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A longer stay in the emergency department increases the risk of patient discrimination and dissatisfaction

Vaseline 2 months ago

Situations in which hospitalized patients remain in the emergency department (ED) for longer than 24 hours are more likely to be associated with incidents of patient discrimination and the risk of dissatisfaction with care, according to new findings.1

In new data presented this week at the American College of Physicians (ACP) Internal Medicine Meeting in Boston, MA, researchers from Harvard Medical School reported this week that emergency room admission time can have a significant impact on the quality of the care and treatment provided to patients. Furthermore, the findings suggest that the effect may be more severe for patients of marginalized races or ethnicities.

Led by Rose McKeon Olson, MD, MPH, of the Division of Global Health Equity at Brigham Women’s Hospital, the researchers sought to determine whether prolonged emergency room stays are associated with an increased risk of perceived discrimination and patient dissatisfaction, stratified by patient racial and ethnic background. . As they noted, U.S. emergency rooms and hospitals have faced “critical overcrowding and capacity issues,” a trend exacerbated by the COVID-19 pandemic.2

“Emergency department admissions are associated with adverse health outcomes,” they wrote. “Its effect on discrimination is unknown.”1

The team conducted a random survey at a large urban teaching hospital from June 2023 through January, assessing hospitalized patients admitted to internal medicine. Patients were stratified 1:1 as either identifying as non-Hispanic white or from a marginalized racial or ethnic background.

The duration of emergency department admission was stratified into 3 durations: <4 hours (reference group), 4 - <24 hours and ≥24 hours. Olson and colleagues assessed for racial discrimination using the Discrimination in Medical Setting Scale and patient dissatisfaction using the Adapted Picker Patient Questionnaire.

Their final analyzes included 525 patients; 274 (52.7%) were of a marginalized race or ethnicity, and the remainder were white. The mean patient age was 60.6 years; 300 (57.1%) were women). Approximately 90% spoke English and patients were primarily privately insured (47.2%), followed by Medicare (42.1%).

Patients were mainly admitted within 4 – <24 hours to the emergency department (n = 202 (38.5%)), followed by ≥24 hours (n = 188 (35.8%)). Only a quarter of the patients were able to board within four hours. Such rates were consistent among both white and marginalized race/ethnicity cohorts.

Olson and colleagues reported that patients on board for ≥24 hours were almost twice as likely to report discrimination based on questionnaire results (odds ratio (OR), 1.84; 95% CI, 1.05 – 3.24). Among patients from marginalized racial/ethnic backgrounds, the risk was even more severe (OR, 2.18; 95% CI, 1.04–4.57; P = 0.04). In white patients the outcome was insignificant (OR, 1.37; 95% CI, 0.55–3.40; P = 0.05).

The researchers additionally noted that patients who were on board for ≥24 hours were 77% more likely to report dissatisfaction with their care (OR, 1.77; 95% CI, 1.02–3.08; P = 0.04).

“Hospitalized patients who stayed in the emergency department for 24 hours or more experienced more discrimination and dissatisfaction with their care,” the team wrote. “Despite similar lengths of boarding time, marginalized races and ethnicities were more likely to report discrimination during prolonged emergency department boarding.”

Although the review was limited by the single-center cohort and the inability to adjust for potential confounding factors, among other shortcomings, the team felt that the findings clarified some clear needs for follow-up assessment.

These ideas, they noted, would include a qualitative study to identify the potentially modifiable causes of discrimination in the emergency department, as well as a retrospective chart review to assess additional measures of boarding time outcomes.

References

  1. McKeon Olson R, Fleurant A, Beauparlant S, Baymon DE, et al. Emergency Department associated with increased racial discrimination and patient dissatisfaction. Poster presented at: American College of Physicians Internal Medicine 2024 Meeting. Boston, MA. April 18 – 20, 2024.
  2. Alharthi S, Al-Moteri M, Plummer V, Al Thobiaty A. The impact of COVID-19 on the emergency department. Healthcare (Basel). 2021;9(10):1295. Published September 29, 2021. doi:10.3390/healthcare9101295