200 Gender Bias Influences Attending's Asked to Interpret EKGs in the Emergency Department

Abstract

Implicit bias in the workplace has been a subject of growing interest in recent years. There is evidence to support subconscious biases affect women in all fields, including medicine. There is a perception that in the emergency department (ED), nursing staff will preferentially go to the male attending physician for electrocardiogram (EKG) interpretation. Based on this, hypothesize that male emergency medicine attendings are asked to interpret and sign off on EKGs more frequently than female attendings, particularly when the EKG is for a patient not assigned to a physician. Our objective was to identify general trends regarding sex disparities in EKG reading. We conducted a retrospective, observational cohort study in the ED at a rural, Level I trauma center. We reviewed the charts of patients who received an EKG at the Vidant Medical Center Emergency Department between November 2016 and September 2017 while a male-female dyad was working on the “P side” (urgent side). We recorded sex of the attending physician who read the EKG, sex of the person handing the EKG, whether the EKG was assigned to an attending and if so, whether the EKG was read by the assigned attending. Chi-square analysis was performed to identify associations between attending sex and all other variables with p<0.05 indicating significance. This study was reviewed and deemed exempt by the University and Medical Center IRB of East Carolina University. 29,757 eligible charts were identified for the study. At the time of analysis, data from 329 charts had been extracted. Our data demonstrated that the EKGs were read by male attendings in 56% of cases and by female attendings in 44% of cases. Of these EKGs, 57% were assigned, meaning an attending was assigned to the patient prior to performing the EKG, and 43% unassigned. Of the assigned EKGs, 91% were read by the correct assigned attending and 9% were read by a different attending. Unassigned EKGs were more likely to be read by a male attending (p=0.003). Individuals handing the EKG were more likely to give them to an attending of the same sex as themselves (p<0.001). Results suggest that the ED nursing staff is more likely to consult a male physician for interpretation if an EKG is unassigned. Hospital-based interventions which address implicit bias may be warranted.