709 - At the Intersection of Race and Disease: Increased Utilization of Behavioral Event Response Teams for Pediatric Patients with Sickle Cell Disease

Angela Amaniampong, Children's Hospital of Philadelphia, philadelphia, PA, United States; Julia LaMotte, Indiana University School of Medicine/Riley Children's Health, Indianapolis, IN, United States; Rachel Peterson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Recent events have prompted hospital systems to critically evaluate policies that may disparately impact marginalized populations. Patients with sickle cell disease (SCD) are predominantly of African descent and often face racial biases that affect their care. Many hospitals have established Behavioral Event Response Teams (BERTs) to address patient agitation and improve workplace safety.

Objective: Our study aimed to investigate racial disparities in the utilization of BERTs within a pediatric hematology and oncology (HO) service.

Design/Methods: Retrospective chart reviews of inpatient BERT alerts were collected from the electronic health record (EHR) from January 2018 to December 2020. Data were sourced from hospital police records and cross-verified with EHR notes including demographic, payor, and primary diagnosis at the time of the alert. BERT alerts that occurred on the HO service were included. Admission diagnosis was categorized as follows; Hematology (non-SCD; HEM), Leukemia/Lymphoma (LL), Neuro-Oncology/Solid Tumor (NOS), and SCD. Outpatient disease team census data was used to capture broad population size. Descriptive statistics, chi-squared, and odds/likelihood ratios were performed using SPSS v29.0.2.

Results: 51 BERT alerts occurred, representing 32 unique patients with an average of 1 alert per patient (range 1-7). All disease groups had a patient receive a BERT alert: HEM (n=2), LL (n=10), NOS (n=13), and SCD (n=26). Patients with SCD represented 22% of the broad HO population but accounted for 51% of alerts called in the inpatient setting. BERT alerts were 3.7x more likely for patients with SCD (100% Black) compared to patients without SCD (16% Black), X2 (1, N=51)=37.128, p<.001, LR=47.12, p = <.001.

Conclusion(s): Patients with SCD were 3.7 times more likely to receive BERT alerts compared to all children on the HO unit and were disproportionately represented among all Black patients within the unit receiving BERT alerts (86.67%). Black patients are often wrongly perceived as threatening, aggressive, or even drug-seeking, a bias that is often amplified for patients with SCD during times of pain crises. Research suggests that police involvement in hospitals is associated with poorer health outcomes for Black youth. Understanding the intersection between race and a disease whose hallmark symptom is pain is crucial for eliminating inequities in care and advancing health equity. Part of this effort should include an assessment of whether BERTs disproportionately impact care delivery for historically marginalized populations, reinforcing structural racism and perpetuating systemic inequities.

Table 1: Demographic Data of all Behavioral Event Response Team Alerts


Table 1: Demographic Data of all Behavioral Event Response Team Alerts