Are disparities in emergency department imaging exacerbated during high-volume periods?

Purpose: Evaluate if disparities in the emergency department (ED) imaging timeline exist, and if disparities are
altered during high volume periods which may stress resource availability.
Methods: This retrospective study was conducted at a four-hospital healthcare system. All patients with at least
one ED visit containing imaging from 1/1/2016 to 9/30/2020 were included. Peak hours were defined as ED
encounters occurring between 5 pm and midnight, while all other ED encounters were non-peak hours. Patient-
flow data points included ED length of stay (LOS), image acquisition time, and diagnostic image assessment time.
Results: 321,786 total ED visits consisted of 102,560 during peak hours and 219,226 during non-peak hours.
Black patients experienced longer image acquisition and image assessment times across both time periods (TR =
1.030; p < 0.001 and TR = 1.112; p < 0.001, respectively); Black patients also had increased length of stay
compared to White patients, which was amplified during peak hours. Likewise, patients with primary payer
insurance experienced significantly longer image acquisition and image assessment times in both periods (TR >
1.00; p < 0.05 for all). Females had longer image acquisition and image assessment time and the difference was
more pronounced in image acquisition time during both peak and non-peak hours (TR = 1.146 and TR = 1.139
respectively with p < 0.001 for both).
Conclusion: When measuring radiology time periods, patient flow throughout the ED was not uniform. There was
unequal acceleration and deceleration of patient flow based on racial, gender, age, and insurance status. Seg-
mentation of patient flow time periods may allow identification of causes of inequity such that disparities can be
addressed with targeted actions.