We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Race and Ethnicity and Primary Language in Emergency Department Triage.
- Authors
Joseph, Joshua W.; Kennedy, Maura; Landry, Alden M.; Marsh, Regan H.; Baymon, Da'Marcus E.; Im, Dana E.; Chen, Paul C.; Samuels-Kalow, Margaret E.; Nentwich, Lauren M.; Elhadad, Noémie; Sánchez, León D.
- Abstract
Key Points: Question: Are there significant differences in triage Emergency Severity Index scores and the intensity of physician evaluations (as measured by work relative value units) provided to Black patients, Hispanic patients, and those identifying as Other racial and ethnic background compared with White patients? Findings: In this cross-sectional study of 249 829 visits to 7 academic and community hospital emergency departments, Patients identifying as Black, Hispanic, and Other tended to have less acute triage scores than their White peers. Despite having the same chief symptoms, Patients identifying as Black, Hispanic, and Other received more intense physician evaluations. Meaning: These findings suggest the need to address systemic disparities in the emergency department triage process. Importance: Emergency department (ED) triage substantially affects how long patients wait for care but triage scoring relies on few objective criteria. Prior studies suggest that Black and Hispanic patients receive unequal triage scores, paralleled by disparities in the depth of physician evaluations. Objectives: To examine whether racial disparities in triage scores and physician evaluations are present across a multicenter network of academic and community hospitals and evaluate whether patients who do not speak English face similar disparities. Design, Setting, and Participants: This was a cross-sectional, multicenter study examining adults presenting between February 28, 2019, and January 1, 2023, across the Mass General Brigham Integrated Health Care System, encompassing 7 EDs: 2 urban academic hospitals and 5 community hospitals. Analysis included all patients presenting with 1 of 5 common chief symptoms. Exposures: Emergency department nurse-led triage and physician evaluation. Main Outcomes and Measures: Average Triage Emergency Severity Index [ESI] score and average visit work relative value units [wRVUs] were compared across symptoms and between individual minority racial and ethnic groups and White patients. Results: There were 249 829 visits (149 861 female [60%], American Indian or Alaska Native 0.2%, Asian 3.3%, Black 11.8%, Hispanic 18.8%, Native Hawaiian or Other Pacific Islander <0.1%, White 60.8%, and patients identifying as Other race or ethnicity 5.1%). Median age was 48 (IQR, 29-66) years. White patients had more acute ESI scores than Hispanic or Other patients across all symptoms (eg, chest pain: Hispanic, 2.68 [95% CI, 2.67-2.69]; White, 2.55 [95% CI, 2.55-2.56]; Other, 2.66 [95% CI, 2.64-2.68]; P <.001) and Black patients across most symptoms (nausea/vomiting: Black, 2.97 [95% CI, 2.96-2.99]; White: 2.90 [95% CI, 2.89-2.91]; P <.001). These differences were reversed for wRVUs (chest pain: Black, 4.32 [95% CI, 4.25-4.39]; Hispanic, 4.13 [95% CI, 4.08-4.18]; White 3.55 [95% CI, 3.52-3.58]; Other 3.96 [95% CI, 3.84-4.08]; P <.001). Similar patterns were seen for patients whose primary language was not English. Conclusions and Relevance: In this cross-sectional study, patients who identified as Black, Hispanic, and Other race and ethnicity were assigned less acute ESI scores than their White peers despite having received more involved physician workups, suggesting some degree of mistriage. Clinical decision support systems might reduce these disparities but would require careful calibration to avoid replicating bias. This cross-sectional study examines emergency department triage and resultant workup by physicians among patients of differing races and ethnicities.
- Subjects
RESEARCH; HOSPITALS; NATIVE Americans; HOSPITAL emergency services; MEDICAL triage; ENGLISH language; ACADEMIC medical centers; MINORITIES; CONFIDENCE intervals; NAUSEA; COMMUNICATION barriers; CROSS-sectional method; ALASKA Natives; HISPANIC Americans; RACE; COMPARATIVE studies; VOMITING; PACIFIC Islanders; CHEST pain; HEALTH equity; PHYSICIANS; EMERGENCY nurses; WHITE people; MEDICAL needs assessment; AFRICAN Americans
- Publication
JAMA Network Open, 2023, Vol 6, Issue 10, pe2337557
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.37557