A new study led by Isaac Agboola, a third-year emergency room resident at Yale New Haven Medical Center, examines how bias influences emergency department treatment, particularly decisions over which patients must be restrained and/or sedated. The authors looked at the medical records for patients who have been physically restrained. And they found that race did significantly predict use of restraints, even controlling for medical issues, sex, and other measures.
Black patients in the emergency department were much more likely to be physically restrained. Often the first step is deeming these patients as “agitated.” The term agitated is defined as a kind of excessive psychomotor activity, which could lead to aggressive or violent behavior. Sometimes it’s dependent on mood. Sometimes it’s due to someone’s underlying psychiatric disorder. “You have to take specific care, especially when looking at vulnerable patients, with labeling them as agitated.” Dr. Agboola explains.
Ambrose Wong, an assistant professor of emergency medicine and co-author of the study adds that “with agitation, you are at risk for bias, because it’s all through the lens of the person observing that behavior.”
“There are a series of simple interventions that I recommend when treating agitated patients,” Dr. Agboola said. “First, remove any redundant staff to bring more calm to the room. I turn down the lights, decreasing stimuli. I talk to the patient. And then I work stepwise. If this person is able to be verbally redirected, great. If they’re not, we try medication. Safety is important for both the patient and the medical staff, but we don’t need to use a fire hose to put out a candle.”
The full study, “The Coats That We Can Take Off and the Ones We Can’t”: The Role of Trauma-Informed Care on Race and Bias During Agitation in the Emergency Department,” was published on the website of the journal Annals of Emergency Medicine. It may be accessed here.