UMEM Educational Pearls

Title: Disposition Decisions and Health Disparities

Keywords: Operations, Disposition, Decision-Making, Disparities, (PubMed Search)

Posted: 9/24/2025 by Mercedes Torres, MD (Updated: 12/5/2025)
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This publication is a retrospective cross-sectional study conducted based on data collected during January 1–December 31, 2019 from a large, academic ED in the Southeastern US with the following research questions and results:

Are there disparities in ED disposition decisions with regard to sex, race and ethnicity?
Result of this study: YES. Authors found statistically significant associations between ED disposition decisions and patient sex, race, as well as ethnicity, with male, Caucasian, and non-Hispanic patients being more likely to be admitted to the hospital compared with their female, African-American and Hispanic counterparts, even when controlling for insurance status.
Do ED operational factors such as ED crowding contribute to the strength of any disparity that might exist?
Result of this study: YES. Longer ED wait times resulted in greater sex-based disposition disparities, with more males being admitted than females with increased ED crowding.

Interesting point regarding how disposition decisions are different from the ample evidence on disparities within triage decisions: The presence of disparities in disposition decisions is noteworthy not only because of their potentially long-term effects on patients’ health, but also because unlike some of the other decisions made in the ED such as triage, they are typically made under relatively less time pressure with deliberation and input from multiple individuals, conditions that are known to make biases less likely.

Authors propose pursing further research to elucidate the factors that contribute to these findings, instituting systems to alert providers in real time to the presence of conditions that could exacerbate disparities in ED care, and including the measurement of disparities along sex, race and ethnicity into health care operations data.

References

Cheng Q, Argon NT, Evans CS, Lin P, Linthicum B, Liu Y, Mehrotra A, Patel MD and Ziya S (2024) An Investigation into Demographic Disparities in Emergency Department Disposition Decisions. Production and Operations Management 34(4): 688–696.