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Race and Ethnicity and Primary Language in Emergency Department Triage.
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- Author(s): Joseph JW;Joseph JW;Joseph JW; Kennedy M; Kennedy M; Kennedy M; Landry AM; Landry AM; Landry AM; Marsh RH; Marsh RH; Marsh RH; Baymon DE; Baymon DE; Baymon DE; Im DE; Im DE; Im DE; Chen PC; Chen PC; Chen PC; Samuels-Kalow ME; Samuels-Kalow ME; Samuels-Kalow ME; Nentwich LM; Nentwich LM; Nentwich LM; Elhadad N; Elhadad N; Sánchez LD; Sánchez LD; Sánchez LD
- Source:
JAMA network open [JAMA Netw Open] 2023 Oct 02; Vol. 6 (10), pp. e2337557. Date of Electronic Publication: 2023 Oct 02.- Publication Type:
Multicenter Study; Journal Article- Language:
English - Source:
- Additional Information
- Source: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
- Publication Information: Original Publication: Chicago, IL : American Medical Association, [2018]-
- Subject Terms:
- Abstract: 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. - References: Artif Intell Med. 2020 Jan;102:101762. (PMID: 31980099)
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JAMA Netw Open. 2020 Dec 1;3(12):e2029650. (PMID: 33320264) - Publication Date: Date Created: 20231012 Date Completed: 20231101 Latest Revision: 20231101
- Publication Date: 20231215
- Accession Number: PMC10570890
- Accession Number: 10.1001/jamanetworkopen.2023.37557
- Accession Number: 37824142
- Source:
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