Hospital staff were significantly more likely to report harmful patient safety events for white patients than for black and other minority patients, a new study found.
Rates of safety events that hospital workers voluntarily reported varied significantly by the patients' race in a 10-hospital system located in the District of Columbia and Maryland from July 1, 2015, to June 30, 2017, according to the study in the Journal of Patient Safety.
While whites made up 39.8% of the system's patients, they accounted for 47.4% of reported safety events, including skin/tissue issues, falls and line and tube draining issues.
Blacks made up 52.3% of total patients but accounted for 46.3% of reported safety events. Other minorities, including Hispanics, made up 7.9% of total patients but accounted for 6.2% of safety events.
The disparity in safety event reporting by race varied substantially across the 10 hospitals in the system. At one hospital, 26% of the patients were white but 42% of the reported safety events involved whites; 66.6% of the patients were black but just 51% of the safety events involved blacks.
The researchers did not determine whether white patients experienced more harmful safety events or whether there was some type of staff reporting bias, such as less attention to safety problems involving lower-income or patients who didn't speak English.
"Factors such as implicit bias could potentially influence (staff's) likelihood of reporting more harmful adverse patient safety events for whites than for blacks and other" minorities, the authors wrote. "Further research is necessary to determine the root cause of the differences found in this study."
The lead author, Angela Thomas, assistant vice president of healthcare delivery research at the MedStar Health Research Institute, said it's the first study to examine this issue across a broad range of safety events.
She and her colleagues are working on follow-up studies to pin down reasons for the disparity in reporting by race. They currently are examining medical charts at one of the system's hospitals to see if they show similar disparities by race in the rates of harmful safety events.
"Once we do that, that gets us closer to figuring out whether whites just have more safety events or there is a reporting bias issue," Thomas said.
She declined to identify the system she studied, though MedStar, the system she works for, has 10 hospitals in the District of Columbia and Maryland.
Patient safety has been a prominent issue since the Institute of Medicine reported in 1999 that 44,000 to 98,000 die from preventable errors in U.S. hospitals each year. Earlier this month, the Leapfrog Group estimated that 161,250 preventable deaths occur each year in hospitals.
Some health systems have put substantial effort into patient safety and clinical improvement initiatives, though critics say the hospital industry's focus on safety and quality of care has waxed and waned.
The authors of the new study said race differences in adverse events may exist for many reasons, including phenotype, health literacy, communication, cultural differences, unequal healthcare access, and differences in illness complexity and healthcare utilization.
The most common types of reported safety events differed for each racial group, the study found. White patients were the only group that experienced surgery/procedure events in the top five most common events. Blacks and other minorities experienced diagnosis/treatment events in the top five while whites did not. Other minority patients were the only group that experienced maternal/childbirth events in the top five.
Thomas said it wouldn't be surprising if other hospitals had similar disparities by patient race in their voluntary safety event reporting systems. She urged them to examine this issue.
"Every organization that wants to keep patients safe should be asking questions and measuring whether safety events are happening disproportionately to some groups versus others," she said.
