, Rose McKeon Olson, Sophie Beauparlant

Category Research

Concept Emergency Department Boarding

Concept Perceived Racial Discrimination

Concept Boarding Duration

Concept Dissatisfaction

Concept Racial and Ethnic Minority Patients

Distinguished Non-Finalist

Presenter Organization Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School

Presenting Author Rose McKeon Olson

Track Quality Improvement

Keywords

emergency department boarding

racial discrimination

patient dissatisfaction

hospitalized patients

cross-sectional study

internal medicine

racial/ethnic marginalized patients

logistic regression

healthcare disparities

prolonged boarding

Emergency Department Boarding

Perceived Racial Discrimination

Boarding Duration

Dissatisfaction

Racial and Ethnic Minority Patients