More on Quality and Safety

Black, Hispanic patients more likely to be brought to safety-net hospital emergency rooms

The largest differences were seen in larger urban areas with multiple emergency rooms and hospitals within the vicinity.

Jeff Lagasse, Associate Editor

National guidelines require emergency medical services transportation to the nearest suitable hospital. To what extent this occurs, and whether this varies by the race and ethnicity of the patient, is unknown, since there is little to no prior research on destination patterns of EMS-transported patients to hospitals.

But a new national study done by researchers at Boston University School of Medicine and Boston Medical Center show large differences in the emergency department and hospital destinations of black and Hispanic patients who are transported by EMS when compared with their non-Hispanic white counterparts. The study appears in JAMA Network Open.


HIMSS20 Digital

Learn on-demand, earn credit, find products and solutions. Get Started >>

Using the national Medicare claims data, the study divided patients based on the ZIP code they lived in, and compared which EDs and hospitals non-Hispanic white, black and Hispanic patients living in the same ZIP code were brought to. The study also looked at how often the most frequently used destinations for white patients were also the destination for black and Hispanic patients.

The results of the study showed there were sizable differences by race and ethnicity in which emergency rooms and hospitals patients were brought to. The largest differences were seen in larger urban areas with multiple emergency rooms and hospitals within the vicinity. The study also found that black and Hispanic patients were more likely to be transported to a safety-net hospital compared to their white counterparts living in the same ZIP code.

According to the researchers, these findings suggest EMS transports are often not transported to the nearest suitable hospital, as recommended by national guidelines. The difference in these transportation destinations may be motivated by factors other than proximity or time.

The exact cause of the pattern is unknown; authors said more research is required to understand the underlying reasons behind the trend.

The research is expected to inform future studies on the impact of ambulance diversion, a practice where hospitals temporarily close emergency departments to new ambulance transports. Massachusetts banned ambulance diversion 10 years ago.


Occasionally a hospital will close itself off to ambulances, and the facilities that do so usually claim it's due to volume issues. A May study, however, suggests that may not always be the case.

Looking specifically at California, Health Services Research uncovered evidence that hospitals turning away ambulances may be doing so for financial reasons; the story was originally reported in the Milwaukee Journal Sentinel. While some hospitals argue that they want to avoid scenarios in which sick patients are spending an eternity waiting in the emergency room, data shows the likelihood of patients being poor may be closer to the truth.

Private hospitals, the study found, are more likely to enact an "ambulance diversion" if a nearby public hospital is already turning away ambulances. Public hospitals typically treat lower-income patients.

Twitter: @JELagasse

Email the writer: