Affiliation:
1. Department of Emergency Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
2. Center for Emergency Care Policy and Research University of Pennsylvania Philadelphia Pennsylvania USA
3. Penn Medicine Center for Health Care Transformation and Innovation University of Pennsylvania Philadelphia Pennsylvania USA
4. Penn Medicine Center for Insights to Outcomes University of Pennsylvania Philadelphia Pennsylvania USA
5. Penn Urban Health Lab University of Pennsylvania Philadelphia Pennsylvania USA
Abstract
AbstractBackgroundTo combat increasing levels of violence in the emergency department (ED), hospitals have implemented several safety measures, including behavioral flags. These electronic health record (EHR)‐based notifications alert future clinicians of past incidents of potentially threatening patient behavior, but observed racial disparities in their placement may unintentionally introduce bias in patient care. Little is known about how patients perceive these flags and the disparities that have been found in their placement.ObjectiveThis study aims to investigate patient perceptions and perceived benefits and harms associated with the use of behavioral flags.MethodsTwenty‐five semistructured qualitative interviews were conducted with a convenience sample of patients in the ED of a large, urban, academic medical center who did not have a behavioral flag in their EHR. Interviews lasted 10–20 min and were recorded then transcribed. Thematic analysis of deidentified transcripts took place in NVivo 20 software (QSR International) using a general inductive approach.ResultsParticipant perceptions of behavioral flags varied, with both positive and negative opinions being shared. Five key themes, each with subthemes, were identified: (1) benefits of behavioral flags, (2) concerns and potential harms of flags, (3) transparency with patients, (4) equity, and (5) ideas for improvement.ConclusionsPatient perspectives on the use of behavioral flags in the ED vary. While many saw flags as a helpful tool to mitigate violence, concerns around negative impacts on care, transparency, and equity were also shared. Insights from this stakeholder perspective may allow for health systems to make flags more effective without compromising equity or patient ideals.
Reference28 articles.
1. Violence in emergency departments is increasing harming patients new research finds. EmergencyPhysicians.org.2018Accessed June 30 2022.https://www.emergencyphysicians.org/press‐releases/2018/10‐2‐2018‐violence‐in‐emergency‐departments‐is‐‐increasing‐harming‐patients‐new‐research‐finds
2. Rising violence in the emergency department. Association of American Medical Colleges.2020. Accessed July 18 2022.https://www.aamc.org/news‐insights/rising‐violence‐emergency‐department
3. Poll: emergency physicians say violence in the ED is on the rise leads to physician burnout and impacts patient care. EmergencyPhysicians.org.2022. Accessed April 3 2023.https://www.emergencyphysicians.org/article/er101/poll‐ed‐violence‐is‐on‐the‐rise
4. Impact of the COVID-19 pandemic on workplace violence at an academic emergency department
5. Balancing safety against obstruction to health care access: An examination of behavioral flags in the VA health care system.