Differences in triage thresholds for patients presenting with possible acute coronary syndromes: more than meets the
Catherine E Milch1, David M Kent, Robin Ruthazer
1Institute for Clinical Research and Health Policy Studies, Center for Cardiovascular Health Services Research, Tufts-New England Medical Center, Boston, MA 02111, USA. catherine.milch@mpi.com
Insights
Hospital funding status impacts emergency care for acute coronary syndromes (ACS). Private hospitals showed higher sensitivity but lower specificity in triage compared to public hospitals, even after adjustments.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Previous studies highlight racial/ethnic disparities in cardiac care.
- These disparities often overlook the influence of institutional factors at healthcare facilities.
- Understanding hospital-level differences is crucial for equitable patient care.
Purpose of the Study:
- To investigate how hospital funding (public vs. private) affects emergency department (ED) triage for suspected acute coronary syndromes (ACS).
- To examine the impact of hospital funding on the likelihood of ED discharge for patients with confirmed ACS.
- To analyze differences in diagnostic accuracy and admission decisions between public and private hospitals.
Main Methods:
- Secondary analysis of data from a randomized controlled trial involving 10,659 ED patients with possible ACS.
- Comparison of triage sensitivity and specificity for ACS diagnosis between public and private hospitals.
- Statistical adjustment for patient-level and hospital-level characteristics to isolate the effect of hospital type.
Main Results:
- Triage at private hospitals was more sensitive (99% vs. 96%) but less specific (30% vs. 48%) for suspected ACS compared to public hospitals.
- These differences in triage accuracy between public and private hospitals remained significant after adjusting for various patient and institutional factors.
- A substantial number of patients (1,856 out of 10,659) were diagnosed with confirmed ACS.
Conclusions:
- Significant disparities in emergency department triage for suspected ACS exist between public and private hospitals.
- These differences persist even when accounting for patient demographics, clinical factors, and institutional characteristics.
- Further research is necessary to elucidate the underlying reasons for these observed triage variations.
Background:
Many studies have shown differences in cardiac care by racial/ethnic groups without accounting for institutional factors at the location of care.
Objective:
Exploratory analysis of the effect of hospital funding status (public vs private) on emergency department (ED) triage decision making for patients with symptoms suggestive of acute coronary syndromes (ACSs) and on the likelihood of ED discharge for patients with confirmed ACS.
Study Design And Setting:
Secondary analysis of data from a randomized controlled trial of 10,659 ED patients with possible ACS in five urban academic public and five private hospitals. The main outcome measures were the sensitivity and specificity of hospital admission for the presence of ACS at public and private hospitals and the adjusted odds of a patient with ACS not being hospitalized at public versus private hospitals.
Results:
Of 10,659 ED patients, 1,856 had confirmed ACS. For patients with suspected ACS, triage decisions at private hospitals were considerably more sensitive (99 vs 96%; p<.001) but less specific (30 vs 48%; p<.001) than at public hospitals. The difference between hospital types persisted after adjustment for multiple patient-level and hospital-level characteristics.
Conclusion:
Significant differences in triage for patients with suspected ACS exist between public and private hospital EDs, even after adjustment for multiple patient demographic, clinical, and institutional factors. Further studies are needed to clarify the causes of the differences.
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