Investigating racial disparities within an emergency department rapid-triage system

Objectives: Racial disparities in emergency medical care are abundant, and processes aimed to increase through-put, such as a rapid triage fast-track (FT) systems, may exacerbate these inequities. A FT strategy may be more susceptible to implicit bias as subjective information is obtained quickly. We aim to determine whether a FT model was associated with greater disparities between Black and White emergency department (ED) patients.Methods: Triage-related outcomes were compared across race using a cohort selected from encounters in an ED that uses a FT model. White and Black patient encounters were exact-matched on potential confounders includ-ing sex; presence of abnormal vital signs; ED arrival time; insurance type; age category; and chief complaint. The primary triage-related outcome was use of the FT area (versus the main ED), and the secondary outcomes were wait time and assigned encounter acuity.Results: Encounters for 5151 Black patients were exact-matched with 7179 encounters for White patients. Weights were applied to address differential numbers of encounters from each group. Within this matched co-hort, Black patients were more likely to be triaged to FT than White patients (odds ratio = 1.28, 95% CI: 1.12; 1.46) and less likely to be given a high acuity score (odds ratio = 0.73, 95% CI: 0.66, 0.81). Among the high -acuity patients, Black patients were 40% more likely to be triaged to the FT area.Conclusions: These results suggest that, after controlling for potential confounders, racial disparities may have been exacerbated in a FT ED triage process. In a FT model utilizing physicians and midlevel providers, this may create tiered levels of care between Black and White patients - an unacceptable side-effect of an effort to increase ED throughput.Published by Elsevier Inc.

Automated summary

The study shows that in a fast-track triage model, White patients are less likely to be triaged to the main emergency department area compared to Black patients, and Black patients are less likely to be given a high acuity score. Among high acuity patients, Black patients are more likely to be triaged to the fast-track area.