Hispanics face longer wait for emergency GI care

Beds lie empty in the emergency room of Tulane University Hospital in New Orleans February 14, 2006.

NEW YORK (Reuters Health) - Hispanic whites seeking emergency treatment for gastrointestinal (GI) illnesses wait twice as long to see a doctor compared to non-Hispanic whites, new research shows.

The most likely explanation for this "striking" disparity is that Hispanic patients may have difficulty communicating to hospital staff, and require help from translators, Dr. Bechien Wu of Brigham and Women's Hospital in Boston, who was involved in the study, told Reuters Health. Based on what he's seen at his hospital, Wu added, "patients who rely upon those services are really apt to have more delay in their assessment."

It's crucial for patients with severe belly pain to see a doctor quickly, Wu said, because this pain may signal a life-threatening condition like stomach hemorrhage or a ruptured appendix.

Wu and his team looked at whether ER crowding influenced how quickly patients with stomach problems were seen by a physician by using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1997 to 2006.

Their analysis included 1.6 million ER visits for acute inflammation of the pancreas, 2.2 million for appendicitis, 1.2 million for gall bladder inflammation, and 3.9 million for upper gastrointestinal tract hemorrhage.

Patients experienced a delay in seeing a physician 24% of the time, the researchers found. Delays were more common for non-Hispanic whites in each of the four diagnostic categories; for example, non-Hispanic whites with appendicitis waited 43.5 minutes to see a doctor, on average, compared to 91.2 minutes for Hispanic whites, while the waiting time for gastrointestinal hemorrhage was 46 minutes for non-Hispanic whites and 73.7 for Hispanic whites.

The NHAMCS data didn't include information on what languages people spoke, Wu and his team point out, but "a major delay in physician assessment and ultimately treatment can occur while waiting for a language interpreter in a busy emergency ward," they point out in a report in the American Journal of Gastroenterology.

The findings are particularly concerning, Wu noted, given that Hispanics are by far the fastest-growing segment of the US population.

The findings could also signal more widespread problems with health care access. "If there's a particular segment of the population that's having to wait longer across the board this could be just the tip of the iceberg in terms of their interaction with the overall health care system."

Employing bilingual "patient navigators" -- health care workers who guide patients through the system -- is one way to tackle the problem, Wu said. "Most emergency departments already have interpreter services. I think it's a question of how we can better utilize those interpreter services."

And making things work better at the front end of the system could be an important way to improve health care quality, he added. "The point of first contact is so critical for getting our patients into the system and managed appropriately."

SOURCE: American Journal of Gastroenterology, July 2009.