title: How nurse gender influences patient priority assignments in US emergency departments.
abstract: 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 determine whether 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 (Mage = 59.5, 92% males) and their triage nurses (n = 774, Mage = 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 levels were associated with more urgent (higher priority) ESI levels by female nurses, yet less urgent ESI levels by male nurses. In contrast, male patients with high RR received more 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, and more 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.
authors.affiliation: Department of Psychology.
authors.forename: Jacob Miguel
authors.initials: JM
authors.lastname: Vigil
authors.affiliation: Department of Educational Psychology.
authors.forename: Patrick
authors.initials: P
authors.lastname: Coulombe
authors.affiliation: Department of Emergency Medicine.
authors.forename: Joe
authors.initials: J
authors.lastname: Alcock
authors.affiliation: Department of Economics.
authors.forename: Sarah See
authors.initials: SS
authors.lastname: Stith
authors.affiliation: Department of Psychology.
authors.forename: Eric
authors.initials: E
authors.lastname: Kruger
authors.affiliation: Department of Obstetrics and Gynecology University of New Mexico, Albuquerque, NM, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Cichowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D015588:Observer Variation; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D012119:Respiration; D012189:Retrospective Studies; D012727:Sex Characteristics; D014218:Triage / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D055815:Young Adult