- Black, Hispanic or Latino, Spanish-speaking and Medicaid patients are more likely to be skipped over in line when waiting in the emergency department, according to a recent study published in JAMA Network Open.
- Being passed over could have impacts on care. Patients who were jumped over in line by someone of the same triage severity level were more likely to be placed in a hallway bed or leave the hospital without receiving treatment, the study found.
- Providers need to take steps to standardize triage processes to address conscious or unconscious bias, including digital tools that require the clinicians to explain their reasoning when a patient skips ahead in line, according to the research.
Emergency departments in the study typically used an acuity-based first come, first served system to sort patients waiting for care, researchers wrote.
A patient with the most severe injury or illness who arrived earliest should be first in line.
But that process isn’t always followed. The study, which analyzed more than 314,000 visits between July 2017 and February 2020, found about 53% of encounters received care in the acuity-based first come, first served system.
Nearly 29% of patients experienced some type of queue jump. More than 14% were skipped for a patient of lower acuity, while nearly 25% were passed over for someone of the same acuity level. Nearly 17% of patients received care ahead of someone of the same acuity, and nearly 8% were seen before a patient of higher acuity.
Medicaid beneficiaries, Black patients and Spanish-speaking patients were more likely to be passed over by same- or lower-acuity patients compared with those on private insurance, White patients and English-speaking patients, respectively. Men were also more likely than women to receive care ahead of same-acuity patients.
Marginalized groups also had lower odds of being bumped up in line. Medicare, Medicaid, Black and Hispanic or Latino patients were less likely to receive care ahead of others during emergency department visits.
Structural racism and classism — recurring problems for the healthcare system — could explain why some patients are skipped over in lines, study authors wrote. White and privately insured patients might also have higher expectations for how quickly they should be seen, making them more likely to advocate for themselves.
They could benefit from better coordinated and documented care as well.
“White and privately insured patients may be more likely to receive referral to the ED by their primary care physician who leaves a care plan note highlighting their concern or informs a specialist to expect the patient, resulting in the patient being treated earlier,” the study’s authors wrote. “By contrast, marginalized patients may have fewer medical records from long-term clinicians, have more safety alerts associated with their records, or be classified as a high utilizer for multiple ED visits.”
Hiring diverse staff and instituting clinical guidelines could improve racism and classism embedded in the emergency department triage process, researchers said.
The study found social factors didn’t significantly impact line skipping for high-acuity encounters, suggesting protocols for serious concerns like trauma or stroke helps to mitigate bias.