The well-documented disparities in cardiac care may begin almost as soon as patients arrive at hospital emergency rooms. In a study published in Academic Emergency Medicine, Massachusetts General Hospital (MGH) researchers report that African-American and Hispanic patients assessed for chest pain were less likely than white patients to be categorized as requiring immediate care, despite a lack of significant differences in symptoms. Such practices directly violate American College of Cardiology and American Heart Association guidelines specifying immediate electrocardiogram (ECG) examination for any patient with chest pain.
"In this first nationally representative sample of emergency room patients, we found persistant racial, gender and insurance-coverage based differences in triage categorization and cardiac testing," says Lenny Lopez, MD, MPH, of the Mongan Institute for Health Policy at MGH, the study's lead author. "Emergency room triage is the critical step that determines the whole cascade of clinical decisons and testing that happens next, so if patients are misclassfied on arrival, they won't receive the care they need when they need it."
Many studies have documented racial, ethnic and gender-based differences in the likelihood that patients with cardiac symptoms will receive procedures like cardiac catheterization, angioplasty and coronary artery bypass surgery. The current study was designed to evaluate whether the initial, emergency-room triage decision a quick assessment to determine which patients need to be seen immediately and which can wait has a role in these disparities. The researchers evaluated data from the National Hospital Ambulatory Health Care Survey of Emergency Departments (NHAMCS-ED) covering 1997-2006, including the age, gender, race/ethnicity and insurance status of patients coming to the surveyed hospital departments (EDs) with chest pain.
The NHAMCS-ED uses four triage categories: em
|Contact: Sue McGreevey|
Massachusetts General Hospital