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
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Oct 2;6(10):e2337557. doi: 10.1001/jamanetworkopen.2023.37557.
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.
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.
Emergency department nurse-led triage and physician evaluation.
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.
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.
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.
急诊科分诊对患者等待治疗的时间有重大影响，但分诊评分所依据的客观标准较少。先前的研究表明，黑人和西班牙裔患者获得的分诊评分不平等，同时医生评估的深度也存在差异。
研究在多中心的学术和社区医院网络中，分诊评分和医生评估中是否存在种族差异，并评估英语非母语患者是否面临类似差异。
设计、背景和参与者：这是一项横断面多中心研究，研究对象为2019年2月28日至2023年1月1日期间在马萨诸塞州综合医院布莱根综合医疗系统就诊的成年人，该系统包括7个急诊科：2家城市学术医院和5家社区医院。分析纳入了所有出现5种常见主要症状之一的患者。
急诊科护士主导的分诊和医生评估。
比较了不同症状以及少数族裔个体与白人患者之间的平均分诊紧急严重程度指数（ESI）评分和平均就诊工作相对价值单位（wRVUs）。
共有249829人次就诊（149861名女性[60%]，美洲印第安人或阿拉斯加原住民0.2%，亚洲人3.3%，黑人11.8%，西班牙裔18.8%，夏威夷原住民或其他太平洋岛民<0.1%，白人60.8%，以及将自己认定为其他种族或族裔的患者5.1%）。中位年龄为48岁（四分位间距，29 - 66岁）。在所有症状中，白人患者的ESI评分比西班牙裔或其他患者更紧急（例如，胸痛：西班牙裔，2.68[95%置信区间，2.67 - 2.69]；白人，2.55[95%置信区间，2.55 - 2.56]；其他，2.66[95%置信区间，2.64 - 2.68]；P <.001），在大多数症状中，白人患者的ESI评分也比黑人患者更紧急（恶心/呕吐：黑人，2.97[95%置信区间，2.96 - 2.99]；白人：2.90[95%置信区间，2.89 - 2.91]；P <.001）。wRVUs的情况则相反（胸痛：黑人，4.32[95%置信区间，4.25 - 4.39]；西班牙裔，4.13[95%置信区间，4.08 - 4.18]；白人3.55[95%置信区间，3.52 - 3.58]；其他3.96[95%置信区间，3.84 - 4.08]；P <.001）。英语非母语患者也出现了类似模式。
在这项横断面研究中，自我认定为黑人、西班牙裔以及其他种族和族裔的患者，尽管接受了医生更全面的检查，但被分配的ESI评分却不如白人同龄人紧急，这表明存在一定程度的分诊错误。临床决策支持系统可能会减少这些差异，但需要仔细校准以避免重复偏差。
