As trauma centers, we set out every day to ensure care is provided to all injured patients equally no matter their social, economic, racial, or ethnic background. Despite all good intentions research studies have shown repeatedly that structural biases exist which impact care based on sex/gender, race, ethnicity and socioeconomic backgrounds despite our perception of unbiased care.1 This is highlighted by mortality differences in trauma based simply on race.2 To address structural disparities in our systems we need to find ways to eliminate implicit bias.
A recent investigation was done by Jeffery et al, which evaluated the implementation of a daily performance improvement checklist to increase institutional compliance with quality measures. Their checklist worked as compliance with screening improved significantly. However, this checklist had a beneficial secondary impact, it eliminated the previously present disparity in screening for uninsured and black patients. This checklist, integrated into their daily sign-out, created a consistent non-biased way to ensure that all patients received equal attention for screening.3 Trauma centers are required to ensure best practices for patient care; these include screening for substance use, providing brief intervention, and most recently the addition of mental health.4 Implementing these screening programs in ways that eliminate chances for disparities is critical as these resources are needed by all, including vulnerable populations.
The process of minimizing and eliminating healthcare disparities in trauma care extends beyond the hospital setting. There is a need to standardizing prehospital trauma prevention programs such as ‘Stop the Bleed’ and ‘ThinkFirst’ in schools and businesses. This would help to ensure equitable access to knowledge and resources for all populations, especially vulnerable populations which fall victim to structural bias.5 6 It is paramount that such trauma prevention programs become and remain equally accessible to all despite their social, economic, racial, or ethnic backgrounds.
Consistency remains the cornerstone for highly reliable, high-quality outcomes. It is critical that standard processes with frequent monitoring are in place to ensure equality for our patients.7 We have been identifying disparities in healthcare for decades. Research in this area needs to not only identify the problem but also offer solutions! Hence, as we investigate disparities in care, and work to improve the performance of our hospital systems, implementing tools which hardwire processes are likely to provide solutions.
Process and quality improvement research and its impacts beyond compliance need to be researched in a way that our efforts are data driven, to ensure our intent for better outcomes are realized by all patients, the same way…every time, no matter what.
Michelle Jeffery, Ashley Toussaint, Rachel L Choron, Zachary P Englert, Charoo Piplani, Timothy Murphy, Lisa A Falcon, Mayur Narayan, Amanda L Teichman
