Study Objectives: Patients who prefer to communicate in a language other than English are vulnerable to the consequences of medical communication barriers. Studies of Non-English Language Preferred (NELP) and English Language Preferred (ELP) patients have shown differences in rates of hospital admission and wait times, factors related to increased costs and lower patient satisfaction. However, few studies consider languages other than Spanish or account for the patient’s acuity level when they present to the Emergency Department (ED). This study investigates differences in care between NELP and ELP patients across three ED operational metrics: hospital admission rate, time from arrival to room, and time from arrival to disposition.

Methods: This retrospective cohort study used electronic health records from January 2020 to December 2020 from an urban academic medical center. Data extracted included age, gender, language preference, disposition, and Emergency Severity Index Score (ESI). NELP patients were languages were grouped into three language categories: Spanish, Chinese (Mandarin, Cantonese, Taishanese, Taiwanese, and Zhongshan-Chinese dialect), and Other (all remaining languages). The primary outcomes were hospital admission rate and times from arrival to the treatment room and arrival to disposition. Data was analyzed with chi-squared tests, logistic, and linear regressions.

Results: Of the 58,079 unique ED encounters in the study period, 26.4% (15,307) patients identified as NELP. Within NELP patient encounters, 75.0% preferred Spanish, 13.9% preferred Chinese, and 11.1% preferred another language. NELP patients had a higher admission rate than ELP (22.6% vs 20.0%, p<0.001), which after adjusting for age and acuity, demonstrated a 15% increased odds (p<0.001). NELP patients waited an average 5.4 minutes longer to be roomed (p<0.001) and 15.6 minutes longer until disposition (p<0.001). This discrepancy was greater for lower acuity patients, with ESI 5 Spanish and Chinese language-preferred patients waiting a longer average 50.4 and 90.6 minutes respectively ( p<0.001; p<0.05).

Conclusion: Even after adjusting for acuity level and age, NELP patients were at higher odds of admission and experienced disparate wait times, particularly at lower acuity levels. Decreased ED throughput not only affects patient experience but can delay treatment for more emergent patients. These disparities demonstrate opportunities to improve ED efficiency and the need to improve health equity.