Home LATEST NEWS HEALTH First Nations more often triaged as low priority cases in ED

First Nations more often triaged as low priority cases in ED


During her long career as a community nurse, Lea Bill often felt that her Aboriginal patients were not treated like others in the health system.

I remember the time when I myself escorted an individual to the emergency room. […] He was immediately categorized as a drug seeker. But he was there because, according to my assessment, he had a serious lung infection., she says.

They waited together for hours, to the point where the patient was ready to give up and go home untreated, despite the severity of his condition.

Eventually I stood up and said “I’m the community nurse. […] My patient is having difficulty breathing. Could it be seen?”.

This is not an isolated example and Lea Bill now has the data to prove it.

The Alberta First Nations Information Governance Center (AFNIGC), of which Lea Bill is now Director, conducted the studyHave (New window)Have (in English) with the University of Alberta and Alberta Health Services (AHS). Together, they analyzed 11,216,238 emergency room visits to Alberta hospitals between 2012 and 2017.

Among visits by First Nations members, only 7.9% were assigned a high triage score when they arrive, which means that they must be seen first.

It was 11.8% of the cases in the other patients.

The researchers observed this statistical difference in all five visit categories studied: trauma and injury, infection, substance abuse, obstetrics and gynecology, and mental health.

Emergencies as the only solution

One of the most prevalent stereotypes about First Nations in the healthcare system is that they overuse or abuse emergency servicessays Patrick McLane, study co-author and associate professor of emergency medicine at the University of Alberta.

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Previous work by the research group has certainly shown that First Nations people use emergency services more often than average, but only because it is often the only way to see a doctor in their community, explains Lea Bill .

This tells us that there is a lack of primary care for First Nations. [….] They have nowhere else to go. »

A quote from Lea Bill, First Nations Information Governance Center of Alberta

Similar diagnoses, different receptions

The data also show that even patients who ultimately have the same diagnosis tend to receive different triage scores based on their ethnicity.

This difference is particularly marked for people diagnosed with an anxiety disorder.

It has also been observed in those suffering from an acute respiratory infection and even in patients with a fractured long bone, whether it is an arm or a leg, for example.

As an aboriginal person, this did not surprise me. But I think it surprised many of the researchers working in this area, comments Lea Bill.

This is the case of Patrick McLane.

We were surprised to see this difference at triage for long bone fractures, which are fairly obvious injuries in the majority of cases. »

A quote from Patrick McLane, associate professor at the University of Alberta

The researchers did not observe a significant difference between the triage scores assigned to Aboriginal and non-Aboriginal patients for cases related to miscarriages and opioid use.

Towards solutions

Persistent prejudices about First Nations people, their use of emergency rooms and substance abuse partly explain the results, according to the researchers.

They also suggest that cultural differences in how pain is expressed may interfere with communication with triage nurses.

And some of our First Nations partners have pointed out that some people don’t trust the health system because of their past experiences and this can limit the information they share during triage., says Patrick McLane.

The University of Alberta, Alberta Health Services and theAlberta First Nations Information Governance Center began this joint research project in 2016. They published several studies based on statistics from Alberta Health Services as well as Indigenous talking circles and testimonials from health professionals.

We want people to see the fact that we’re measuring these things as a positive sign. It’s a sign that we’re going to improve and that people are interested in it.

I think things are going in a good direction, also believes Lea Bill.

She says the public health agency has started involving theAlberta First Nations Information Governance Center or other partners in a growing number of research projects.

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