Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients?

Abstract

Background and importance There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. Objective To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. Methods The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). Outcome measures and analysis Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3–5 for nonvital emergencies were grouped together for analysis. Results Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1–5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8–18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference −11% (95% CI −18% to −4%)] but not people of southeast Asian [55% vs. 58%, difference −3% (95% CI −10–5%)] and North African [61% vs. 58%, difference 3% (95% CI −4–10%)] appearance. Conclusion In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.

Using case vignettes to study the presence of outcome, hindsight, and implicit bias in acute unplanned medical care: a cross-sectional study

“…have shown differences in analgesia prescription for different races and sex, with lower analgesia prescriptions for black people [8][9][10], and women [21,22]. In our study, analgesia prescription was similar for men and women.…”

“…Implicit bias, another significant factor in unplanned medical care, involves unconscious negative evaluations of one group relative to another. For instance, racial implicit bias influences treatment decisions, affecting prescription practices in healthcare [8][9][10]. Vulnerable groups, such as patients with functional disorders [e.g.…”