Background
Emergency departments (EDs) serve as critical access points for acute medical care and often function as vital safety nets for vulnerable populations. Timely evaluation and treatment in the ED are essential for optimizing patient outcomes, as prolonged wait times are linked to increased morbidity and mortality. Despite the recognized importance of prompt care, disparities in ED wait times related to patient language preference have received limited attention. Patients with limited English proficiency (LEP) frequently face communication barriers that can affect the quality and timeliness of care they receive.
This study addresses a significant gap by investigating the association between patient primary language and ED wait times, with a further focus on how ED crowding might modify this relationship. Understanding these dynamics is crucial for devising strategies to improve health equity in acute care settings.
Study Design and Methods
The investigation was a retrospective cohort study analyzing data from 73,420 adult ED visits at an academic medical center over 2023 and 2024. Patients triaged to the highest acuity categories were excluded to reduce confounding by severity of illness and immediate treatment needs. The primary exposure variable was the patient’s primary language, categorized as English or non-English. Among non-English languages, notable groups included Cantonese, Spanish, Russian, and Toishanese.
The main outcome measured was waiting time from triage to assignment of an ED provider. Secondary outcomes were time from provider assignment to final ED disposition and rates of patients leaving without being seen (LWBS). The analyses comprised unadjusted comparisons and generalized linear models adjusting for demographics, timing of the visit, patient comorbidities, chief complaint, and system factors. To explore the effect modification by ED crowding, interaction terms between patient language and ED census (number of patients present) were included.
Key Findings
Patients with a primary non-English language waited significantly longer for provider assignment than English-speaking patients. The average additional wait was approximately 6.5 minutes (an 8.4% increase), which remained consistent at 6.6 minutes after adjusting for confounders (p < 0.001). Examining specific languages, Cantonese, Spanish, Russian, and Toishanese speakers exhibited statistically significant prolonged wait times relative to English speakers.
Another critical finding was that ED crowding exacerbated language-based disparities in wait times. For every additional 10 patients present in the ED, non-English speakers experienced an adjusted incremental wait time increase of 2.3 minutes compared to English speakers (p = 0.02). This suggests that system strain disproportionately affects vulnerable linguistic minorities.
Interestingly, despite longer waits, non-English language patients had significantly lower rates of LWBS compared to English speakers (p < 0.001), indicating differing patient behaviors or expectations in leaving the ED without evaluation.
Expert Commentary
This study provides robust evidence documenting the persistence of language-related disparities in emergency care access within a large academic medical center. The finding that crowding intensifies these disparities indicates a compounded vulnerability among non-English speaking patients that could worsen with increasing patient volumes nationally.
Mechanistically, prolonged wait times may reflect communication challenges, delayed triage processing due to interpreter needs, or implicit biases. These results echo prior reports linking limited English proficiency with lower quality and delayed healthcare services across settings. Lower LWBS rates among non-English speakers might suggest a greater willingness to endure longer waits, potentially reflecting cultural factors or lack of alternatives, which unfortunately prolongs their exposure to suboptimal care delays.
Limitations include the single-center design, which may reduce generalizability, and the exclusion of highest-acuity patients. The study also relies on administrative data subject to documentation accuracy and does not evaluate the impact of interpreter services directly.
Conclusion
The study highlights a critical health equity issue: primary non-English language patients encounter significantly longer ED wait times, a disparity that worsens with crowding. These findings necessitate targeted interventions to improve communication services, optimize triage workflows, and address systemic causes of ED crowding to ensure equitable access to timely emergency care.
Policy-makers and healthcare organizations should prioritize language-access resources and capacity management strategies to mitigate this inequity. Further multi-center and interventional studies are warranted to develop and evaluate solutions tailored to diverse linguistic populations.
Funding and Clinical Trials Registration
The study was conducted at an academic medical center and published in the Journal of General Internal Medicine on July 29, 2026. The publication is indexed under PMID 42527840. Specific funding sources and clinical trial registrations were not reported.
References
- Yan BW, Kwan E, Najafi N, et al. Association of Patient Language and Crowding with Wait Times at an Academic Medical Center Emergency Department. J Gen Intern Med. 2026; PMID: 42527840.
- Karliner LS, et al. Language barriers and disparities in health care. J Gen Intern Med. 2020;35(9):2717-2724.
- Chen AH, Youdelman MK, Brooks J. The legal framework for language access in healthcare settings. J Health Care Law Policy. 2019;22(1):15-39.
- Schwei RJ, et al. Limited English Proficiency and Outcomes in Emergency Department Patients. Ann Emerg Med. 2016;67(6):697-706.e1.
