Association of limited English proficiency with emergency department irregular departures and return visits: A cross-sectional cohort study in the Upper Midwest between January 2018 and December 2021.

OBJECTIVES: Patients with limited English proficiency (LEP) have been shown to experience disparities in emergency department (ED) care. The objectives of this study were to examine the associations between LEP and irregular ED departures and return ED visits. METHODS: We conducted a multicenter cross-sectional analysis of 18 EDs within an integrated health system in the upper Midwest from January 1, 2018, to December 31, 2021. ED visits of pediatric and adult patients who were discharged on the index visit were included for analysis. We analyzed the association of LEP with irregular departures, 72-h and 7-day return visits, and ED disposition at the time of that return visit. Multivariable model associations were calculated using generalized estimating equations and reported as odds ratios (OR) with 95% confidence intervals (CIs). RESULTS: A total of 745,464 total ED visits were analyzed, including 27,906 (3.7%) visits among patients with LEP. The most common preferred languages among patients with LEP were Spanish (12,759; 45.7%), Somali (4978; 17.8%), and Arabic (3185; 11.4%). After multivariable adjustment there were no differences in proportions of irregular departures (OR 1.09, 95% CI 0.99-1.21), 72-h returns (OR 0.99, 95% CI 0.92-1.06), or 7-day returns (OR 0.99, 95% CI 0.93-1.05) between patients with LEP or English proficiency. Patients with LEP returning within 72 h (OR 1.19, 95% CI 1.01-1.40) and 7 days (OR 1.15, 95% CI 1.01-1.33) were more likely to be admitted to the hospital. CONCLUSIONS: After multivariable adjustment, we did not find an increased frequency of irregular ED departures or 72-h or 7-day returns among patients with LEP compared with people proficient in English. However, we did find that higher proportions of patients with LEP were admitted to the hospital at the time of the return ED visit.

Association between patients' body mass index and emergency department wait times: A multicenter observational cohort investigation by the reducing disparities increasing equity in emergency medicine (REDEEM) study group.

OBJECTIVE: Numerous studies have demonstrated evidence of obesity bias in healthcare settings, however, little is known about obesity bias in the Emergency Department (ED). The objective of this study was to investigate obesity bias in an ED setting by assessing the association between body mass index (BMI) and door-to-room (DTR) or door-to-provider (DTP) times among ED patients. METHODS: We conducted an observational cohort study of all adult patient (age ≥ 18 years of age) visits to 21 Mayo Clinic and Mayo Clinic Health System EDs between November 1, 2018 and March 31, 2020. We compared DTR and DTP times based on BMI category. RESULTS: We found that median DTR and DTP times for adults with class 3 obesity are significantly shorter than patients in the normal weight category. For men with class 3 obesity, median DTR and DTP times were 7.5% and 5.4% shorter than men in the normal weight category. Relative to women in the normal weight category, the median DTR and DTP times were 4.6% and 3.8% faster for women in obesity class 1, 4.9% and 5.1% faster for women in obesity class 2, and DTR was 4.4% faster for women in obesity class 3. These percentage differences translated to slightly shorter wait times of 0.4-1.2 min compared to median wait times for patients with normal BMI. CONCLUSION: We did not find evidence of longer wait times experienced by people with obesity. Rather, patients with obesity often experienced wait times that were shorter than patients of normal weight.

Non-pharmacologic interventions improve comfort and experience among older adults in the Emergency Department.

OBJECTIVE: Determine if a comfort cart would improve older adults' comfort and facilitate communication during Emergency Department (ED) visits. METHODS: A comfort cart containing low-cost, non-pharmacological interventions to improve patient comfort and ability to communicate (e.g., hearing amplifiers, reading glasses) were made available to patients aged ≥65 years. Patients and clinicians were surveyed to assess effectiveness. We followed the Standards for Quality Improvement Reporting Excellence: SQUIRE 2.0 guidelines. RESULTS: Three hundred patients and 100 providers were surveyed. Among patients, 98.0%, 95.1%, and 67.5% somewhat or strongly agreed that the comfort cart improved comfort, overall experience, and independence, respectively. Among providers, 97.0%, 95.0%, 87.0%, and 83% somewhat or strongly agreed that the comfort cart provided comfort, improved patient satisfaction, increased ability to give compassionate care, and increased patient orientation. CONCLUSION: The comfort cart was an affordable and effective intervention that improved patients' comfort by facilitating communication, wellbeing, and compassionate care delivery.