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Sangal RB, Khidir H, Agarwal AK. Interrogating and Uprooting Systemic Racism in the Emergency Department. JAMA HEALTH FORUM 2024; 5:e242347. [PMID: 39177981 DOI: 10.1001/jamahealthforum.2024.2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
This Viewpoint discusses how recognizing systemic racism in emergency departments will allow for the mitigation of racial and ethnic disparities and promote equitable treatment for all patients.
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Affiliation(s)
- Rohit B Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Hazar Khidir
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
| | - Anish K Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Transformation and Innovation, Philadelphia, Pennsylvania
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Gonzales RE, Seeburger EF, Friedman AB, Agarwal AK. Patient perceptions of behavioral flags in the emergency department: A qualitative analysis. Acad Emerg Med 2024; 31:640-648. [PMID: 38511415 DOI: 10.1111/acem.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND To combat increasing levels of violence in the emergency department (ED), hospitals have implemented several safety measures, including behavioral flags. These electronic health record (EHR)-based notifications alert future clinicians of past incidents of potentially threatening patient behavior, but observed racial disparities in their placement may unintentionally introduce bias in patient care. Little is known about how patients perceive these flags and the disparities that have been found in their placement. OBJECTIVE This study aims to investigate patient perceptions and perceived benefits and harms associated with the use of behavioral flags. METHODS Twenty-five semistructured qualitative interviews were conducted with a convenience sample of patients in the ED of a large, urban, academic medical center who did not have a behavioral flag in their EHR. Interviews lasted 10-20 min and were recorded then transcribed. Thematic analysis of deidentified transcripts took place in NVivo 20 software (QSR International) using a general inductive approach. RESULTS Participant perceptions of behavioral flags varied, with both positive and negative opinions being shared. Five key themes, each with subthemes, were identified: (1) benefits of behavioral flags, (2) concerns and potential harms of flags, (3) transparency with patients, (4) equity, and (5) ideas for improvement. CONCLUSIONS Patient perspectives on the use of behavioral flags in the ED vary. While many saw flags as a helpful tool to mitigate violence, concerns around negative impacts on care, transparency, and equity were also shared. Insights from this stakeholder perspective may allow for health systems to make flags more effective without compromising equity or patient ideals.
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Affiliation(s)
- Rachel E Gonzales
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Medicine Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Medicine Center for Insights to Outcomes, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily F Seeburger
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Medicine Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Urban Health Lab, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ari B Friedman
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anish K Agarwal
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Medicine Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Medicine Center for Insights to Outcomes, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kopp Z, Kryzhanovskaya I, Cornes S. Things We Do for No Reason™: Indiscriminate use of behavioral alerts. J Hosp Med 2024; 19:619-622. [PMID: 38073083 DOI: 10.1002/jhm.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 07/04/2024]
Affiliation(s)
- Zoë Kopp
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
| | - Irina Kryzhanovskaya
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, California, USA
| | - Susannah Cornes
- Department of Neurology, Division of Clinical Neurology, University of California, San Francisco, California, USA
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Haimovich AD, Taylor RA, Chang-Sing E, Brashear T, Cramer LD, Lopez K, Wong AH. Disparities Associated With Electronic Behavioral Alerts for Safety and Violence Concerns in the Emergency Department. Ann Emerg Med 2024; 83:100-107. [PMID: 37269262 PMCID: PMC10689576 DOI: 10.1016/j.annemergmed.2023.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/12/2023] [Accepted: 04/05/2023] [Indexed: 06/05/2023]
Abstract
STUDY OBJECTIVE Although electronic behavioral alerts are placed as an alert flag in the electronic health record to notify staff of previous behavioral and/or violent incidents in emergency departments (EDs), they have the potential to reinforce negative perceptions of patients and contribute to bias. We provide characterization of ED electronic behavioral alerts using electronic health record data across a large, regional health care system. METHODS We conducted a retrospective cross-sectional study of adult patients presenting to 10 adult EDs within a Northeastern United States health care system from 2013 to 2022. Electronic behavioral alerts were manually screened for safety concerns and then categorized by the type of concern. In our patient-level analyses, we included patient data at the time of the first ED visit where an electronic behavioral alert was triggered or, if a patient had no electronic behavioral alerts, the earliest visit in the study period. We performed a mixed-effects regression analysis to identify patient-level risk factors associated with safety-related electronic behavioral alert deployment. RESULTS Of the 2,932,870 ED visits, 6,775 (0.2%) had associated electronic behavioral alerts across 789 unique patients and 1,364 unique electronic behavioral alerts. Of the encounters with electronic behavioral alerts, 5,945 (88%) were adjudicated as having a safety concern involving 653 patients. In our patient-level analysis, the median age for patients with safety-related electronic behavioral alerts was 44 years (interquartile range 33 to 55 years), 66% were men, and 37% were Black. Visits with safety-related electronic behavioral alerts had higher rates of discontinuance of care (7.8% vs 1.5% with no alert; P<.001) as defined by the patient-directed discharge, left-without-being-seen, or elopement-type dispositions. The most common topics in the electronic behavioral alerts were physical (41%) or verbal (36%) incidents with staff or other patients. In the mixed-effects logistic analysis, Black non-Hispanic patients (vs White non-Hispanic patients: adjusted odds ratio 2.60; 95% confidence interval [CI] 2.13 to 3.17), aged younger than 45 (vs aged 45-64 years: adjusted odds ratio 1.41; 95% CI 1.17 to 1.70), male (vs female: adjusted odds ratio 2.09; 95% CI 1.76 to 2.49), and publicly insured patients (Medicaid: adjusted odds ratio 6.18; 95% CI 4.58 to 8.36; Medicare: adjusted odds ratio 5.63; 95% CI 3.96 to 8.00 vs commercial) were associated with a higher risk of a patient having at least 1 safety-related electronic behavioral alert deployment during the study period. CONCLUSION In our analysis, younger, Black non-Hispanic, publicly insured, and male patients were at a higher risk of having an ED electronic behavioral alert. Although our study is not designed to reflect causality, electronic behavioral alerts may disproportionately affect care delivery and medical decisions for historically marginalized populations presenting to the ED, contribute to structural racism, and perpetuate systemic inequities.
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Affiliation(s)
- Adrian D Haimovich
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | - Erika Chang-Sing
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Taylor Brashear
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Laura D Cramer
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT
| | - Kevin Lopez
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Tuffuor K, Su H, Meng L, Pinker E, Tarabar A, Van Tonder R, Chmura C, Parwani V, Venkatesh AK, Sangal RB. Inequities among patient placement in emergency department hallway treatment spaces. Am J Emerg Med 2024; 76:70-74. [PMID: 38006634 DOI: 10.1016/j.ajem.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Limited capacity in the emergency department (ED) secondary to boarding and crowding has resulted in patients receiving care in hallways to provide access to timely evaluation and treatment. However, there are concerns raised by physicians and patients regarding a decrease in patient centered care and quality resulting from hallway care. We sought to explore social risk factors associated with hallway placement and operational outcomes. STUDY DESIGN/METHODS Observational study between July 2017 and February 2020. Primary outcome was the adjusted odds ratio (aOR) of patient placement in a hallway treatment space adjusting for patient demographics and ED operational factors. Secondary outcomes included left without being seen (LWBS), discharge against medical advice (AMA), elopement, 72-h ED revisit, 10-day ED revisit and escalation of care during boarding. RESULTS Among 361,377 ED visits, 100,079 (27.7%) visits were assigned to hallway beds. Patient insurance coverage (Medicaid (aOR 1.04, 95% CI 1.01,1.06) and Self-pay/Other (1.08, (1.03, 1.13))) with comparison to private insurance, and patient sex (Male (1.08, (1.06, 1.10))) with comparison to female sex are associated with higher odds of hallway placement but patient age, race, and language were not. These associations are adjusted for ED census, triage assigned severity, ED staffing, boarding level, and time effect, with social factors mutually adjusted. Additionally adjusting for patients' social factors, patients placed in hallways had higher odds of elopement (1.23 (1.07,1.41)), 72-h ED revisit (1.33 (1.08, 1.64)) and 10-day ED revisit (1.23 (1.11, 1.36)) comparing with patients placed in regular ED rooms. We did not find statistically significant associations between hallway placement and LWBS, discharge AMA, or escalation of care. CONCLUSION While hallway usage is ad hoc, we find consistent differences in care delivery with those insured by Medicaid and self-pay or male sex being placed in hallway beds. Further work should examine how new front-end processes such as provider in triage or split flow may be associated with inequities in patient access to emergency and hospital care.
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Affiliation(s)
- Kwame Tuffuor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America.
| | - Huifeng Su
- Yale University School of Management, United States of America
| | - Lesley Meng
- Yale University School of Management, United States of America
| | - Edieal Pinker
- Yale University School of Management, United States of America
| | - Asim Tarabar
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America
| | - Reinier Van Tonder
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America
| | - Chris Chmura
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America; Centers for Outcomes Research, Yale University, United States of America
| | - Rohit B Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, United States of America
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Agboola IK, Rosenberg A, Robinson L, Brashear TK, Eixenberger C, Shah D, Pavlo AJ, Im DD, Ray JM, Coupet E, Wong AH. A Qualitative Study of Racial, Ethnic, and Cultural Experiences of Minority Clinicians During Agitation Care in the Emergency Department. Ann Emerg Med 2024; 83:108-119. [PMID: 37855791 PMCID: PMC10843036 DOI: 10.1016/j.annemergmed.2023.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
STUDY OBJECTIVE Racial and ethnic bias in health care has been documented at structural, organizational, and clinical levels, impacting emergency care, including agitation management in the emergency department (ED). Little is known about the experiences of racial and ethnic minority ED clinicians caring for racial and ethnic minority groups, especially during their agitated state. The objective of this study was to explore the lived experiences of racial and ethnic minority ED clinicians who have treated patients with agitation in the ED. METHODS We performed semistructured individual interviews of Black, Latino, and multiracial clinicians who worked at 1 of 3 EDs from an urban quaternary care medical center in the Northeast United States between August 2020 and June 2022. We performed thematic analysis through open coding of initial transcripts and identifying additional codes through sequential iterative rounds of group discussion. Once the codebook was finalized and applied to all transcripts, the team identified key themes and subthemes. RESULTS Of the 27 participants interviewed, 14 (52%) identified as Black, 9 (33%) identified as Hispanic/Latino, and 4 (15%) identified as multiracial and/or other race and ethnicity. Three primary themes emerged from racial and ethnic minority clinician experiences of managing agitation: witness of perceived bias during clinical interactions with patients of color who bear racialized presumptions of agitation, moral injury and added workload to address perceived biased agitation management practices while facing discrimination in the workplace, and natural advocacy and allyship for agitated patients of color based on a shared identity and life experience. CONCLUSIONS Our study found that through their shared minority status, racial and ethnic minority clinicians had a unique vantage point to observe perceived bias in the management of agitation in minority patients. Although they faced added challenges as racial and ethnic minority clinicians, their allyship offered potential mitigation strategies for addressing disparities in caring for an underserved and historically marginalized patient population.
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Affiliation(s)
- Isaac K Agboola
- Department of Emergency Medicine, NorthShore University Health System, Evanston, Illinois; Department of Emergency Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alana Rosenberg
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
| | - Leah Robinson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Taylor K Brashear
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Dhruvil Shah
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Anthony J Pavlo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Dana D Im
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jessica M Ray
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - Edouard Coupet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
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Sangal RB, Su H, Khidir H, Parwani V, Liebhardt B, Pinker EJ, Meng L, Venkatesh AK, Ulrich A. Sociodemographic Disparities in Queue Jumping for Emergency Department Care. JAMA Netw Open 2023; 6:e2326338. [PMID: 37505495 PMCID: PMC10383013 DOI: 10.1001/jamanetworkopen.2023.26338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/18/2023] [Indexed: 07/29/2023] Open
Abstract
Importance Emergency department (ED) triage models are intended to queue patients for treatment. In the absence of higher acuity, patients of the same acuity should room in order of arrival. Objective To characterize disparities in ED care access as unexplained queue jumps (UQJ), or instances in which acuity and first come, first served principles are violated. Design, Setting, and Participants Retrospective, cross-sectional study between July 2017 and February 2020. Participants were all ED patient arrivals at 2 EDs within a large Northeast health system. Data were analyzed from July to September 2022. Exposure UQJ was defined as a patient being placed in a treatment space ahead of a patient of higher acuity or of a same acuity patient who arrived earlier. Main Outcomes and Measures Primary outcomes were odds of a UQJ and association with ED outcomes of hallway placement, leaving before treatment complete, escalation to higher level of care while awaiting inpatient bed placement, and 72-hour ED revisitation. Secondary analysis examined UQJs among high acuity ED arrivals. Regression models (zero-inflated Poisson and logistic regression) adjusted for patient demographics and ED operational variables at time of triage. Results Of 314 763 included study visits, 170 391 (54.1%) were female, the mean (SD) age was 50.46 (20.5) years, 132 813 (42.2%) patients were non-Hispanic White, 106 401 (33.8%) were non-Hispanic Black, and 66 465 (21.1%) were Hispanic or Latino. Overall, 90 698 (28.8%) patients experienced a queue jump, and 78 127 (24.8%) and 44 551 (14.2%) patients were passed over by a patient of the same acuity or lower acuity, respectively. A total of 52 959 (16.8%) and 23 897 (7.6%) patients received care ahead of a patient of the same acuity or higher acuity, respectively. Patient demographics including Medicaid insurance (incident rate ratio [IRR], 1.11; 95% CI, 1.07-1.14), Black non-Hispanic race (IRR, 1.05; 95% CI, 1.03-1.07), Hispanic or Latino ethnicity (IRR, 1.05; 95% CI, 1.02-1.08), and Spanish as primary language (IRR, 1.06; 95% CI, 1.02-1.10) were independent social factors associated with being passed over. The odds of a patient receiving care ahead of others were lower for ED visits by Medicare insured (odds ratio [OR], 0.92; 95% CI, 0.88-0.96), Medicaid insured (OR, 0.81; 95% CI, 0.77-0.85), Black non-Hispanic (OR, 0.94; 95% CI, 0.91-0.97), and Hispanic or Latino ethnicity (OR, 0.87; 95% CI, 0.83-0.91). Patients who were passed over by someone of the same triage severity level had higher odds of hallway bed placement (OR, 1.01; 95% CI, 1.00-1.02) and leaving before disposition (OR, 1.02; 95% CI, 1.01-1.04). Conclusions and Relevance In this cross-sectional study of ED patients in triage, there were consistent disparities among marginalized populations being more likely to experience a UQJ, hallway placement, and leaving without receiving treatment despite being assigned the same triage acuity as others. EDs should seek to standardize triage processes to mitigate conscious and unconscious biases that may be associated with timely access to emergency care.
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Affiliation(s)
- Rohit B. Sangal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Huifeng Su
- Department of Operations, Yale University School of Management, New Haven, Connecticut
| | - Hazar Khidir
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth Liebhardt
- Emergency Department, Yale New Haven Hospital, New Haven, Connecticut
| | - Edieal J. Pinker
- Department of Operations, Yale University School of Management, New Haven, Connecticut
| | - Lesley Meng
- Department of Operations, Yale University School of Management, New Haven, Connecticut
| | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
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Seeburger EF, Gonzales R, South EC, Friedman AB, Agarwal AK. Qualitative Perspectives of Emergency Nurses on Electronic Health Record Behavioral Flags to Promote Workplace Safety. JAMA Netw Open 2023; 6:e239057. [PMID: 37079303 PMCID: PMC10119742 DOI: 10.1001/jamanetworkopen.2023.9057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
Importance Emergency nurses experience high levels of workplace violence during patient interactions. Little is known about the efficacy of behavioral flags, which are notifications embedded within electronic health records (EHRs) as a tool to promote clinician safety. Objective To explore the perspectives of emergency nurses on EHR behavioral flags, workplace safety, and patient care. Design, Setting, and Participants In this qualitative study, semistructured interviews were conducted with emergency nurses at an academic, urban emergency department (ED) between February 8 and March 25, 2022. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Data analysis was performed from April 2 to 13, 2022. Main Outcomes and Measures Themes and subthemes of nursing perspectives on EHR behavioral flags were identified. Results This study included 25 registered emergency nurses at a large academic health system, with a mean (SD) tenure of 5 (6) years in the ED. Their mean (SD) age was 33 (7) years; 19 were women (76%) and 6 were men (24%). Participants self-reported their race as Asian (3 [12%]), Black (3 [12%]), White (15 [60%]), or multiple races (2 [8%]); 3 participants (12%) self-reported their ethnicity as Hispanic or Latinx. Five themes (with subthemes) were identified: (1) benefits of flags (useful advisory; prevents violence; engenders compassion), (2) issues with flags (administrative and process issues; unhelpful; unenforceable; bias; outdated), (3) patient transparency (patient accountability; damages patient-clinician relationship), (4) system improvements (process; built environment; human resources; zero-tolerance policies), and (5) difficulties of working in the ED (harassment and abuse; unmet mental health needs of patients; COVID-19-related strain and burnout). Conclusions and Relevance In this qualitative study, nursing perspectives on the utility and importance of EHR behavioral flags varied. For many, flags served as an important forewarning to approach patient interactions with more caution or use safety skills. However, nurses were skeptical of the ability of flags to prevent violence from occurring and noted concern for the unintended consequences of introducing bias into patient care. These findings suggest that changes to the deployment and utilization of flags, in concert with other safety interventions, are needed to create a safer work environment and mitigate bias.
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Affiliation(s)
- Emily F. Seeburger
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Penn Urban Health Lab, University of Pennsylvania, Philadelphia
| | - Rachel Gonzales
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Penn Urban Health Lab, University of Pennsylvania, Philadelphia
| | - Ari B. Friedman
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Anish K. Agarwal
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia
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