Recognizing and Removing Disparities in Patient Care

In a perfect world, every patient seeking medical services would be given equal care and treatment regardless of their background. However, in reality, that’s not always the case. Gender, race, ethnicity, and socioeconomic disparities are well-documented within the healthcare system. These factors not only affect the care patients receive, but their overall outcomes. In order to overcome these disparities, it is incredibly important for the industry to recognize and monitor where the discrepancies lie.  

Closing the gap 

Through data, ESO is working to identify areas in which we can improve outcomes for all patients. One of these areas is assessing patients with ED-diagnosed strokes. While stroke assessment is documented 38% of the time for patients overall, it is only documented 32% of the time for Hispanic/Latino patients. There are steps to take to work towards closing this gap, such as not prioritizing a set list of symptoms as “normal EKG” and recognizing atypical presentations across different patient populations.  

EMS services can proactively work to improve how they communicate within their communities. Does your department have interpreter policies, interpretation tools, charting standards, and quality assurance reporting to properly assist patients with limited English proficiency? When you’re creating educational resources, are you considering the different languages within your community? The “AHORA” stroke screening tool is a great example of this. The Spanish translation of the “BE-FAST” tool, AHORA, has been effective in helping to improve stroke symptom awareness in Spanish-speaking communities.  

Working towards better detection 

Another area ESO has identified as an opportunity to improve is how EMS services detect a possible STEMI or NSTEMI with a 12-lead EKG. Pre-hospital detection can ensure that the catheterization laboratory is ready by the time the patient arrives, saving precious minutes that can lead to a better outcome. Currently, conventional EMS education tends to center symptoms of a STEMI or NSTEMI for males as “typical” and females as “atypical.” This may unintentionally prioritize 12-lead EKGs in males and create a higher likelihood of failing to recognize symptoms in females.  

To combat this, it’s important to review agency protocols around its use for patients with suspected STEMI or NSTEMI. Research has shown that occurrence of false positive prehospital EKGs is low, while also showing that early identification improves patients outcomes. So be ready to perform and transmit 12-lead EKGs for basic life support units as well as those with advanced life support capabilities.  

Documenting 12-lead EKG in discrete data fields, such as under procedure or vital sign, rather than only in the free-text narrative can also help to ensure better monitoring and improvement initiatives. Then, tracking the outcomes for all patients diagnosed with STEMI or NSTEM, rather than just providing feedback for suspected cases can identify any delays in diagnosis that are hindering care. 

In order to improve patient outcomes overall, ESO is studying disparities across the board, including those happening outside of the EMS and hospital settings. One area we found in need of improvement is bystander CPR. Of the 86,000 patients that suffered cardiac arrest before EMS arrival last year, 25% received bystander CPR. For Black or African American patients, that number was even lower at 18%.  

Improving the numbers

So how can EMS services work together to improve these numbers? Working with organizations like the American Heart Association to offer education, AED training, and CPR training at local high schools and in the general community is a good first step, especially in communities with low rates of bystander CPR. EMS services can also partner with places of gathering within their communities such as grocery stores, places of worship, and athletic facilities to increase access to AEDs. 

Addressing disparities within healthcare will not be a quick solution, but a series of changes big and small over time. It is EMS services’ responsibility to their patients to put in this work and create a better system for us all. Prioritizing the hiring, retaining, and promoting front-line employees, senior staff, and executive board members who reflect the demographics of their communities is a step in the right direction. As well as creating a paid advisory board filled with community members from a variety of different racial and ethnic backgrounds to help advise their agencies on how to overcome the challenges and barriers their EMS clinicians face within their services

For more insights on improving patient care based on industry data, download the ESO EMS Index today.