TY - JOUR
T1 - How nurse gender influences patient priority assignments in US emergency departments
AU - Vigil, Jacob Miguel
AU - Coulombe, Patrick
AU - Alcock, Joe
AU - Stith, Sarah See
AU - Kruger, Eric
AU - Cichowski, Sara
N1 - Publisher Copyright:
© 2016 International Association for the Study of Pain.
PY - 2017
Y1 - 2017
N2 - The goals of this study were to compare whether emergency department (ED) patients' pain intensity (PI) is measured differently by male and female nurses and to determinewhether PI, heart rate (HR), and respiratory rate (RR)were used to prioritize patient urgency differently by male and female nurses. The associations between patients' PI|HR|RR and the Emergency Severity Index (ESI) scores they were assigned by attending nurses were analyzed using a national database of electronic medical records of US Veterans Affairs ED patients from 2008 to 2012. A total of 129,991 patients presenting for emergency care (Mage559.5, 92% males) and their triage nurses (n5774, Mage 5 47.5, 18% males) were analyzed, resulting in a total of 359,642 patient-provider interactions. Patients' PI did not differ by the nurse's gender; however a cross-classified mixed-effects model showed that nurse gender influenced how PI and RR measurements informed the ESI levels that male patients received.Higher PI levelswere associated with more urgent (higher priority) ESI levels by female nurses, yet less urgent ESI levels bymale nurses. In contrast,male patients with high RR receivedmore urgent ESI levels by male nurses, whereas the nurse gender did not influence ESI assignments for female patients. These findings show that ED patients receive disparate treatment based on inherent characteristics of their triage nurses, andmore standardized (eg, automated) protocols that can account for implicit social factors on health care practice for reliably assessing and prioritizing ED patients may be currently warranted.
AB - The goals of this study were to compare whether emergency department (ED) patients' pain intensity (PI) is measured differently by male and female nurses and to determinewhether PI, heart rate (HR), and respiratory rate (RR)were used to prioritize patient urgency differently by male and female nurses. The associations between patients' PI|HR|RR and the Emergency Severity Index (ESI) scores they were assigned by attending nurses were analyzed using a national database of electronic medical records of US Veterans Affairs ED patients from 2008 to 2012. A total of 129,991 patients presenting for emergency care (Mage559.5, 92% males) and their triage nurses (n5774, Mage 5 47.5, 18% males) were analyzed, resulting in a total of 359,642 patient-provider interactions. Patients' PI did not differ by the nurse's gender; however a cross-classified mixed-effects model showed that nurse gender influenced how PI and RR measurements informed the ESI levels that male patients received.Higher PI levelswere associated with more urgent (higher priority) ESI levels by female nurses, yet less urgent ESI levels bymale nurses. In contrast,male patients with high RR receivedmore urgent ESI levels by male nurses, whereas the nurse gender did not influence ESI assignments for female patients. These findings show that ED patients receive disparate treatment based on inherent characteristics of their triage nurses, andmore standardized (eg, automated) protocols that can account for implicit social factors on health care practice for reliably assessing and prioritizing ED patients may be currently warranted.
KW - Communication
KW - Health disparities
KW - Interpersonal
KW - Pain intensity
KW - Patient care
UR - http://www.scopus.com/inward/record.url?scp=85015732576&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015732576&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000000725
DO - 10.1097/j.pain.0000000000000725
M3 - Article
C2 - 28187101
AN - SCOPUS:85015732576
SN - 0304-3959
VL - 158
SP - 377
EP - 382
JO - Pain
JF - Pain
IS - 3
ER -