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Diversity matters: How to address health disparities… : Emergency medicine news


COVID-19, equity in emerging markets, health disparities


We have seen an unprecedented increase in demand for emergency services throughout the pandemic. Many emergency departments receive patients who otherwise (pre-pandemic) would never have entered the medical system. This interaction between constants (staff, space, resources) and variables (volume of patients, patient acuity, seasonality) changes daily.

Capacity may be a concern, but an increased footprint is definitely a byproduct. With growing demand, increasing utilization, a larger patient pool and a rapidly expanding footprint, an increase in patient diversity is also expected; in fact, we have observed this phenomenon, and it raises the question: how do we react?

Department heads remained nimble, meeting unforeseen challenges and leveraging human potential to solve problems in real time. The catch is that most crisis management strategies do not include health equity measures; it’s almost as if these concerns come second (or third or fourth) to staying afloat. If one lesson has been learned over the past two years, however, it is that health disparities are exacerbated during crises and that social and structural factors of health modulate outcomes. This is why health equity should be higher on the totem.

As we make the necessary adjustments in the game, it is imperative to center health equity and focus on the implications of a more diverse patient base. This represents a forward-thinking approach and can help improve downstream health outcomes. Here are some concrete steps managers should consider in the process:

Conduct a needs assessment

Needs assessment is fundamental in public health. This is often done as a preliminary step to better understand the state of vital resources within a given population or community. Ultimately, the information obtained can be used to develop targeted strategies or solutions.

A needs assessment is warranted to identify and develop ways to better serve current and new patients in this environment of growing patient base and diversity. Many screening tools are standardized and can be easily deployed during the low points of an emergency department visit (in the waiting room, during registration and triage, before discharge). Its greatest utility would be as a data collection tool for clinical operations.

Update clinical operations metrics

The clinical operations team has one of the toughest jobs in emergency medicine; its members must understand how system-wide models influence performance, efficacy and clinical outcomes. They are able to generate data that informs department-wide actions through the use of carefully defined metrics and endpoints.

Clinical operations teams should make health equity a quiet priority and assign metrics to track movement on this front. A proper needs assessment will provide key information to inform actions and shape targeted strategies. More importantly, the most subtle gaps in care can be revealed and addressed by regularly communicating health equity measures.

Engage the interdisciplinary pillars

Emergencies thrive on our team spirit – we’re all in this together, every hour of every day. This is demonstrated by a culture shift towards interdisciplinary patient care in most departments. PEs need to be more proactive in engaging non-physician colleagues in the ecosystem to ensure the needs of diverse patient populations are met.

This includes nursing, social work, case management, interpretation and language services, spiritual services and all branches of research operating within the emergency. A wealth of knowledge can be found among these disciplines, often in areas that PEs do not prioritize. Collaboration can allow us to leverage the expertise of our colleagues and the established network of resources to chart the course for asynchronous community engagement. This typically lays the groundwork for program development and qualifies for additional public or private funding streams.

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Each department has designated liaisons who regularly engage stakeholders across the hospital. They know the escalation channels like the back of their hands and have built relationships across the silos of the medical system. Often, these high-level discussions are aimed at obtaining support or requesting resources, essentially the needs of the ministry.

In line with the previous points, different needs will emerge due to an influx of new and diverse patients; these liaisons act as proxy advocates for providers and patients. Ideally, an overlap and an open thread of communication should be present between the DEI task force, the ED clinical operations team, and a departmental champion. The collective work of capturing, quantifying and highlighting the needs of a diverse pool of patients is an essential step. Armed with this data, the Liaison Officer can amplify and communicate to stakeholders departmental strategies that prioritize health equity. This is how health equity can be operationalized.

Anyone who crosses the emergency threshold deserves optimal care; that a given health center becomes its medical home is secondary. Our goal should be to best meet the needs of all patients, especially in times of fluctuating demand. Our approaches must also take into account this rapid increase in patient diversity. The careful and thoughtful adjustment of resources to ensure a minimal drop in care from one patient to the next is a concrete example of change focused on health equity. It takes effort and courage, but fortunately there is no lack of it in our specialty.

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Dr. Brownis an emergency physician and assistant professor of social emergency medicine at Stanford Hospital. He is also the Impact Director of TRAP Medicine, a salon-based wellness initiative that leverages the cultural capital of barbershops to address the physical and emotional health of men and boys. black. He has also worked with ABC News’ medical unit and contributed articles on health equity and wellness. The New York Times, USA Today, GQ, and The root. Follow him on Twitter@gr8vision. Read his past articles on