P1457 - Disparities in Emergency Department Wait Times for Acute Gastrointestinal Bleeding: Results From the National Hospital Ambulatory Medical Care Survey, 2009-2018

Mohamad Aghaie Meybodi, MD, Amjad Shaikh, MD, Reza Hashemipour, MD, Sushil Ahlawat, MD
Rutgers New Jersey Medical School, Newark, NJ

Introduction: Time is critical in addressing acute gastrointestinal (GI) bleeding. Delayed resuscitation may lead to worse outcomes. To our knowledge, no large-scale study examining wait times for patients who present for GI bleeding has been conducted. The aim of this study was to assess ED wait times for GI bleeding and identifying factors associated with delayed treatment.

Methods: Patients with GI bleeding were pulled from the National Hospital Ambulatory Medical Care Survey- Emergency Department (NHAMCS-ED) database from the years 2009 to 2018. Pediatric cases (Age< 18) were excluded from the study. Groups were stratified based on site of bleed, age group, sex, residency, region, and payment type. The primary outcome was the ED wait time. Secondary outcomes were identifying factors associated with a delay in treatment. Linear regression was used to determine factors significantly associated with wait time.

Results: A total of 1998 patients were included in the study. 644 (32.2%) patients were admitted to the hospital. The most common site of GI bleed reported anorectal (37.3%). The most represented age group was 25-44 years of age (29.1%). 44.8% of cases presented with comorbidity, the most common being hypertension (15.3%). The average wait time was 46.16±87.49 minutes. Upon multivariate analysis, significant factors affecting wait time included race (p= 0.01) and payment method (p< 0.01). Non-Hispanic white patients had the shortest wait time (41.25 ±79.85). The longest wait time was experienced by non-Hispanic black patients (58.64 ± 98.45). Patients with private insurance had the shortest wait time (58.64 ± 98.45).

Discussion: Race and payment status appeared to be a significant factor in wait time for patients presenting for acute GI bleeding. Disparities in the ED demonstrate the necessity of further health policies and education. Regions may also play a role as busy inner-city centers may have a large number of patients who may be uninsured/under-insured, though by virtue of volume, may also have delayed wait times.

		Total	GI Bleeding	Hematemesis	Melena	Ano-rectal
N		1998	140 (7%)	418 (20.9%)	695 (34.8%)	745 (37.3%)
Age		51.56±21.66	63.16±20.82	43.11 ± 19.61	51.57 ± 21.2	54.12 ± 21.73
Age grouop	18-24	242 (12.1%)	9 (6.4%)	88 (21.1%)	71 (10.2%)	74 (9.9%)
	25-44	582 (29.1%)	19 (13.6)	147 (35.2%)	224 (32.2%)	192 (25.8%)
	45-64	558 (27.9%)	38 (27.1%)	119 (28.5%)	182 (26.2%)	219 (29.4%)
	65-74	234 (11.7%)	26 (18.6%)	29 (6.9%)	93 (13.4%)	86 (11.5%)
	>75	385 (19.1%)	48 (34.3%)	35 (8.4%)	125 (18%)	174 (23.4%)
Sex	Male	973 (48.7%)	64 (45.7%)	235 (56.2%)	323 (46.5%)	351 (47.1%)
	Female	1025 (51.3%)	76 (54.3%)	183 (43.8%)	372 (53.5%)	394 (52.9%)
Residency	Private	1791 (89.2%)	112 (80%)	376 (90%)	639 (91.9%)	664 (89.1%)
	Nursing home	84 (4.2%)	17 (12.1%)	17 (4.1%)	17 (2.4%)	33 (4.4%)
	Homeless/Shelter	22 (1.1%)	1 (0.7%)	1.9 (8%)	3 (0.4%)	10 (1.3%)
Racer and ethnic	Non-His White	1311 (65.6%)	98 (70%)	258 (61.7%)	472 (67.9%)	483 (64.8%)
	Non-His Black	381 (19.1%)	20 (14.3%)	94 (22.5%)	118 (17%)	149 (20%)
	Hispanic	245 (12.3%)	18 (12.9%)	54 (12.9%)	81 (11.7%)	92 (12.3%)
	Non-His other	62 (3.1%)	4 (2.9%)	12 (2.9%)	24 (3.5%)	21 (2.3%)
Payment	Private ins	750 (37.5%)	53 (37.9%)	122 (29.2%)	288 (41.4%)	287 (38.5%)
	Medicare	668 (33.4%)	70 (50%)	83 (19.9%)	243 (35%)	272 (36.5%)
	Medicaid	524 (26.2%)	28 (20%)	149 (35.6%)	183 (26.3%)	164 (22%)
	Self pay	268 (13.4%)	10 (7.1%)	71 (17 %)	86 (12.4%)	101 (13.6%)
	Charity	33 (1.7%)	2 (1.4%)	7 (1.7%)	11 (1.6%)	13 (1.7%)
Wait time		46.16±87.49	27.86±43.03	40.48 ± 78.11	48.13 ± 84.39	50.94 ± 100.15
Length of visit		282±330.42	368.75±588.34	261.72 ± 201.71	284.79 ± 311.19	273.73 ± 332.18
Geographic region	Northeast	382 (19.1%)	39 (27.9%)	52 (12.4%)	115 (16.5%)	175 (23.5%)
	Midwest	482 (24.1%)	23 (16.4%)	108 (25.8%)	187 (26.9%)	164 (22%)
	South	681 (34.1%)	47 (33.6%)	152 (36.4)	230 (33.1%)	252 (33.8%)
	West	454 (22.7%)	31 (22.1%)	106 (25.4)	163 (23.5%)	154 (20.7%)

Table: Baseline characteristic of patients who presented to the emergency department with GI bleeding.


Disclosures:
Mohamad Aghaie Meybodi indicated no relevant financial relationships.
Amjad Shaikh: IDEXX – Employee.
Reza Hashemipour indicated no relevant financial relationships.
Sushil Ahlawat indicated no relevant financial relationships.


Mohamad Aghaie Meybodi, MD, Amjad Shaikh, MD, Reza Hashemipour, MD, Sushil Ahlawat, MD. P1457 - Disparities in Emergency Department Wait Times for Acute Gastrointestinal Bleeding: Results From the National Hospital Ambulatory Medical Care Survey, 2009-2018, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.