Race plays a role in ED outcomes. Here's what you need to know.

People of color—and Black patients in particular—tend to have worse health outcomes in the ED, including higher mortality rates, lower ESI triage scores, and lower odds of receiving a surgical consultation, research shows.

To address this, emergency physicians can implement a series of strategies to help eliminate racial disparities in emergency care.

Worse outcomes for Black patients

Emergency medicine was created to ensure that quality care would be available 24/7 to any patient in urgent need. It was also intended that such care would be delivered equitably.

But as issues of unequal care for patients of color have come to light, EDs are challenged to address “the acute and chronic emergency of racism,” according to the Annals of Emergency Medicine.^[]

A study published by JAMA Surgery looked at the rates of surgical consultations among Black and White Medicare patients admitted to the ED.^[] Data were analyzed for 1,686,940 patients aged 65.5 and older, of whom 12.7% were Black and 87.3% were White.

After adjusting for socioeconomic covariates, the researchers found that Black patients had 11% lower odds of obtaining a surgical consultation compared with similarly presenting White patients.

A 12-year study published in 2020 by Frontiers in Medicine also found differences in health outcomes and resource utilization among racial and ethnic groups treated in EDs.^[]

Researchers found that Asian patients were 1.21 times more likely than White patients to be admitted to the hospital after a visit to the ED. Hispanic patients, on the other hand, were admitted to the hospital post-ED visit at similar rates as White patients.

Black patients, however, had 7% lower odds of receiving an “urgent” ESI score than White patients. They were 10% less likely to be admitted to the hospital and were 1.26 times more likely to die in the ED or hospital compared with White patients.

The results of these studies indicate that racial disparities in the ED largely affect Black patients, who have consistently worse health outcomes than patients of other races.

Addressing racial disparities

The COVID-19 pandemic brought the severity of racial disparities in medicine to the forefront, according to the article published by the Annals of Emergency Medicine.

The authors suggested that emergency clinicians can employ the following strategies to help address these disparities:

• Learn the history of racism in medicine. The colonization of African and Indigenous peoples in the Americas led to the foundational belief that Black people were subhuman. This history has influenced clinical practice, medical education, research, and health resource allocation for patients of color in the US.

• Become familiar with implicit bias education. Racial profiling, sensationalized stereotyping in the media, and misinformation regarding unfamiliar cultures can converge to create implicit biases—one of the reasons why Black patients have long-standing distrust in the US healthcare system. Emergency physicians can employ the Trauma-Informed Medical Education (TIME) model to become aware of the emotional injury caused by bias and discrimination, and learn how to prevent further harm to Black patients. They can also examine their own implicit bias. TIME “fosters awareness that students and trainees can experience trauma from a biased system and culture and advocates for the establishment of policies and practices that support learners to prevent further retraumatization,” according to the Annals of Emergency Medicine authors.

• Implement cultural humility and competence. Cultural humility is a thought process that encourages self-reflection on the part of the healthcare professional (HCP) concerning their ability to understand people who are different from themselves. It fosters the realization that “culture” refers to more than ethnicity and race. Cultural competence is a skill, but it is also an accountability to take action against racism by “striving to know more about all communities with whom we work,” the authors wrote.

• Facilitate conversations about inequality. Becoming an ally to a racial group different from one’s own will require HCPs to get comfortable with having uncomfortable conversations. They should be open to feedback without expecting rewards or recognition.

Using these strategies in their daily work may help HCPs address and help prevent racial bias and disparities in the quality of care to people of color in emergency settings.