Exploring Emergency Department Wait-Times for Individuals with Alcohol Use Disorder with +/- Elevated Blood Alcohol Concentration

Introduction: As of 2021, 29.5 million U.S. people ages 12 and older have been diagnosed with Alcohol Use Disorder (AUD), an increase from 15.7 million reported cases in 2015. As the prevalence of AUD continues to increase, healthcare providers must anticipate alcohol-associated admissions due to increased chronic disease and premature mortality.

The Emergency Department (ED) is the most used point of entry into the healthcare system for patients experiencing a traumatic injury and one of the most common admission sites for patients with AUD. AUD is consistently regarded as one of the most stigmatized disorders globally, which provides a major barrier for those seeking medical treatment.Given the increased likelihood of staff experiencing individuals in the ED with AUD or a positive blood alcohol content (BAC) test, identifying potential barriers of individuals with AUD seeking care in the ED may improve overall hospital care outcomes. Thus, the primary objective of our study was to evaluate the potential effects of having an AUD diagnosis on wait times during admission to the ED. Therefore hypothesized that those with AUD+/BAC+ will have longer wait times than those who are AUD-/BAC-.

Methods/Materials: We conducted a cross-sectional analysis of the 2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) dataset that reports Emergency Departments (ED) admissions in the United States. Each ED is randomly assigned a 4-week reporting period in which there is a random collection of patient data and characteristics. Each hospital was trained in data collection, verified for eligibility and aided in creating a collection plan prior to participation in the survey. After calculating mean wait times for each sociodemographic of our sample, we assessed differences in these wait times using binary and multivariable linear regression models.

Results: Results from our binary regression showed that compared to individuals with no history of alcohol misuse and were BAC negative, we found that individuals who were AUD-/BAC+ had a shorter wait time (min -18.43, SE = 1.92, t = -9.59, P <.001). Additionally, those who were AUD+/BAC+ had shorter wait times compared to AUD-/BAC- as well (min = -11.11, SE = 4.05; t = -2.75, P = .006). In our adjusted model, only those with AUD-/BAC+ significantly differed from the reference group—having a 16.7 minute shorter wait time on average (SE = 2.97; t = -5.62, P <.001) compared to the AUD-/BAC- group.

Discussion/Conclusions: Overall, our study showed no significant difference in emergency department wait times between individuals with and without a history of AUD, although those presenting under the influence of alcohol had shorter wait times. This shows that whether or not AUD-related stigma exists in EDs, it does not negatively affect the timeliness of when an individual with AUD is seen by a doctor. We still recommend training for ED physicians, healthcare workers, and staff to identify and mitigate implicit bias to continue to remove barriers to treatment and improve patient care amongst all populations.