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Abstract Background Emergency departments increasingly serve patients who prefer a language other than English. Honoring patients’ language preferences is crucial for quality and cultural appropriateness of care. We sought to assess whether time spent in caring for patients who preferred a language other than English differed from patients whose language preference was English. Secondarily, we sought to assess professional reimbursement across the two groups. Methods We retrospectively analyzed an existing dataset from a time‐in‐motion study that included direct observation measurements of emergency physicians’ time spent during patient encounters. Our primary outcome was physician time spent conducting patient care, comparing patients who preferred a language other than English to patients who preferred English. Secondarily, we sought to assess if relative value unit (RVU)‐based compensation differed across the two groups. We calculated descriptive statistics and performed multivariable regression. Results Across 218 patient encounters, physicians spent 18.6% longer on encounters with patients whose preferred a language other than English (median = 18.5 min, interquartile range [IQR] 14.8–27.9 min) than for those who preferred English (median = 15.6 min, IQR 11.5–22.9 min; p = 0.04). After controlling for other factors, patients’ preferred language was not associated with increased RVUs (β = −0.12, t = −1.94, p = 0.055). Conclusions Emergency physicians appear to spend more time caring for patients who prefer a language other than English. This additional effort during the care of this potentially vulnerable population may not be reflected in past and current reimbursement structures. Additional research is prudent as we seek to better address social determinants of health in care delivery and reimbursement systems.

Introduction: We sought to describe emergency department (ED) buprenorphine treatment variability among EDs with varying operational characteristics. Methods: We performed a retrospective cohort study of adult patients with opioid use disorder discharged from 12 hospital-based EDs within a large healthcare system as a secondary data analysis of a quality improvement study. Primary outcome of interest was buprenorphine treatment rate. We described treatment rates between EDs, categorized by tertile of operational characteristics including annual census, hospital and intensive care unit (ICU) admission rates, ED length of stay (LOS), and boarding time. Secondary outcomes were ED LOS and 30-day return rates. Results: There were 7,469 unique ED encounters for patients with opioid use disorder between January 2020–May 2021, of whom 759 (10.2%) were treated with buprenorphine. Buprenorphine treatment rates were higher in larger EDs and those with higher hospital and ICU admission rates. Emergency department LOS and 30-day ED return rate did not have consistent associations with buprenorphine treatment. Conclusion: Rates of treatment with ED buprenorphine vary according to the operational characteristics of department. We did not observe a consistent negative relationship between buprenorphine treatment and operational metrics, as many feared. Additional funding and targeted resource allocation should be prioritized by departmental leaders to improve access to this evidence-based and life-saving intervention.

Abstract Objectives To evaluate whether subcutaneous neutralizing monoclonal antibody (mAb) treatment given in the emergency department (ED) setting was associated with reduced hospitalizations, mortality, and severity of disease when compared to nontreatment among mAb‐eligible patients with coronavirus disease 2019 (COVID‐19). Methods This retrospective observational cohort study of ED patients utilized a propensity score‐matched analysis to compare patients who received subcutaneous casirivimab and imdevimab mAb to nontreated COVID‐19 control patients in November–December 2021. The primary outcome was all‐cause hospitalization within 28 days, and secondary outcomes were 90‐day hospitalization, 28‐ and 90‐day mortality, and ED length of stay (LOS). Results Of 1340 patients included in the analysis, 490 received subcutaneous casirivimab and imdevimab, and 850 did not received them. There was no difference observed for 28‐day hospitalization (8.4% vs. 10.6%; adjusted odds ratio [aOR] 0.79, 95% confidence intervals [CI] 0.53–1.17) or 90‐day hospitalization (11.6% vs. 12.5%; aOR 0.93, 95% CI 0.65–1.31). However, mortality at both the 28‐day and 90‐day timepoints was substantially lower in the treated group (28‐day 0.6% vs. 3.1%; aOR 0.18, 95% CI 0.08–0.41; 90‐day 0.6% vs. 3.9%; aOR 0.14, 95% CI 0.06–0.36). Among hospitalized patients, treated patients had shorter hospital LOS (5.7 vs. 11.4 days; adjusted rate ratio [aRR] 0.47, 95% CI 0.33–0.69), shorter intensive care unit LOS (3.8 vs. 10.2 days; aRR 0.22, 95% CI 0.14–0.35), and the severity of hospitalization was lower (aOR 0.45, 95% CI 0.21–0.97) compared to untreated. Conclusions Among ED patients who presented for symptomatic COVID‐19 during the Delta variant phase, ED subcutaneous casirivimab/imdevimab treatment was not associated with a decrease in hospitalizations. However, treatment was associated with lower mortality at 28 and 90 days, hospital LOS, and overall severity of illness.

Introduction: Prolonged emergency department (ED) length of stay (LOS) has been shown to adversely affect patient care. We sought to determine factors associated with ED LOS via analysis of a large, national, ED operations database., Methods: We performed retrospective, multivariable, linear regression modeling using the 2019 Emergency Department Benchmarking Alliance survey results to identify associated factors of ED LOS for admitted and discharged patients., Results: A total of 1,052 general and adult-only EDs responded to the survey. Median annual volume was 40,946. The median admit and discharge LOS were 289 minutes and 147 minutes, respectively. R-squared values for the admit and discharge models were 0.63 and 0.56 with out-of-sample R-squared values of 0.54 and 0.59, respectively. Both admit and discharge LOS were associated with academic designation, trauma level designation, annual volume, proportion of ED arrivals occurring via emergency medical services, median boarding, and use of a fast track. Additionally, admit LOS was associated with transfer-out percentage, and discharge LOS was associated with percentage of high Current Procedural Terminology, percentage of patients <18 years old, use of radiographs and computed tomography, and use of an intake physician., Conclusion: Models derived from a large, nationally representative cohort identified diverse associated factors of ED length of stay, several of which were not previously reported. Dominant within the LOS modeling were patient population characteristics and other factors extrinsic to ED operations, including boarding of admitted patients, which was associated with both admitted and discharged LOS. The results of the modeling have significant implications for ED process improvement and appropriate benchmarking.