The following is a summary of “Disparities Associated With Electronic Behavioral Alerts for Safety and Violence Concerns in the Emergency Department” published in the February 2024  issue of Emergency Medicine by Haimovich, et al.

Electronic behavioral alerts are flags in an electronic health record to inform staff about past violent or disruptive behavior in emergency departments (EDs). However, these alerts can make people think less of patients and lead to bias. They describe ED electronic behavioral alerts using data from electronic health records in a big, regional healthcare system.

For a study, researchers sought to look at all the adult patients who went to 10 adult emergency departments in the Northeastern United States from 2013 to 2022. It was a retrospective cross-sectional study. Electronic behavioral alerts were checked by hand for safety concerns and then put into groups based on the type of worry. 

They looked at information about each patient at the time of their first visit to the ED, where an electronic behavioral alert had gone off, or at the time of their first visit during the study period if they did not have any electronic behavioral alerts. They used a mixed-effects regression analysis to find risk factors at the patient level linked to using safety-related electronic behavioral alerts. 

In the analysis of 2,932,870 ED visits, 6,775 (0.2%) were identified with electronic behavioral alerts, encompassing 789 unique patients and 1,364 alerts. Of these, 88% (5,945) were adjudicated as safety concerns, involving 653 patients. Patients with safety-related electronic behavioral alerts exhibited a median age of 44 years, with 66% being men and 37% being Black. These encounters demonstrated higher rates of discontinuance of care (7.8% vs. 1.5% with no alert; P < 0.001). The prevalent themes in electronic behavioral alerts included physical (41%) or verbal (36%) incidents involving staff or other patients. Logistic analysis revealed that factors associated with a higher risk of patients having safety-related alerts encompassed Black non-Hispanic ethnicity (adjusted OR 2.60; 95% CI 2.13 to 3.17), age younger than 45 (vs. aged 45-64 years: adjusted OR 1.41; 95% CI 1.17 to 1.70), male gender (vs. female: adjusted OR 2.09; 95% CI 1.76 to 2.49), and public insurance (Medicaid: adjusted OR 6.18; 95% CI 4.58 to 8.36; Medicare: adjusted OR 5.63; 95% CI 3.96 to 8.00 vs. commercial).

Source: sciencedirect.com/science/article/abs/pii/S019606442300272X