Racial Disparities in Door-to-Clinician Time for Cardiac Chest Pain in the Emergency Department

Abstract

Introduction: Timely evaluation in the emergency department (ED) is critical for patients with cardiac chest pain. Although racial disparities in ED wait times have been reported, few studies have focused specifically on cardiac-related presentations. In this study we assessed racial and ethnic disparities in ED door-to-clinician time for cardiac chest pain.

Methods: We conducted a retrospective analysis of adult ED visits for cardiac chest pain (2019-2025) at a tertiary-care academic hospital. Patients ≥ 18 years of age were included. Race/ethnicity was categorized as White, Hispanic/Latino, Black, Native American, Asian, or other/unknown. Multivariable generalized linear modeling assessed the association between race/ethnicity and door-to-clinician time, adjusting for demographics and clinical variables.

Results: The study included 3,925 patients. The overall median door-to-clinician time was 15.9 minutes (interquartile range 8.0-36.0). In unadjusted bivariate analyses, significant differences were observed across racial and ethnic groups (P < .001). Native American patients experienced the longest delays (23.8 minutes [13.9-49.8]), followed by Asian (18.6 minutes [8.4-36.5]) and Hispanic/Latino patients (17.1 minutes [9.3-43.7]). In contrast, White and Black patients had shorter median wait times of 14.9 minutes [7.1-33.9] and 15.0 minutes [8.8-38.7], respectively. After adjustment for age, sex, triage acuity, clinician type, and initial vital signs, Hispanic/Latino patients waited 18.2 minutes vs 14.9 minutes for White patients (absolute +3.3 minutes; 22% longer; relative risk 1.22, 95% CI, 1.09-1.36, P < .001). Adjusted times were also higher for Black (16.5 minutes), Native American (17.7 minutes), and Asian patients (15.1 minutes), but differences were not statistically significant.

Conclusion: Hispanic/Latino patients with cardiac chest pain experienced a 22% longer ED wait time than White patients. Our findings highlight the need for targeted interventions and multisite research to ensure equitable, timely care for all patients with acute cardiac conditions.

Figure

Flow diagram showing inclusion and exclusion criteria for a retrospective study examining door-to-clinician times for cardiac chest pain by race/ethnicity. AMA, against medical advice; ESI, Emergency Severity Index.