Black patients in cardiac distress are more likely than white patients to suffer harm from having their ambulance diverted away from overcrowded emergency departments in their local hospitals, according to a study published in BMJ Open. Furthermore, these patients were less likely to receive specialized cardiac care at the hospitals where they do receive treatment and have lower one-year survival rates.
Investigators analyzed data from 26 California counties, including ambulance diversion logs and Medicaid records of patients suffering heart attacks between 2001 and 2011. The study investigated inequities in treatment, access and outcomes between black and white Medicaid patients.
Of the 30,000 patients studied, those with longer diversion times universally fared more poorly than patients who were provided specialized care right away. Researchers found that patients subjected to more than 12 hours of diversion had reduced access to cardiac care units, catheterization labs and facilities that specialized in improving blood flow to the heart, as well as higher one-year mortality levels.
"The take-home findings from this study are two-fold," Renee Hsia, M.D., professor of emergency medicine and health policy at UCSF, said in a statement. "First, we now better understand the mechanisms behind emergency department crowding and how it affects patients. Not only are crowded hospitals less able to deliver high-quality care, but even sick patients get diverted to hospitals with less technology. On top of that, they are less likely to receive appropriate treatment."
Racial disparities in healthcare have stubbornly resisted in the U.S. in spite of efforts to eliminate them. Black and Hispanic surgical patients remain at higher risk of longer hospital stays, complications and mortality. In 2013, Massachusetts hospitals banned ambulance diversions altogether, in spite of fears of rampant ED overcrowding.