Physician Perceptions of the Evaluation and Management of Incarcerated Patients in the Emergency Department

BACKGROUND: Incarcerated patients in the United States are frequently seen in the emergency department. Although other specialties have reported differential care for patients who are incarcerated, little is known about the emergency physicians' evaluation and management of patients who are incarcerated. OBJECTIVE: The aim of our study was to characterize emergency physician (EP) perceptions of the emergency department (ED) care of incarcerated patients. METHODS: We surveyed emergency medicine resident and attending physicians at three academic safety-net EDs that regularly treat incarcerated patients from May to June 2023. We conducted thematic analysis of responses about perceptions of ED evaluation and management of incarcerated patients. RESULTS: There were 80 total completed surveys, comprising a 27% response rate of full-time staff across three institutions. Three major themes emerged. First, participants perceived structural and interpersonal bias against incarcerated patients while in the ED. Second, while participants overall reported differences in ED care of incarcerated patients, there was mixed consensus about whether EPs conducted more abbreviated workups or utilized more testing and imaging. Third, participants reported uncertainty regarding best practices for interacting with law enforcement and confusion regarding coordination of care with sending/receiving correctional facilities. CONCLUSION: Our study found that EPs reported bias against incarcerated patients, lack of consensus describing current and best practices for ED care of incarcerated patients, and uncertainty regarding law enforcement and coordination of care. Further research is needed to address bias, elucidate EP practice patterns and outcomes of incarcerated patients, and establish best practices.