Category: Administration
Keywords: racial disparities, antibiotic prescribing (PubMed Search)
Posted: 8/14/2024 by Kevin Semelrath, MD
(Updated: 8/17/2024)
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This retrospective study found that while overall rates of antibiotic prescriptions for viral URIs were low (that's good!), patients identified as non Hispanic white were prescribed antibiotics, despite guidelines advising against them, at a higher rate than non white patients (that's bad). It also found that in areas of socioeconomic deprivation, the prescribing rates were lower across all races than in more affluent areas (that's good and bad!)
Open AccessPublished:January 23, 2024DOI:https://doi.org/10.1016/j.annemergmed.2023.12.003
Category: Administration
Keywords: pulse oximetry, skin pigmentations (PubMed Search)
Posted: 6/15/2024 by Kevin Semelrath, MD
(Updated: 2/7/2025)
Click here to contact Kevin Semelrath, MD
This article shows us that even things we think of as objective measures in medicine may actually perpetuate systemic biases.
The study evaluated controlled hypoxemia in a group of volunteers. Traditional pulse ox devices measured falsely elevated pulse ox readings in participants with dark skin pigmentation and low tissue perfusion. It suggested different types of devices that may have improved accuracy in patients with darker skin pigmentation, but the underlying problem still exists.
Bottom line, this goes to prove what we have taught, never rely on a single value to reassure yourself of the patient's status, always take into account the bigger picture.
Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesth Analg. 2024 Mar 1;138(3):552-561. doi: 10.1213/ANE.0000000000006755. Epub 2023 Dec 18. PMID: 38109495
Category: Administration
Keywords: DEI, Ramadan, fasting (PubMed Search)
Posted: 3/16/2024 by Kevin Semelrath, MD
(Updated: 2/7/2025)
Click here to contact Kevin Semelrath, MD
This study is out of the American University of Beirut, Lebanon, and courtesy of our own Mazen El Sayed!
Many patients of Muslim faith will observe fasting during the month of Ramadan, with no food, water, oral of IV medication taken from sunrise to sunset
This study showed a lower daily ED volume than during non Ramadan months, however did show a higher length of stay during Ramadan.
It also found an increase in mortality rates during Ramadan (OR 2.88) and 72 hour ED bounce-backs (OR 1.34)
Be sensitive and aware of the needs of your patients of Muslim faith during this holy month of fasting.
Ramadan Kareem
Impact of Ramadan on emergency department visits and on medical emergencies. Reem G Al Assaad, Rana Bachir, Mazen J. El Sayed. Europena Journal of Emergency Medicine. 2018, 25:440-444.
Category: Administration
Keywords: restraint use (PubMed Search)
Posted: 1/21/2024 by Kevin Semelrath, MD
(Updated: 2/7/2025)
Click here to contact Kevin Semelrath, MD
This study was a retrospective review of restraint use at a level 1 trauma center in the Midwest.
It found the following were factors in a patient encounter associated with an increased risk of restraint usage:
This study found a decreased OR of restraint use with Black or Hispanic race, which was in contrast to other studies
This was a single center, retrospective study, so it was already limited in what it could tell us. In addition, they didn't see the reason for the restraints being ordered in the first place. Nonetheless, it does show that people in certain marginalized groups have a higher likelihood of ending up in restraints. Please think twice when ordering restraints in the ED, especially for behavioral reasons
Published:September 19, 2023DOI:https://doi.org/10.1016/j.annemergmed.2023.08.009
Category: Administration
Keywords: DEI, social Z codes (PubMed Search)
Posted: 9/23/2023 by Kevin Semelrath, MD
(Updated: 2/7/2025)
Click here to contact Kevin Semelrath, MD
Since the switch from fee for service to value based care in the US, there has been a marked push to improve our documentation to expand our MDM and differential considerations. We are all here becoming adept at the medical documentation (thanks Dr. Adler!), but may not be adequately documenting our patients' social determinants of health using the social Z codes, a subset of ICD-10 coding language
This study wanted to look at the overall prevelance of social Z code utilization. They used the Nationwide Emergency Department Sample (NEDS), a nationwide database of ED visits, to look at this particular documentation. They examined 35 million (!) ED visits and found that only 1.2% had any social Z code included in the documentation. Given how many resources are linked to a verified (eg documented) need, this raises the idea that if Z codes are better documented, this may lead to increased funding for things like food, housing and transportation insecurities.
Limitations- the authors only examined the ED visits for ICD-10 codes, they didn't specifically look at the notes themselves which may have contained SDOH information. They also found that the social Z codes were more often documented in visits coded for mental health diagnoses, potentially indicating bias. There is also the concern that patients may not want the social z codes included, given the stigma around things like homelessness.
Overall, social Z code documentation could potentially unlock better resources for our patients by documenting a specific need in a population. More will come as documentation continues to evolve.
Molina, MF, et al. Social Risk Factor Documentation in Emergency Departments. Annals of Emergency Medicine, Vol 81, No. 1; January 2023. p38-46
Category: Administration
Keywords: DEI, racial disparity, substance use disorder (PubMed Search)
Posted: 7/22/2023 by Kevin Semelrath, MD
(Updated: 2/7/2025)
Click here to contact Kevin Semelrath, MD
Substance use disorder is now known to be a function of brain disease and not a moral failure. Patients with substance use disorder are highly complex and often use the ED at a higher frequency than those without the disorder. However, these patients are also frequently the target of implicit bias and stigmatizing behavior from the healthcare team that can lead to worsened outcomes. Add on top of that a racial disparity, and we can see how this group of patients can have really bad health outcomes.
This study looked at the length of time to treatment of patients with SUD, to see if there was a difference within this group based on racial or ethnic differences. It did find that black patients with SUD did wait on average 35% longer in the ED before being seen or treated. This difference was statistically significant.
While this study wasn't designed to identify the causes of such a disparity, it does raise concern for implicit bias being in effect among not only the healthcare workers, but ingrained into the healthcare systems themselves.
Patient's with SUD are a vulnerable group of patients, and black patients with SUD are experiencing a disparity in time to treatment. This should remind us all to seek out ways to remove these biases and disparities from the systems where we work.