Racism is causing First Nations patients to leave emergency departments without completing care, research shows

Anti-Indigenous racism leads to First Nations patients in Alberta being more likely to leave emergency rooms without receiving treatment than non-First Nations patients, according to new research published today in the Journal of the Canadian Medical Association.

The research was co-led by Lea Bill, a registered nurse and director of the Alberta First Nations Information Governance Center, and Patrick McLane, adjunct associate professor of emergency medicine at the University of Alberta, and was supported and funded by seven Alberta First Nations. by the Canadian Institutes of Health Research.

“There are several factors that influence the decision to leave the emergency department without being seen,” says Bill.

“Some of these include the way First Nations people are treated while they wait to be seen, such as minimizing and dismissing the urgency of presenting symptoms, and using inappropriate language towards them while in the emergency department are.” Bill says some patients report feeling unsafe.

The team used a mixed quantitative and qualitative approach to explore the reasons behind previous research findings, which found that more First Nations patients than non-First Nations patients leave the emergency department without completing care (6.7 percent versus 3 .6 percent).

“We knew that more First Nations people were leaving, so what this article does is really dig into why,” McLane explains.

“We wondered if there could be something else that could explain the differences, such as different types of hospitals or a more rural location. This article suggests that, no, the thing that makes the difference seems to be First Nations identity.”

The researchers analyzed data from nearly 12 million emergency room visits between 2012 and 2017, and shared the results through sharing circles, focus groups and telephone interviews with First Nations patients, health directors and first responders. The researchers also conducted a quantitative analysis to control for factors such as final diagnosis, geography and demographics of patients other than First Nations status, and found that none explained the difference in outcomes.

“It matters if care isn’t completed,” McLane says. “Some of those people who left may have needed to be admitted to hospital for further treatment or may have needed a referral to a specialist.”

The researchers report that about one in 20 people who left the emergency department early and returned within three days were subsequently hospitalized.

SUB: Relationships, training and process changes are crucial

The patients and providers who provided perspectives on why patients leave before care is completed noted factors such as long wait times, poor communication, and the perception that the emergency department was unable or unwilling to meet patient needs.

Other reasons for leaving were specific to First Nations patients. Participants described healthcare providers relying on anti-Indigenous stereotypes and language, and feeling like they had to wait longer than non-First Nations patients who appeared to need less urgent care.

“This doctor didn’t even know me,” said one patient. “The first thing he asked me was: how much did you drink? What? I got up and walked outside.”

The new findings were consistent with the team’s previous publication of interviews with health care providers, who reported that First Nations patients “are exposed to disrespect through tone and body language, experience overt racism and may be neglected or not taken seriously.” ”

First Nations partners have expressed the need for more First Nations-led health care services and facilities to ensure quality care for First Nations members.

Since 2023, the group has been working on an anti-racism intervention to ensure patients across Alberta receive fair and dignified care. The University of Alberta and the Alberta First Nations Information Governance Center are working with the Blackfoot Confederacy Tribal Council, Stoney Nakoda Tsuut’ina Tribal Council, Bigstone Health Commission, Maskwacis Health Services, Paul First Nation Health Services, Yellowhead Tribal Council and Kee Tas Kee Now Tribal Council. The project is funded by a $1.75 million grant from the CIHR.

McLane says the intervention will be tailored to local conditions, but relationship building, education and setting up new processes in general will be key to tackling the problem.

“We think simulation education will be valuable, so don’t just give lectures or go through materials, but practice how to have a conversation with a colleague who expresses a racist stereotype or how to keep a patient in care if he/she feels that he or she is being discriminated against. and plan to leave,” says McLane.

“I see a lot of desire among providers to address this anti-Indigenous racism.”