OBJECTIVE
We aimed to evaluate the enforcement of a staff-initiated children’s hospital safe sleep policy for evidence of systemic racism.
PATIENTS AND METHODS
Retrospective medical record review of staff-initiated safe sleep policy enactments was performed. Demographic data of infants aged 12 months or younger with an unsafe sleep event (USE) documented in the electronic health record were compared with logistic regression to infants without USEs. Time to escalation of USEs was analyzed using survival analysis. Descriptive statistics were used to compare median number of warnings and outcomes of escalation for each demographic group.
RESULTS
Of 233 infants with USEs, a disproportionate number were Non-Hispanic Black (NHB) (52%) compared with infants without USEs (23% NHB) (P < .01). When adjusting for confounding variables, NHB infants were 2.42 times more likely to have an USE compared with Non-Hispanic white (NHW) infants (OR, 2.42; 95% CI, 1.63–3.58; P < .01). NHW infants had a significantly longer median time between first and second warnings compared with all other groups (P < .01), and the time to fourth warning for NHW infants was over 6 times that for NHB infants. The only instances of USEs that escalated to hospital security involved NHB infants.
CONCLUSION
Disparities suggestive of systemic racism were identified in the enforcement of a children’s hospital safe sleep policy. For hospitals looking to adopt or revise safe sleep policies, the authors suggest careful consideration of potential impacts on already systemically marginalized families. We suggest replacing punitive consequences of policy nonadherence with interventions to facilitate behavior change in the hospital and after discharge.