Triage Discordance in an Academic Pediatric Emergency Department and Disparities by Race, Ethnicity, and Language for Care

被引:1
作者
Jafari, Kaileen [1 ,2 ]
Burns, Brian [3 ]
Barry, Dwight [4 ]
Koid, Cassandra [5 ,6 ]
Tan, Tina [1 ]
Hartford, Emily [1 ,2 ]
机构
[1] Univ Washington, Dept Pediat, Div Emergency Med, Seattle, WA USA
[2] Seattle Childrens Res Inst, Ctr Clin & Translat Res, Seattle, WA USA
[3] Seattle Childrens Hosp, Pediat Emergency Med, Seattle, WA USA
[4] Seattle Childrens Hosp, Clin Analyt, Seattle, WA USA
[5] Tulane Univ, Sch Med, Dept Pediat, New Orleans, LA USA
[6] Louisiana State Univ, Hlth Sci Ctr, Dept Pediat, New Orleans, LA USA
关键词
triage; health disparities; IMPLICIT BIAS; RELIABILITY; IMPACT; PAIN;
D O I
10.1097/PEC.0000000000003211
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BackgroundMinoritized patients are disproportionately represented in low-acuity emergency department (ED) visits in the United States in part caused by lack of timely access to primary and urgent care. However, there is also the possibility that implicit bias during triage could contribute to disproportionate representation of minority groups in low-acuity ED visits. Triage discordance, defined as when ED resources used are different from initial triage score predictions, can be used as a proxy for triage accuracy. Recent data suggest that discordant triage may be common, although little is known about the interaction with race, ethnicity, and language for care.ObjectivesThis study aims to determine the prevalence of discordant triage among moderate- and low-acuity pediatric ED encounters and the interaction with patient race, ethnicity, and language for care.MethodsWe performed a retrospective analysis of pediatric ED encounters from 2019 with Emergency Severity Index (ESI) scores of 3, 4, or 5 at an academic referral hospital. The primary outcome was triage discordance, encompassing overtriage (ESI 3 and 4) and undertriage (ESI 4 and 5). Logistic and multinomial regressions were used to assess discordant triage by race, ethnicity, and language group.ResultsTriage discordance occurred in 47% (n = 18,040) of encounters. Black and Hispanic patients had higher likelihood of undertriage for ESI 5 (adjusted odds ratio 1.21, 95% confidence interval [CI] 1.01-1.46 and 1.27, 95% CI 1.07-1.52, respectively), and Black patients were more likely to be overtriaged in ESI 3 (1.18, 95% CI 1.09-1.27). Those with a language other than English for care had higher proportions of overtriage for ESI 3 (1.08, 95% CI 1.04-1.12) and undertriage for ESI 5 (1.23, 95% CI 1.11-1.37).ConclusionsWe found high rates of triage discordance in our pediatric ED, with significant associations with race, ethnicity, and language for care. Future research should evaluate the source of triage discordance and develop quality improvement efforts to improve equitable care.
引用
收藏
页码:681 / 687
页数:7
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