Emergency Severity Index Protocol Reveals Ethnic Disparities in Emergency Department Triage Decisions
Hispanic patients receive lower-acuity triage scores than non-Hispanic white patients at four U.S. emergency departments, despite presenting with identical clinical symptoms and hospital contexts, according to an analysis published in nature.com. The study examined 1.35 million patient encounters across medical centers using the standardized Emergency Severity Index triage protocol. Researchers found that Hispanic patients faced lower odds of receiving an emergent level-2 score compared to non-Hispanic white patients, with odds ratios ranging from 0.75 to 0.90 across all participating sites.
Disparities Shift Across Risk Levels in Standardized Protocols
The racial and ethnic gaps in triage assignments fluctuate depending on how the clinical algorithm scores the patient’s initial risk level. Disparities widen significantly where the protocol scores patients into lower-risk categories, yielding Hispanic-to-white odds ratios between 0.73 and 0.88. Conversely, these gaps narrow where the algorithm places patients into higher-risk categories, with odds ratios shifting between 0.83 and 1.00. This pattern indicates a disparate benefit-of-the-doubt application during clinical discretion, according to the findings.
Non-Hispanic Black patients experienced similar disparities compared to white patients at two of the four evaluated emergency departments. At those specific locations, Black patients registered emergent triage odds ratios of 0.73 and 0.89. The data demonstrate that standardization through a unified protocol does not completely eliminate differential treatment rooted in human assessment during the initial intake phase.
Standardized decision support may increase emergency department stays
Implementing tighter decision support tools could help mitigate these persistent triage discrepancies across busy hospital networks. Researchers project that strictly standardized decision support would induce a worst-case increase in emergency department lengths of stay ranging from 1.0% to 3.8% across the studied sites.
Which hospitals and triage levels the study evaluated?
Which hospitals were included in the triage study?
The analysis evaluated 1.35 million patient encounters drawn from four distinct emergency departments across the United States that utilize the Emergency Severity Index protocol.
What specific triage levels were compared by researchers?
Investigators independently scored patient visits as either emergent level-2 or urgent level-3 by applying standard criteria computationally, and then compared those results directly against the nurse-assigned triage levels.
How much delay could standardized decision support cause?
Researchers estimate that implementing stricter decision support systems to curb these disparities would produce a worst-case increase in emergency department lengths of stay between 1.0% and 3.8% across the hospital sites.