Hospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock

Taylor, Stephanie Parks; Karvetski, Colleen; Templin, Megan; Taylor, Brice

doi:10.1097/ccm.0000000000002829

Cited by 19 publications

(22 citation statements)

References 22 publications

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“…While we did not analyze the impact of patient characteristics, such as race or ethnicity, on timeliness of care, other studies have found that nonwhite patients may be subject to assessment and treatment delays in the ED. 18,19 If similar trends hold true in our sample, it is possible that our study underestimates the magnitude of difference in high-acuity care timeliness between FREDs and HEDs.…”

Section: Discussionsupporting

confidence: 53%

“…Of note, as previously demonstrated, 11 we found that the baseline characteristics of patient visits to FREDs and HEDs were different, with FREDs tending to serve fewer minority patients. While we did not analyze the impact of patient characteristics, such as race or ethnicity, on timeliness of care, other studies have found that nonwhite patients may be subject to assessment and treatment delays in the ED 18,19 . If similar trends hold true in our sample, it is possible that our study underestimates the magnitude of difference in high‐acuity care timeliness between FREDs and HEDs.…”

Section: Discussionmentioning

confidence: 83%

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Timeliness of Care for High‐acuity Conditions at Hospital‐affiliated Freestanding Emergency Departments

Baehr

Ledbetter

Bookman

et al. 2020

Academic Emergency Medicine

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Background: Hospital-affiliated freestanding emergency departments (FREDs) are rapidly proliferating in some states and have been the subject of recent policy debate. As FREDs' role in acute care delivery is expanding in certain regions, little is known about the quality of care that they provide for their sickest patients. Our aim was to compare timeliness of emergent care at FREDs and hospital-based EDs (HEDs) for patient visits with selected high-acuity and time-sensitive conditions. Methods: We performed a retrospective observational analysis of adult patient visit data from 19 FREDs and five HEDs from one health system over a 1-year period. Median times to events and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated via Cox regression. Results: The median time to electrocardiogram for visits with chest pain was 10 minutes at FREDs and 9 minutes at HEDs (HR = 0.91 [CI = 0.87 to 0.96]). Time to cardiac catheterization lab for visits with ST-segment elevation myocardial infarction (STEMI) was 78 minutes at FREDs, inclusive of transfer time, and 31 minutes at HEDs (HR = 0.41 [CI = 0.24 to 0.71]). Time to computed tomography for visits with stroke was 37 minutes at FREDs and 29 minutes at HEDs (HR = 0.42 [CI = 0.31 to 0.58]). Among visits with sepsis, FREDs had longer times to lactate collection (HR = 0.41 [CI = 0.30 to 0.56]), blood culture collection (HR = 0.24 [CI = 0.11 to 0.51]), and antibiotic administration (HR = 0.61 [CI = 0.26 to 1.42]). Beta agonists were administered for visits with asthma exacerbations in 24 minutes at FREDs and 44 minutes at HEDs (HR = 2.50 [CI = 2.34 to 2.68]), with similar times for anticholinergic and corticosteroid administration. Conclusions: Freestanding EDs provided more timely care than HEDs for visits with asthma exacerbation and less timely care for acute chest pain, stroke, and sepsis, although absolute differences were small. Even though STEMI patients at FREDs required transfer for catheterization, they tended to receive care in line with national guidelines.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 83%

Timeliness of Care for High‐acuity Conditions at Hospital‐affiliated Freestanding Emergency Departments

Baehr

Ledbetter

Bookman

et al. 2020

Academic Emergency Medicine

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“…Among patients admitted to the ICU for sepsis, uninsured patients experience a shorter length of stay, receive less interventions, and have inferior clinical outcomes compared to insured patients [40,42]. Lacking insurance is also associated with greater use of low-quality hospitals that fail to deliver guideline-adherent therapy [63,68,69].…”

Section: Hospital-based Factorsmentioning

confidence: 99%

Factors Underlying Racial Disparities in Sepsis Management

et al. 2018

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Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against minority groups, a growing body of literature has found patient, community, and hospital-based factors to be driving racial differences. In this article, we provide a focused review on some of the factors driving racial disparities in sepsis. We also suggest potential interventions aimed at reducing health disparities in the prevention, early identification, and clinical management of sepsis.

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“…There are several possible explanations for why racial minorities experience disparate outcomes in sepsis, including access to care, comorbidities, implicit biases, and biological or environmental factors, 17‐20 as well as characteristics of hospitals most likely to care for racial minorities 13,15,21 . One explanation that has not been explored is that racial disparities in sepsis are mediated by language.…”

mentioning

confidence: 99%

The Association between Limited English Proficiency and Sepsis Mortality

Jacobs

Prasad

Fang

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: Limited English proficiency (LEP) has been implicated in poor health outcomes. Sepsis is a frequently fatal syndrome that is commonly encountered in hospital medicine. The impact of LEP on sepsis mortality is not currently known. OBJECTIVE: To determine the association between LEP and sepsis mortality. DESIGN: Retrospective cohort study. SETTING: 800-bed, tertiary care, academic medical center. PATIENTS: Electronic health record data were obtained for adults admitted to the hospital with sepsis between June 1, 2012 and December 31, 2016. MEASUREMENTS: The primary predictor was LEP. Patients were defined as having LEP if their self-reported primary language was anything other than English and interpreter services were required during hospitalization. The primary outcome was inpatient mortality. Mortality was compared across races stratified by LEP using chi-squared tests of significance. Bivariable and multivariable logistic regressions were performed to investigate the association between mortality, race, and LEP, adjusting for baseline characteristics, comorbidities, and illness severity. RESULTS: Among 8,974 patients with sepsis, we found that 1 in 5 had LEP, 62% of whom were Asian. LEP was highly associated with death across all races except those identifying as Black and Latino. LEP was associated with a 31% increased odds of mortality after adjusting for illness severity, comorbidities, and other baseline characteristics, including race (OR 1.31, 95% CI 1.06-1.63, P = .02). CONCLUSIONS: In a single-center study of patients hospitalized with sepsis, LEP was associated with mortality across nearly all races. This is a novel finding that will require further exploration into the causal nature of this association.

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Hospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock

Cited by 19 publications

References 22 publications

Timeliness of Care for High‐acuity Conditions at Hospital‐affiliated Freestanding Emergency Departments

Timeliness of Care for High‐acuity Conditions at Hospital‐affiliated Freestanding Emergency Departments

Factors Underlying Racial Disparities in Sepsis Management

The Association between Limited English Proficiency and Sepsis Mortality

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