Association of Race and Ethnicity With Triage Emergency Severity Index Scores and Total Visit Work Relative Value Units for Emergency Department Patients

Abstract

Our study results suggest that significant racial and ethnic disparities exist in the ESI scores assigned to patients during nursing triage evaluation and in the intensity of services provided during physician evaluation for patients presenting with the same acute chief symptoms. When nurses assign White patients more acute ESI scores at triage, they may also order diagnostic tests prior to a physician's involvement, leading to downstream increases in wRVUs. Additional decisions made at triage associated with race, ethnicity, and socioeconomic status, such as assignment to a room or hallway bed, may also influence physicians. 6 However, our findings suggest that when controlling for triage, significant racial and ethnic disparities persist in physicians' evaluations, particularly for Black and Hispanic patients.This study has several significant limitations, including a smaller proportion of patients identifying as Asian and American Indian or Alaska Native and a heterogenous other race or ethnicity category, limiting our ability to draw conclusions about these populations. More work is needed to determine where in the triage and physician evaluation processes these disparities arise and what can be done to remedy them.

Race and Ethnicity and Primary Language in Emergency Department Triage

“…In this multicenter cross-sectional study of patients presenting to the ED, we found that White patients with the same chief symptoms were frequently assigned more acute ESI scores compared with Black patients, Hispanic patients, and patients identifying as having an Other racial or ethnic background. These findings are broadly consistent with those of Joseph et al, 4 and the acute nature of these symptoms suggests that racial and ethnic disparities in triage cannot be explained primarily in terms of differences in visits for nonurgent care. 15 These disparities likely have structural, institutional, and interpersonal causes.…”

“…Our findings differ from previous studies considering the total number of wRVUs associated with patients' ED visits, as we did not find a higher visit intensity for White patients. 4 Instead, we found that patients with Black, Hispanic, and Other racial and ethnic backgrounds tended to have higher wRVUs associated with their visits for many symptoms. As White patients in our study tended to be older and might be expected to have higher visit acuity, these findings suggest that the racial and ethnic disparities observed in triage may be more consequential than they might initially appear.…”

“…Several studies have documented major disparities in the assignment of ESI triage scores to ED patients according to their race and ethnicity. [3][4][5][6] Specifically, Black and Hispanic patients tend to be assigned lower-acuity triage scores than were White patients, even with identical chief symptoms, such as abdominal pain. [3][4][5] A recent study has also reported that Black patients wait longer to be brought back into the ED even when assigned the same triage scores as White patients.…”

“…[3][4][5][6] Specifically, Black and Hispanic patients tend to be assigned lower-acuity triage scores than were White patients, even with identical chief symptoms, such as abdominal pain. [3][4][5] A recent study has also reported that Black patients wait longer to be brought back into the ED even when assigned the same triage scores as White patients. 6 These disparities are paralleled by a tendency among physicians to provide patients of minority race and ethnicity with fewer diagnostic and therapeutic interventions than their White peers.…”

Sociodemographic Disparities in Queue Jumping for Emergency Department Care

“…However, the tool is a subjective measure applied with wide variability which introduces opportunity for bias . For example, minoritized racial and ethnic groups who do not receive immediate care wait longer to be seen and Black patients are assigned lower triage scores and experience longer wait times, which can result in increased leaving without being seen (LWBS) rates . Furthermore, LWBS has been associated with ED revisit rates which is increasingly used as an ED and hospital performance measure .…”