Oral Papers: Medical Specialties III: Emergency Medicine, Surgery
Race-based bias in healthcare occurs at organizational, structural, and clinical levels, and may impact emergency psychiatric consultation. Numerous studies have demonstrated that individuals of color receive different treatment in emergency departments than whites including longer wait times1 and higher rates of involuntary hospitalization.2 Limited literature exists on the role of race and ethnicity in emergency psychiatric settings. Identifying the role of race and ethnicity in rates of restraint, emergency psychiatric utilization, and disposition may highlight areas for improvement and guide interventions to address health disparities.
We performed a retrospective chart review of medical records for all emergency department visits at an academic medical center in Boston from 2016-2018. We extracted the following variables: age, gender, race, homelessness, order for acute psychiatric consultation, insurance type, disposition, diagnosis, order for restraint, and length of stay. A random effects linear regression will be used to examine potential predictors of use of restraints, psychiatric disposition, and acute psychiatric service utilization.
Data extraction is complete, and analysis is underway. From January 2016 through December 2018, there were 195,092 emergency room visits by 120,469 individuals. Sixty-eight percent of visits were by white patients, 10% of visits by black patients, 4.3% Asian, 1.3 % Hispanic or Latino, 0.2% American Indian/Alaskan Native (AI/AN), 0.1 % Native Hawaiian/Pacific Islander, and 5.7% reported race as unavailable or declined to report. Psychiatric consultations were requested for 12,217 visits. 7.9% of ED visits by black patients resulted in psychiatric consultation versus 6.4% of visits for white, 4.6% Asian, 5.5% Hispanic or Latino, 7.3% AI/AN, 6.0% Native Hawaiian/Pacific Islander, and 10.2% of visits for patients of unknown race. Physical restraint was involved in 1.4% of visits.
Data analysis is underway. Prior research has suggested that patients of color are triaged differently in the ER compared to white patients1 and that there is a higher rate of use of emergency psychiatric services for individuals of color.2 There are likely many factors at play, including differences in access to outpatient resources leading to greater reliance on emergency care among black patients. Interpersonal racism in the perception of black patients may also contribute to these differences.
This work will be used to identify factors that may be predictive of restraint use, ED disposition, and high utilization of emergency psychiatric services to help identify areas for intervention. Our overarching goal is institutional improvement, with the hope of promoting a culture of inclusion, safety, and health equity.
1Schrader, C. D., & Lewis, L. M. (2013). Racial Disparity in Emergency Department Triage. The Journal of Emergency Medicine, 44(2), 511–518.
2Snowden, L. R., Catalano, R., & Shumway, M. (2009). Disproportionate Use of Psychiatric Emergency Services by African Americans. Psychiatric Services, 60(12), 1664–1671.