Racial differences in triage assessment at rural vs urban Maine emergency departments.

Data continue to accumulate demonstrating that those belonging to racialized groups face implicit bias in the emergency care delivery system across many indices, including triage assessment. The Emergency Severity Index (ESI) was developed and widely implemented across the US to improve the objectivity of triage assessment and prioritization of care delivery; however, research continues to support the presence of subjective bias in triage assessment. We sought to assess the relationship between perceived race and/or need for translator and assigned ESI score and whether this was impacted by hospital geography. We performed retrospective EMR-based review of patients presenting to urban and rural emergency departments of a health system in Maine with one of the top ten most common chief complaints (CC) across a 5-year period, excluding psychiatric CCs. We used multivariable regression to analyze the relationships between perceived race, need for translator, and gender with ESI score, wait time, and hallway bed assignments. We found that patients perceived as non-white were more likely to receive lower acuity ESI scores and have longer wait times as compared to patients perceived as white. Patients perceived as female were more likely to receive lower acuity scores and wait longer to be seen than patients perceived as male. The need for an interpreter was associated with increased wait times but not significantly associated with ESI score. After stratification by hospital geography, evidence of subjective bias was limited to urban emergency departments and was not evident in rural emergency departments. Further investigation of subjective bias in emergency departments in Maine, particularly in urban settings, is warranted.

Tools used to measure the impact of comorbidities on surgical outcomes in children with complex chronic conditions: A scoping review.

AIM: To identify and describe assessment tools used to measure the impact of comorbidities on postoperative outcomes in children with complex chronic conditions (CCC). METHOD: This was a scoping review using five electronic databases. The search was conducted in March 2022 by a medical librarian. There were no date or language restrictions. Included studies were full-text articles published in peer-reviewed journals that described a tool used to measure the impact of comorbidities in children with CCC to assess postoperative outcomes. A standardized data charting tool was used. RESULTS: A total of 2157 articles were retrieved. Five studies reporting on six comorbidity measures met inclusion criteria. All were cohort studies and were secondary analyses of data from an administrative database (n = 4) or a patient registry (n = 1). Sample sizes ranged from 645 to 25 747 participants. One paper described the assessment of reliability. Only one form of validity - predictive validity - was assessed in three papers for five measures. INTERPRETATION: Findings from this scoping review revealed a paucity of comorbidity assessment tools validated for use with children with CCC; significant conceptual and measurement challenges exist in the current scientific literature.

"I don't want to be the squeaky wheel": Addressing bias as a leader in emergency medicine.

BACKGROUND: Implicit bias poses a barrier to inclusivity in the health care workforce and is detrimental to patient care. While previous studies have investigated knowledge and training gaps related to implicit bias, emergency medicine (EM) leaders' self-awareness and perspectives on bias have not been studied. Using art to prompt reflections on implicit bias, this qualitative study explores (1) the attitudes of leaders in EM toward implicit bias and (2) individual or structural barriers to navigating and addressing bias in the workplace. METHODS: Investigators facilitated an hour-long workshop in May 2022 for those with leadership positions in the Society for Academic Emergency Medicine (SAEM), a leading national EM organization, including 62 attending physicians, eight residents/fellows, and four medical students. The workshop utilized arts-based methods to generate a psychologically supportive space to lead conversations around implicit bias in EM. The session included time for individual reflection, where participants used an electronic platform to respond anonymously to questions regarding susceptibility, fears, barriers, and experiences surrounding bias. Two independent coders compiled, coded, and reviewed the responses using an exploratory constructivist approach. RESULTS: A total of 125 responses were analyzed. Four major themes emerged: (1) acceptance that bias exists; (2) individual barriers, including fear of negative reactions, often due to power dynamics between respondents and other members of the ED; (3) institutional barriers, such as insufficient funding and unprotected time committed to addressing bias; and (4) ambiguity about defining and prioritizing bias. CONCLUSIONS: This qualitative analysis of reflections from an arts-based workshop highlights perceived fears and barriers that may impact EM physicians' motivation and comfort in addressing bias. These results may help guide interventions to address individual and structural barriers to mitigating bias in the workplace.

Implicatoins of youth bulling on mental health / Implicancias del bullying sobre la salud mental de los adolescentes

INTRODUCTION: Youth bullying is an international phenomenon that has similar mental health implications in different populations globally. The purpose of this literature review is to describe bullying and its impact on youths' mental health, examines the state of science on bullying interventions, and describes implications for nursing for addressing this problem. METHODOLOGY: Four international databases were searched for all English and Spanish language articles including youth bullying and mental health effects. Articles chosen for review included meta-analyses, and systematic and integrated reviews which focused on youth bullying and mental health. DISCUSSION/CONCLUSIONS: Findings indicated that youths who differed from their peers in some way are at high risk of being a victim of bullying. Victims of bullying can display externalizing behaviors such as aggression, but more commonly display internalizing behavior such as withdrawal, and increasing suicidality. Nurses, in schools or other community settings, as well as primary and acute care are well positioned to help identify victims of bullying and to intervene, potentially reducing or eliminating the long term negative mental health effects of bullying. Future research should focus on groups likely to be bullied but not yet extensively studied, like lesbian, gay, bisexual, queer, transgender youth and those with autism spectrum disorders. More effective interventions are needed to decrease the prevalence of bullying and reduce the effect of bullying on victims.

INTRODUCCIÓN: El bullying en adolescentes es un fenómeno internacional cuyas implicaciones sobre la salud mental son similares en distintas poblaciones a nivel global. El propósito de esta revisión bibliográfica es describir el concepto de bullying y su impacto sobre la salud mental de los jóvenes'. Asimismo, examinar el estado de la ciencia en relación con las intervenciones en casos de bullying y describir las implicaciones que tiene para la enfermería el abordaje de este problema. METODOLOGÍA: Se efectuó la búsqueda en cuatro bases de datos internacionales de todos los artículos escritos en inglés y en español que incluyeran efectos sobre la salud mental y bullying en adolescentes. Los artículos seleccionados para esta revisión incluyeron tanto metaanálisis como revisiones sistemáticas e integradas enfocadas de manera fundamental a los aspectos de bullying en adolescentes y la salud mental. DISCUSIÓN/CONCLUSIONES: Se encontró que aquellos jóvenes que tienen características diferentes de sus compañeros se encuentran de alguna manera en alto riesgo de ser víctimas de bullying. Estas víctimas pueden mostrar conductas de externalización como agresión, y conductas de internalización como retraimiento y más comúnmente, tendencias suicidas. Las enfermeras, tanto en escuelas como en otras instalaciones comunitarias, tanto en cuidados primarios como agudos se encuentran bien capacitadas para ayudar a identificar a las víctimas de bullying y para intervenir reduciendo potencialmente e incluso eliminando los efectos negativos del bullying sobre la salud mental a largo plazo. Las futuras investigaciones deberán centrarse en los grupos susceptibles de ser intimidados y los cuales aún no han sido suficientemente estudiados, como aquellos de jóvenes lesbianas, gays, bisexuales, transexuales y personas con trastornos del espectro autista. Intervenciones más eficaces para disminuir la prevalencia del bullying y reducir el efecto de la intimidación sobre las víctimas son necesarias.