ObjectivesHealth disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care.MethodsA scoping review was conducted to capture the broad nature of the literature. A database search was conducted in MEDLINE/PubMed, EMBASE, CINAHL Plus, Social Sciences Citation Index, SCOPUS, and JSTOR. Five journals and reference lists of included articles were hand searched. Inclusion and exclusion criteria were defined iteratively to ensure literature captured was relevant to our research question. Data were extracted using predetermined variables, and additional extraction variables were added as familiarity with the literature developed.ResultsSearching yielded 1,157 citations, reduced to 153 following removal of duplicates, and title and abstract screening. After full-text screening, 83 articles were included. Included articles report that, in EDs, patient race and ethnicity impact analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient subjective experiences. Authors of included studies propose a variety of possible causes for these disparities.ConclusionsFurther research on the existence of disparities in care within EDs is warranted to explore the causes behind observed disparities for particular health conditions and population groups in specific contexts.
Introduction: Health disparities between racial and ethnic groups have been well documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there is a lack of scientific reviews in this important area. The objective of this review is to provide an overview of the literature on the impact of patient race and ethnicity on ED care. Methods: A scoping review guided by the framework described by Arksey and O'Malley was undertaken. This approach was taken because it was best suited to the goal of providing an overview of all of the literature, given the broad nature of the topic. All studies with primary outcomes considering the impact of patient race and ethnicity on “throughput” factors in the ED as defined by Asplin et al., were considered. Outcomes considered included triage scores, wait times, analgesia, diagnostic testing, treatment, leaving without being seen, and patient experiences. Literature from Canada, the United States, Australia, and New Zealand was considered. A database search protocol was developed iteratively as familiarity with the literature developed. Inclusion and exclusion decisions were made using an established model. Results: The original search yielded 1157 citations, reduced to 453 after duplicate removal. 153 full texts were included for screening, of which 85 were included for final data extraction. Results indicate there is evidence that minority racial and ethnic groups experience disparities in triage scores, wait times, analgesia, treatment, diagnostic testing, leaving without being seen, and subjective experiences. Authors’ suggested explanations for these disparities can be placed in the following categories: (1) communication differences; (2) conscious or unconscious bias; (3) facility and resource factors in hospitals with higher minority presentation rates; and (4) differences in clinical presentations. Conclusion: This scoping review provides an overview of the literature on the impacts of race and ethnicity on ED care. As disparities have been shown to exist in numerous contexts, further research on the impact of race and ethnicity in ED care is warranted, especially in the Canadian literature. Such explorations could aid in the informing and creation of policy, and guide practice.
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