Vigil Jacob Miguel, Coulombe Patrick, Alcock Joe, Stith Sarah See, Kruger Eric, Cichowski Sara
Department of Psychology.
Department of Educational Psychology.
Pain. 2017 Mar;158(3):377-382. doi: 10.1097/j.pain.0000000000000725.
The goals of this study were to compare whether emergency department (ED) patients' pain intensity (PI) is measured differently by male and female nurses and to determine whether PI, heart rate (HR), and respiratory rate (RR) were used to prioritize patient urgency differently by male and female nurses. The associations between patients' PI|HR|RR and the Emergency Severity Index (ESI) scores they were assigned by attending nurses were analyzed using a national database of electronic medical records of US Veterans Affairs ED patients from 2008 to 2012. A total of 129,991 patients presenting for emergency care (Mage = 59.5, 92% males) and their triage nurses (n = 774, Mage = 47.5, 18% males) were analyzed, resulting in a total of 359,642 patient-provider interactions. Patients' PI did not differ by the nurse's gender; however a cross-classified mixed-effects model showed that nurse gender influenced how PI and RR measurements informed the ESI levels that male patients received. Higher PI levels were associated with more urgent (higher priority) ESI levels by female nurses, yet less urgent ESI levels by male nurses. In contrast, male patients with high RR received more urgent ESI levels by male nurses, whereas the nurse gender did not influence ESI assignments for female patients. These findings show that ED patients receive disparate treatment based on inherent characteristics of their triage nurses, and more standardized (eg, automated) protocols that can account for implicit social factors on health care practice for reliably assessing and prioritizing ED patients may be currently warranted.
本研究的目的是比较男性和女性护士对急诊科（ED）患者疼痛强度（PI）的测量是否存在差异，并确定男性和女性护士在根据PI、心率（HR）和呼吸频率（RR）确定患者紧急程度的优先级方面是否存在差异。使用2008年至2012年美国退伍军人事务部急诊科患者电子病历的全国数据库，分析了患者的PI、HR、RR与主治护士为他们分配的急诊严重程度指数（ESI）分数之间的关联。共分析了129991名前来急诊的患者（平均年龄=59.5岁，92%为男性）及其分诊护士（n=774名，平均年龄=47.5岁，18%为男性），产生了总共359642次患者与医护人员的互动。患者的PI不因护士性别而异；然而，一个交叉分类混合效应模型显示，护士性别会影响PI和RR测量结果如何影响男性患者获得的ESI级别。较高的PI水平与女性护士给予的更紧急（更高优先级）的ESI级别相关，而与男性护士给予的不太紧急的ESI级别相关。相比之下，RR较高的男性患者由男性护士给予更紧急的ESI级别，而护士性别对女性患者的ESI分配没有影响。这些发现表明，急诊科患者因分诊护士的固有特征而受到不同的治疗，目前可能需要更标准化（如自动化）的方案，以考虑医疗保健实践中隐含的社会因素，从而可靠地评估急诊科患者并确定其优先级。
