Racial and Demographic Differences in Use of a Trauma Center Confidential Status Policy

Confidential status is a hospital trauma center practice of restricting communication with all visitors of violently injured patients, including family and friends. The practice is intended to protect patients and staff from harm in situations involving violence or safety concerns, though it may have unintended negative impacts.

A mixed-methods study using retrospective cohort and qualitative study designs was conducted at a single urban academic Level 1 trauma center with a confidential status practice. Using retrospective chart review of traumatically injured patients from 2015 to 2020, we performed multivariable logistic regression examining associations between placement on confidential status and patient characteristics including age, race/ethnicity, and intent of injury. Surveys and semi-structured interviews were conducted to examine knowledge of the confidential status policy and perceived effects on patient care and clinical workflow.

Of the 42,540 traumatically injured patients were included, 319 were placed on confidential status. Those with confidential status were most commonly injured by assault (62%). Multivariable regression showed Black (OR 2.69, 95% CI 1.97-3.68) and Latine (OR 1.46, 95% CI 1.03-2.07) patients were more likely to be placed on confidential status compared to White patients. All survey respondents reported providing direct care for patients in which the confidential status was enforced; however, only 38% reported having read the policy. Most respondents reported neutral perceptions regarding the policy's impact on patient care and patient experience, while only 12% reported positive perceptions. Four qualitative themes were identified: family trauma, discrimination, stressed workplace environment, and policy ineffectiveness.

Racial/ethnic differences were observed in the use of confidential status. Staff perceptions raised concerns regarding unintended negative effects of the policy on patients and families.