A new study by researchers at Yale University finds that nearly one third of emergency room patients are jumped in line, with those from marginalized groups — including lower-income patients, non-white patients, and non-English speakers — more likely to be cut by others.
Typically, when a patient enters an emergency department they are given an initial assessment by a triage team and assigned a score based on their medical need. That score comes from the emergency severity index, which ranges from one to five. A score of “one” is assigned to the most urgent events, like cardiac arrest; a “five” is the least urgent, encompassing needs like prescription refills. According to this system, if two patients come in at the same time, the one with the more severe score will be treated first. If two patients have the same score, the person who arrived earlier will be treated first.
But this study of electronic health record data from two high-volume emergency departments between July 2017 and February 2020, found that 28.8 percent of patients were passed over at least once by patients with a lower severity score or later arriving patients with the same severity score. Patients with Medicaid as their primary insurance were more likely to be queue-jumped than those with private insurance. Similarly, patients who were Black or Hispanic were more likely to be passed over than White patients and Spanish-speaking patients were more likely to be queue-jumped by English-speaking patients. The researchers also found that patients who were jumped over were more likely to leave before their care was completed, and more likely to be placed in a hallway rather than a room.
The good news is that the researchers found no disparity in queue jumping when they assessed patients with the most severe scores, those experiencing stroke or trauma, for example.
The full study, “Sociodemographic Disparities in Queue Jumping for Emergency Department Care,” was published on the JAMA Open Network. It may be accessed here.