History of Equity, Diversity, and Inclusion in Trauma Surgery: for Our Patients, for Our Profession, and for Ourselves

Abstract

Purpose of Review Disparities exist in outcome after injury, particularly related to race, ethnicity, socioeconomics, geography, and age. The mechanisms for this outcome disparity continue to be investigated. As trauma care providers, we are challenged to be mindful of and mitigate the impact of these disparities so that all patients realize the same opportunities for recovery. As surgeons, we also have varied professional experiences and opportunities for achievement and advancement depending upon our gender, ethnicity, race, religion, and sexual orientation. Even within a profession associated with relative affluence, socioeconomic status conveys different professional opportunities for surgeons. Recent Findings Fortunately, the profession of trauma surgery has undergone significant progress in raising awareness of patient and professional inequity among trauma patients and surgeons and has implemented systematic changes to diminish these inequities. Herein we will discuss the history of equity and inclusion in trauma surgery as it has affected our patients, our profession, and our individual selves. Summary Our goal is to provide a historical context, a status report, and a list of key initiatives or objectives on which all of us must focus. In doing so, the best possible clinical outcomes can be achieved for patients and the best professional and personal “outcomes” can be achieved for practicing and future trauma surgeons.

Breaking barriers and advancing diversity, equity, and inclusion in trauma and acute care surgery: A current perspective

“…Active support involves implementing policies such as paid leave and on-site childcare, accommodations that may benefit marginalized groups such as single and working mothers. 20 Morbidity and mortality and root cause analysis conferences also suggest potential sources of bias for institutional improvement. An independent review system may be necessary to hold leaders responsible for implementing reform.…”

“…Diversity, equity, and inclusion task forces are responsible for implementing fair policies and seeking creative solutions to challenges faced by minority workers. Active support involves implementing policies such as paid leave and on-site childcare, accommodations that may benefit marginalized groups such as single and working mothers 20 . Morbidity and mortality and root cause analysis conferences also suggest potential sources of bias for institutional improvement.…”

“…Studies show varying patient outcomes across populations with unequal diagnostic imaging rates, medication prescriptions, emergency surgery procedures, access to palliative and hospice care, length of hospital stay, post-discharge resources, and evaluation of abuse. 20 The Affordable Care Act and Medicaid expansion have aided efforts addressing these disparities by increasing access to health care for millions of Americans, particularly those from low-income and minority communities. 21 While the Affordable Care Act provisions, such as the Essential Health Benefits, helped reduce health care disparities, further reform is essential to ensure universal access to quality care.…”

“…Various factors, including geography, institution capacity, available services, under-triage, and unconscious biases among acute care surgery providers disproportionately affect patients of minority demographics, resulting in limited access to quality care. Studies show varying patient outcomes across populations with unequal diagnostic imaging rates, medication prescriptions, emergency surgery procedures, access to palliative and hospice care, length of hospital stay, post-discharge resources, and evaluation of abuse 20 …”