95. PROVIDER-REPORTED INEQUITY IN CARE DELIVERED DURING RAPID RESPONSE TEAM (RRT) ACTIVATIONS AMONG PATIENTS OF COLOR (POC) AND LOW-ENGLISH PROFICIENT (LEP) PATIENTS

• Published in: Academic pediatrics 2020-09, Vol.20 (7), p.e45-e46
• Main Authors: McDade, Jessica E., MD, Olszewski, Aleksandra, MD, McMahon, Elizabeth, RN, Masse, Elizabeth, RN, Martinez, Julia, RN, Ramos, Jessica, Bell, Shaquita, MD, Lein, Missy, RN, Roberts, Joan, MD
• Format: Article
• Language: English
• Subjects: Neonatal and Perinatal Medicine; Pediatrics
• ISSN: 1876-2859
• DOI: 10.1016/j.acap.2020.06.116

BackgroundCognitive biases related to race, culture, or language are shown to impact quality of care in hospital settings. Some types of cognitive bias have been negatively associated with decisions to call RRTs, but little is known about biases related to race, culture, or language and their impact on decisions to call RRTs or on care delivered during RRTs. MethodsWe implemented a novel RRT standardized debrief form and included the question “How might health inequity have played a role in this RRT?” with response choices of race, gender, language, culture, religion, or other. In this retrospective cohort study, we compared provider-reported inequity in the first 6 weeks following implementation of the RRT debrief among POC or LEP patients with white or English-proficient patients, respectively. Fishers exact test was used to assess differences between groups. ResultsThere were 117 RRTs during the study period. Sixty of these patients were POC, and 24 were LEP (20 LEP patients were also POC). Providers reported inequity impacting care in 17/117 RRTs (15%), with 16 (94%) occurring during an RRT for a POC (p=0.0002). Table 1 shows frequencies of reported inequity types. For LEP families, 10 providers (42%) reported language inequity. An interpreter was used during 8/24 RRTs where one was indicated. Providers who were part of an RRT that did not use an interpreter for an LEP family reported inequity 4 out of 16 times (25%), compared to 6 (75%) of the 8 providers who did use an interpreter (p=0.03). ConclusionProvider-reported inequity in care during RRTs was highly prevalent in our study, with the majority occurring for POCs. Use of interpreters when indicated was low. RRT teams that used an interpreter for LEP families were more likely to identify inequities compared to those that did not, suggesting that education regarding identification of inequity and interpreter use may be beneficial. Future work may investigate change in reported rate of inequity over time, ways in which inequity manifests during RRTs, and outcomes of RRTs.