P3C069: A Retrospective Review of Racial and Ethnic Disparities in Security Activations at a Midwestern Tertiary Pediatric Hospital

Background: The impact of implicit bias in patient-provider communication and in clinical decision-making is associated with worse health outcomes and healthcare experiences for patients of color. However, less is known about the role of implicit bias in providers’ perception of safety in the healthcare setting and decision-making regarding escalation of security response. This study seeks to identify racial, ethnic, and socioeconomic disparities related to security assessments in the inpatient and outpatient setting and to evaluate for evidence of implicit bias of provider-activated security assessments. Our goal is to identify opportunities for improved communication in patient-provider interactions and opportunities for de-escalation education.

Methods: Our team conducted a retrospective chart review of security assessments at a midwestern tertiary children’s hospital and ambulatory clinics from October to December 2014-2019 (n =1748). Data analyzed included patient demographics, reason for security activation, and outcomes of the security assessment (including visitation limitations). Univariate with Fischer’s exact test and multivariate analyses were used to compare frequency of security activations between demographic groups.

Results: Compared to the race and ethnicity distribution of the overall patient population (19% Black, 14% Hispanic, 55% White), there were significantly more security activations for Black patients (51.7% Black, 8.3% Hispanic, 30.8% White). Black patients were 3.8 times (p < 0.01) and 4.5 times (p < 0.01) more likely than White patients to have security activations in the inpatient and outpatient settings, respectively. When the reason listed for security activation was “perceived aggression,” more than half of the cases (51.4%) were for Black patients, 7.8% for Hispanic, and 31.5% for White. Of those cases where security was activated for perceived aggression, Black patients were more likely to have visitation restricted than other racial groups (44% for Black patients, 31% for Hispanic, and 30% for White).

Conclusion: While hospital security serves to ensure the safety of healthcare providers, our study demonstrates that implicit bias likely influences security activations and assessments. Development of decision support tools regarding security activation and utilization of alternative interventions, such as social work consultation for patient/family support, may help create a more just and equitable healthcare environment that promotes better experiences for communities of color.