Disorderly queues: How does unexpected demand affect queue prioritisation in emergency care?

The sharp increase in emergency department (ED) use in England has created long queues at busy times. Care professionals may prioritize some patients in these queues, increasing delays for others and potentially impacting both equity and efficiency. We calculate a measure of queue prioritisation for all 11M attendances at an ED in England in 2017/18, and examine whether some patient groups (ethnic minorities, females, and residents of deprived neighbourhoods) are discriminated against in this prioritisation process. We reduce the risk of unobservable confounding by examining how patient re-ordering responds to unexpected demand surges. To do so, we leverage high-dimensional fixed effects to partial out hospital-specific month-day-of-the-week seasonality to obtain plausibly exogenous daily demand shocks. We further reduce the risk of observable confounding by including detailed severity adjusters. We find that females, ethnic minorities and residents of deprived neighbourhoods are all systematically deprioritised, especially when EDs are busy. Our findings highlight the importance of queue prioritization as a contributor to ED inequities in access to care.