Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints
Introduction: Black and Hispanic patients are frequently assigned lower acuity triage scores than White patients. This can lead to longer wait times, less aggressive care, and worse outcomes. In this study we aimed to determine whether these effects are more pronounced for patients with subjective c...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2023-08-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/2540m57d |
| _version_ | 1827794033861197824 |
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| author | Cassandra Peitzman Jossie A. Carreras Tartak Margaret Samuels-Kalow Ali Raja Wendy L. Macias-Konstantopoulos |
| author_facet | Cassandra Peitzman Jossie A. Carreras Tartak Margaret Samuels-Kalow Ali Raja Wendy L. Macias-Konstantopoulos |
| author_sort | Cassandra Peitzman |
| collection | DOAJ |
| description | Introduction: Black and Hispanic patients are frequently assigned lower acuity triage scores than White patients. This can lead to longer wait times, less aggressive care, and worse outcomes. In this study we aimed to determine whether these effects are more pronounced for patients with subjective complaints. Methods: We performed a retrospective analysis for all adult visits between 2016-2019 at an urban academic emergency department (ED) with acuity-based pods. We determined rates of initial high-acuity triage both across all patients and among the subset located in the high-acuity pod at time of disposition (either through initial assignment or subsequent up-triage). Analysis was performed for common chief complaints categorized as subjective (chest pain, dyspnea, any pain); observed (altered mental status); numeric (fever, hypotension); or protocolized (stroke, ST-elevation myocardial infarction). We constructed logistic regression models to control for age, race, gender, method of arrival, and final disposition. Results: We analyzed 297,355 adult ED visits. Black and Hispanic patients were less likely to be triaged to high-acuity beds (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.73-0.79 for Black, and aOR 0.87, 95% CI 0.84-0.90 for Hispanic patients). This effect was more pronounced for those with subjective chief complaints, including chest pain (aOR 0.76, 95% CI 0.73-0.79 for Black and 0.88, 95% CI 0.78-0.99 for Hispanic patients), dyspnea (aOR 0.79, 95% CI 0.68-0.92 and 0.8, 95% CI 0.72-0.99), and any pain (aOR 0.83, 95% CI 0.75-0.92 and 0.89, 95% CI 0.82-0.97, respectively). Among patients in the high-acuity pod at time of disposition, Black and Hispanic patients were disproportionately triaged to lower acuity pods on arrival (aOR 1.47, 95% CI 1.33-1.63 for Black and aOR 1.27, 95% CI 1.15-1.40 for Hispanic adults), with significant differences observed only for subjective chief complaints. No differences were observed for observed, objective, or protocolized complaints in either analysis. Conclusion: Black and Hispanic adults, including those who ultimately required high-acuity resources, were disproportionately triaged to lower acuity pods. This effect was more pronounced for patients with subjective chief complaints. Additional work is needed to identify and overcome potential bias in the assessment of patients with subjective chief complaints in ED triage. |
| first_indexed | 2024-03-11T18:27:02Z |
| format | Article |
| id | doaj.art-7d7fb331db6149cdb33f9647afcddb11 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-03-11T18:27:02Z |
| publishDate | 2023-08-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-7d7fb331db6149cdb33f9647afcddb112023-10-13T16:02:12ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182023-08-0124588889310.5811/westjem.5904459044Racial Differences in Triage for Emergency Department Patients with Subjective Chief ComplaintsCassandra Peitzman0Jossie A. Carreras Tartak1Margaret Samuels-Kalow2Ali Raja3Wendy L. Macias-Konstantopoulos4Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, MassachusettsMassachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, MassachusettsMassachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, MassachusettsMassachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, MassachusettsMassachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, MassachusettsIntroduction: Black and Hispanic patients are frequently assigned lower acuity triage scores than White patients. This can lead to longer wait times, less aggressive care, and worse outcomes. In this study we aimed to determine whether these effects are more pronounced for patients with subjective complaints. Methods: We performed a retrospective analysis for all adult visits between 2016-2019 at an urban academic emergency department (ED) with acuity-based pods. We determined rates of initial high-acuity triage both across all patients and among the subset located in the high-acuity pod at time of disposition (either through initial assignment or subsequent up-triage). Analysis was performed for common chief complaints categorized as subjective (chest pain, dyspnea, any pain); observed (altered mental status); numeric (fever, hypotension); or protocolized (stroke, ST-elevation myocardial infarction). We constructed logistic regression models to control for age, race, gender, method of arrival, and final disposition. Results: We analyzed 297,355 adult ED visits. Black and Hispanic patients were less likely to be triaged to high-acuity beds (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.73-0.79 for Black, and aOR 0.87, 95% CI 0.84-0.90 for Hispanic patients). This effect was more pronounced for those with subjective chief complaints, including chest pain (aOR 0.76, 95% CI 0.73-0.79 for Black and 0.88, 95% CI 0.78-0.99 for Hispanic patients), dyspnea (aOR 0.79, 95% CI 0.68-0.92 and 0.8, 95% CI 0.72-0.99), and any pain (aOR 0.83, 95% CI 0.75-0.92 and 0.89, 95% CI 0.82-0.97, respectively). Among patients in the high-acuity pod at time of disposition, Black and Hispanic patients were disproportionately triaged to lower acuity pods on arrival (aOR 1.47, 95% CI 1.33-1.63 for Black and aOR 1.27, 95% CI 1.15-1.40 for Hispanic adults), with significant differences observed only for subjective chief complaints. No differences were observed for observed, objective, or protocolized complaints in either analysis. Conclusion: Black and Hispanic adults, including those who ultimately required high-acuity resources, were disproportionately triaged to lower acuity pods. This effect was more pronounced for patients with subjective chief complaints. Additional work is needed to identify and overcome potential bias in the assessment of patients with subjective chief complaints in ED triage.https://escholarship.org/uc/item/2540m57d |
| spellingShingle | Cassandra Peitzman Jossie A. Carreras Tartak Margaret Samuels-Kalow Ali Raja Wendy L. Macias-Konstantopoulos Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints Western Journal of Emergency Medicine |
| title | Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints |
| title_full | Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints |
| title_fullStr | Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints |
| title_full_unstemmed | Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints |
| title_short | Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints |
| title_sort | racial differences in triage for emergency department patients with subjective chief complaints |
| url | https://escholarship.org/uc/item/2540m57d |
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