Emergency Severity Index Scores Differ by Health Provider’s Gender andPatient’s Age

Abstract

Background: Experimental research shows that laywomen express higher levels of empathy than men to pain suffering behaviors in others and female practitioners interact with and may prescribe different levels of pain medication to patients than male practitioners. Objectives: In this study we conduct a small medical records review to examine the possibility that female emergency department nurses assign lower levels (i.e., more urgent, serious, resource extensive) of emergency severity index (ESI) scores of patients presenting for care in the emergency department than male nurses, raising the possibility that patients receive disparate treatment during triage depending on the gender of medical staff. Methods: The patient-provided pain scores and the examiner-determined ESI scores of forty-eight male, emergency de- partment patients (21-89yrs, Mage = 57.2, SDage = 19.3) were examined across multiple visits, along with the gender of their triage examiner at each visit of (127 total patient/provider interactions). Results: A cross-classified mixed-effects model to analyze the influence of examiner gender on the triage scores that showed a significant Examiner Gender x Patient Age interaction. Further probing showed that female practitioners ascribed significantly lower ESI scores than male practitioners, although this effect was limited to patients younger than 55 years of age. Conclusion: These findings warrant larger-scale investigations of patient and examiner influences on patient treatment, which are necessary for creating more standardized protocols for reliably assessing emergency-care patients and for reducing health disparities in patient treatment quality.