September 24, 2010 | 11:02 AM |

Having Chest Pain While Black: MGH Finds Triage Bias

FILED UNDER: Medicine/Science, Personal Health, bias, cardiac, disparities, heart attack

Among patients diagnosed as having a probable heart attack, emergency room staffs tend to treat everyone alike. But among patients merely suffering chest pain, those who are African-American or Hispanic are less likely to be classified as emergency cases and to get EKGs and other cardiac testing, according to a national study just released by Massachusetts General Hospital and published in the journal Academic Emergency Medicine.

The hospital reports:

Among patients who received an ED diagnosis of probable myocardial infarction (heart attack), there were no significant differences in initial symptoms between racial or ethnic groups…But among all those presenting with chest pain, African American and Hispanic patients were significantly less likely than white patients to be triaged as emergent. In addition, African American and Hispanic patients, as well as those who were uninsured or covered by Medicaid, were less likely to receive such basic cardiac testing procedures as ECG, cardiac monitoring or measurement of cardiac enzymes. Factors such as whether patients arrived by ambulance or the day of the week on which they were seen did not make any difference.

“These differences in ED triage may be important drivers of disparities in testing, procedures and eventual outcomes,” says [lead author Lenny] Lopez. “If you are misclassified at this first step, you’re less likely to get the ECG because your condition is not considered urgent. In the long term, you may have an even more severe heart attack that could have been prevented if intervention had occurred earlier. This is not an area of medicine where there is a lack of clarity about what we are supposed to do, so quality improvement strategies need to focus on 100 percent guideline-driven triage management for every single patient.”

  • Deanne Munroe

    I read with interest your article referring to research done at MGH and published in a peer reviewed journal. Oddly enough there is no journal article available. It is my experience that the race, culture or sex of an individual makes no difference when working up things such as chest pain in the ED. The more studies done, the higher the acuity and subsequently the higher reimbursement. The behaviors stated make no sense from not only a medical/legal view but certainly not from a financial view.
    The premise of the article is that all subsequent care of a patient is based on the clinical assessment skills of the triage nurse without any nurse practitioner, physician assistant, resident, or attending physician evaluating a patient. It is too bad that many people will read this without any critical thinking applied and actually believe this bogus story. The writer should be ashamed for promolgating his own agenda.

  • Guest

    The uninsured (mostly minorities) will never have the same care. If there’s money involved and our healthcare system runs as a business, these situations will continue to happen. Is this racism or a question of medical ethics? Perhaps both. Our system needs a change now, and that may include extricating the middle man who is the only true beneficiary in this whole mess (insurance companies).

  • Evan Pankey

    It seems that this could be easily addressed by a combination of better data capture, triage guidelines and decision support around patients reporting chest pain. ED departments could pick there own protocols to follow and generate ‘report cards’ for staff (for internal usage) and for the institution (for external reporting). That would encourage individuals and institutions to strive to eliminate these kinds of results and possibility reveal new patterns and opportunities for improvement.