A Qualitative Study of Racial, Ethnic, and Cultural Experiences of Minority Clinicians During Agitation Care in the Emergency Department

• Published in: Annals of emergency medicine 2024-02, Vol.83 (2), p.108-119
• Main Authors: Agboola, Isaac K., Rosenberg, Alana, Robinson, Leah, Brashear, Taylor K., Eixenberger, Christopher, Shah, Dhruvil, Pavlo, Anthony J., Im, Dana D., Ray, Jessica M., Coupet, Edouard, Wong, Ambrose H.
• Format: Article
• Language: English
• Subjects: Black or African American; Emergency Service, Hospital; Ethnicity; Hispanic or Latino; Humans; Minority Groups; Perceived Discrimination; Physicians; Psychomotor Agitation - therapy; Racial Groups; United States
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2023.09.014

Racial and ethnic bias in health care has been documented at structural, organizational, and clinical levels, impacting emergency care, including agitation management in the emergency department (ED). Little is known about the experiences of racial and ethnic minority ED clinicians caring for racial and ethnic minority groups, especially during their agitated state. The objective of this study was to explore the lived experiences of racial and ethnic minority ED clinicians who have treated patients with agitation in the ED. We performed semistructured individual interviews of Black, Latino, and multiracial clinicians who worked at 1 of 3 EDs from an urban quaternary care medical center in the Northeast United States between August 2020 and June 2022. We performed thematic analysis through open coding of initial transcripts and identifying additional codes through sequential iterative rounds of group discussion. Once the codebook was finalized and applied to all transcripts, the team identified key themes and subthemes. Of the 27 participants interviewed, 14 (52%) identified as Black, 9 (33%) identified as Hispanic/Latino, and 4 (15%) identified as multiracial and/or other race and ethnicity. Three primary themes emerged from racial and ethnic minority clinician experiences of managing agitation: witness of perceived bias during clinical interactions with patients of color who bear racialized presumptions of agitation, moral injury and added workload to address perceived biased agitation management practices while facing discrimination in the workplace, and natural advocacy and allyship for agitated patients of color based on a shared identity and life experience. Our study found that through their shared minority status, racial and ethnic minority clinicians had a unique vantage point to observe perceived bias in the management of agitation in minority patients. Although they faced added challenges as racial and ethnic minority clinicians, their allyship offered potential mitigation strategies for addressing disparities in caring for an underserved and historically marginalized patient population.