Colby Feeney, MD, FHM
Clinical question: Do race and ethnicity predict the use of security emergency responses (SER) in a non-psychiatric inpatient setting?
Background: Studies have demonstrated increased restraint use in certain racial groups in the emergency department (ED) and inpatient psychiatry settings. While there is also literature to suggest increased use of security for nonwhite patients, there is little known about the association between race and ethnicity identification and the use of SERs and restraints in the non-psychiatric inpatient setting.
Study design: Retrospective cohort study
Setting: Single tertiary academic hospital in the Northeastern U.S.
Synopsis: Analyzing non-psychiatric hospitalization data from 24,212 patients, researchers found that patients self-identifying as Black had increased odds of having an SER compared to white patients (2.8% versus 1.6%, odds ratio [OR], 1.82 [CI, 1.39 to 2.39], P < 0.01). The effect was diminished but still present even after controlling for previously described predictors of SERs (adjusted OR, 1.36 [CI, 1.02 to 1.81], P = 0.037). Hispanic patients did not have a significant difference in odds of having a SER compared to non-Hispanic patients, and there was not a significant difference between groups for the incidence of using restraints during the SERs. Important limitations of the study are its generalizability as it included data from only a single center and the patient population was predominantly white and non-Hispanic. The researchers speculate that the study was not powered to detect a difference in the use of restraints given the low frequency of SERs. Although the methods of this study do not reveal the cause, the study team predicts that implicit bias and racism may contribute to the differential use of SERs.
Bottom line: Black patients had higher odds of SERs during non-psychiatric inpatient hospitalization compared to white patients, and Hispanic ethnicity was not associated with increased odds of SERs.
Citation: Valtis YK, Stevenson KE, et al. Race and ethnicity and the utilization of security responses in a hospital setting. J Gen Intern Med. 2023;38(1):30-5.
Dr. Feeney is a med-peds hospitalist and the program director of the combined internal medicine-pediatrics residency program at Duke University Hospital and assistant professor in the departments of medicine and pediatrics at Duke University School of Medicine in Durham, N.C.