Patient race, ethnicity, and care in the emergency department: A scoping review

Abstract

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.

Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments

“…Healthcare disparities among racial and ethnic minorities have been widely documented. A recent scoping review by Owens et al ., revealed that minority groups had less acute triage scores, longer waiting times and were less likely to receive analgesia 36 . Furthermore, there were increased rates of Left Without Being Seen and Leaving Against Medical Advice among Indigenous minority groups globally 36 .…”

“…A recent scoping review by Owens et al ., revealed that minority groups had less acute triage scores, longer waiting times and were less likely to receive analgesia 36 . Furthermore, there were increased rates of Left Without Being Seen and Leaving Against Medical Advice among Indigenous minority groups globally 36 . Aboriginal and Torres Strait Islander peoples are two and a half times more likely to have leave events compared to non‐Indigenous Australians 37 .…”

“…Perceived discrimination has implications for both physical and psychological health outcomes for racial minorities, with higher rates of psychological distress, mental health diagnoses, early substance use, hypertension and low birth weight 42 . Furthermore, it may contribute to distrust of medical professionals 35,36,39 resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations 39 . Vicarious discrimination may also impact the relationship that the individual's family and community have with the healthcare system 42 …”

“…36 Furthermore, there were increased rates of Left Without Being Seen and Leaving Against Medical Advice among Indigenous minority groups globally. 36 Aboriginal and Torres Strait Islander peoples are two and a half times more likely to have leave events compared to non-Indigenous Australians. 37 Leave events are associated with frequent representations to ED, delays in receiving adequate medical care and increased morbidity and mortality.…”

Factors associated with unscheduled care use by cancer decedents: a systematic review with narrative synthesis

“…The differences in healthcare systems, especially in availability of health care coverage and personal/individual cost of accessing healthcare, does have the potential to affect which factors influence unscheduled care use by cancer decedents. Furthermore, there are significant population and demographic differences between the USA and other countries, particularly with regards to the association between ethnicity and socioeconomic status 45 , which may have confounded the association between race and unscheduled care use by failing to correct for deprivation 46,47 . Having more studies conducted outwith the USA would be of benefit to improving the relevance of these findings to countries with national health systems.…”