ER triage decisions delay care for blacks, Hispanics

Black Americans and Hispanics who show up at emergency rooms with chest pain are less likely than whites to get the care they need, despite displaying the same symptoms, according to a study published in the Sept. 24 issue of Academic Emergency Medicine.

Although American College of Cardiology and American Heart Association guidelines call for patients who present with chest pain to undergo immediate electrocardiograms, just who gets them varies.

"Emergency room triage is the critical step that determines the whole cascade of clinical decisions and testing that happens next, so if patients are misclassified on arrival, they won't receive the care they need when they need it," lead author Lenny Lopez, Md, MPH, of the Mongan Institute for Health Policy at Massachusetts General Hospital, said in a statement.

Among all patients who presented with chest pain, black and Hispanic patients were significantly less likely than white patients to be triaged as emergent cases, researchers found. For the study, researchers defined "emergent triage" to include those patient who needed to be seen immediately and those who could wait 15 to 60 minutes.

What's more, black and Hispanic patient--as well as those who were uninsured or covered by Medicaid--were less likely to receive such basic cardiac testing procedures as ECG, cardiac monitoring  or measurement of cardiac enzymes.

The differences in ED triage may affect disparities in testing, procedures and outcomes, Lopez said. If you're misclassified at the first step, you're less likely to get the ECG, because your condition is not considered urgent. In the long term, you may suffer an even more severe heart attack that could have been prevented had an intervention occurred earlier. Quality improvement strategies need to focus on 100 percent guideline-driven triage management for every single patient, Lopez said.

To learn more:
- read the abstract from Academic Emergency Medicine
- read this Massachusetts General Hospital press release
- here is the HealthDay News story
- check out the Cardiovascular Business story

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