Association of Black Race With Physical and Chemical Restraint Use Among Patients Undergoing Emergency Psychiatric Evaluation

Smith, Colin M.; Turner, Nicholas; Thielman, Nathan M.; Tweedy, Damon; Egger, Joseph; Gagliardi, Jane P.

doi:10.1176/appi.ps.202100474

Cited by 43 publications

(28 citation statements)

References 30 publications

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“…We hypothesise that assessments of violence or aggression in psychiatric ED settings are biased based on demographic (eg, race, housing) and contextual factors (eg, police involvement), leading to inequities in care for samples defined by these intersecting features. Specifically, we expect to find higher structured risk assessment scores (ie, DASA ratings) in racially marginalised groups, 32 foreign-born individuals, and potentially for patients admitted to the ED by police. Extending on previous work, 46 47 narratives or clinical notes describing these patients may contain more negative sentiment.…”

Section: Introductionmentioning

confidence: 99%

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry

et al. 2023

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IntroductionManaging violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML.Methods and analysisWe pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups.Ethics and disseminationThe project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.

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Section: Introductionmentioning

confidence: 99%

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry

et al. 2023

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“…One of the fundamental tenets and legal obligations of EM is the duty to provide access to care to anyone, at any time, without regard for ability to pay 1 . Patients with one or more minoritized identities are often vulnerable and underserved by our current health system and rely disproportionately on the emergency care system for access, 2 which is itself related to persistent racial disparities in several aspects of acute care 3–14 . Racism is a pervasive attribute of our culture that affects many aspects of medical care, including health outcomes, 3,15 access to care, 16,17 affordability, 18,19 health literacy, 20,21 quality of care, 7,8 interventions received, 4–14,22 and trust in the health care system 23,24 …”

Section: Introductionmentioning

confidence: 99%

“…We must additionally understand how the process of research in emergency care may perpetuate racism. While there are still gaps in the literature, it has been clearly demonstrated that racial disparities exist in the quality of acute care provided to patients 3–13,22 . However, proven interventions to reduce racism, disparities, and racial bias in emergency care and systems—as well as racial bias in current heuristics, clinical care, and research study design—are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…1 Patients with one or more minoritized identities are often vulnerable and underserved by our current health system and rely disproportionately on the emergency care system for access, 2 which is itself related to persistent racial disparities in several aspects of acute care. [3][4][5][6][7][8][9][10][11][12][13][14] Racism is a pervasive attribute of our culture that affects many aspects of medical care, including health outcomes, 3,15 access to care, 16,17 affordability, 18,19 health literacy, 20,21 quality of care, 7,8 interventions received, [4][5][6][7][8][9][10][11][12][13][14]22 and trust in the health care system. 23,24 Racism is traditionally a system of structured opportunity and assignment of value that intentionally disadvantages individuals based…”

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confidence: 99%

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2022 consensus conference on diversity, equity, and inclusion: Developing an emergency medicine research agenda for addressing racism through health care research

Davis

Sánchez

Jarman

et al. 2023

Academic Emergency Medicine

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Racism in emergency medicine (EM) health care research is pervasive but often underrecognized. To understand the current state of research on racism in EM health care research, we developed a consensus working group on this topic, which concluded a year of work with a consensus‐building session as part of the overall Society for Academic Emergency Medicine (SAEM) consensus conference on diversity, equity, and inclusion: “Developing a Research Agenda for Addressing Racism in Emergency Medicine,” held on May 10, 2022. In this article, we report the development, details of preconference methods and preliminary results, and the final consensus of the Healthcare Research Working Group. Preconference work based on literature review and expert opinion identified 13 potential priority research questions that were refined through an iterative process to a list of 10. During the conference, the subgroup used consensus methodology and a “consensus dollar” (contingent valuation) approach to prioritize research questions. The subgroup identified three research gaps: remedies for racial bias and systematic racism, biases and heuristics in clinical care, and racism in study design, and we derived a list of six high‐priority research questions for our specialty.

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“…The intensity of acute patient care can in fact intensify race-based differences in care. Among other metrics, the use of seclusion, and of mechanical or chemical restraints is telling: their use is signi cantly higher among Black than white patients, both in adults (Nash et al, 2021;Smith et al, 2021) and in children and adolescents (Donovan, Plant, Peller, Siegel, & Martin, 2003; Martin, Krieg, Esposito, Stubbe, & Cardona, 2008). Our study showed that Black children were four times as likely to be restrained or secluded and Hispanics were 50% more likely to be restrained or secluded.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of racism in a children's psychiatric inpatient unit: A qualitative study of entrenching and uprooting factors

Asuzu

Ijeli

Cardona

et al. 2022

Psychiatric Ment Health Nurs

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Mental health professionals are well positioned to help dismantle racism and structural barriers compromising optimal patient care. What the paper adds to existing knowledgeWe describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it.By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting What are the implications for practice?Our two-domain / six-theme model may serve as a rubric for individuals to engage in systematic and orderly self-re ection, or for organizations in auditing or programmatic evaluationThe unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace

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Association of Black Race With Physical and Chemical Restraint Use Among Patients Undergoing Emergency Psychiatric Evaluation

Cited by 43 publications

References 30 publications

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry

2022 consensus conference on diversity, equity, and inclusion: Developing an emergency medicine research agenda for addressing racism through health care research

Perceptions of racism in a children's psychiatric inpatient unit: A qualitative study of entrenching and uprooting factors

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