Colleen K Gutman1, Liliana Cousins2, Jesse Gritton3, Eileen J Klein4, Julie C Brown4, Jack Scannell5, K Casey Lion6. 1. Present Address: Department of Pediatrics, Emory University, Atlanta, Ga (CK Gutman); Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion). Electronic address: ckays@emory.edu. 2. Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion). 3. Present Address: American Cancer Society, Seattle, Wash (J Gritton); Center for Child Health, Behavior and Development (J Gritton, J Scannell, and KC Lion). 4. Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion); Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Wash (EJ Klein, JC Brown). 5. Present Address: School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom (J Scannell); Center for Child Health, Behavior and Development (J Gritton, J Scannell, and KC Lion). 6. Department of Pediatrics, University of Washington (CK Gutman, L Cousins, EJ Klein, JC Brown, and KC Lion); Center for Child Health, Behavior and Development (J Gritton, J Scannell, and KC Lion).
Abstract
OBJECTIVE: Families with limited English proficiency (LEP) experience communication barriers and are at risk for adverse events after discharge from the pediatric emergency department (ED). We sought to describe the characteristics of ED discharge communication for LEP families and to assess whether the use of a professional interpreter was associated with provider communication quality during ED discharge. METHODS: Transcripts of video-recorded ED visits for Spanish-speaking LEP families were obtained from a larger study comparing professional interpretation modalities in a freestanding children's hospital. Caregiver-provider communication interactions that included discharge education were analyzed for content and for the techniques that providers used to assess caregiver comprehension. Regression analysis was used to assess for an association between professional interpreter use and discharge education content or assessment of caregiver comprehension. RESULTS: We analyzed 101 discharge communication interactions from 47 LEP patient visits; 31% of communications did not use professional interpretation. Although most patients (70%) received complete discharge education content, only 65% received instructions on medication dosing, and only 55% were given return precautions. Thirteen percent of the patient visits included an open-ended question to assess caregiver comprehension, and none included teach-back. Professional interpreter use was associated with greater odds of complete discharge education content (odds ratio [OR], 7.1; 95% confidence interval [CI], 1.4-37.0) and high-quality provider assessment of caregiver comprehension (OR, 6.1; 95% CI, 2.3-15.9). CONCLUSIONS: Professional interpreter use is associated with superior provider discharge communication behaviors. This study identifies clear areas for improving discharge communication, which may improve safety and outcomes for LEP children discharged from the ED.
OBJECTIVE: Families with limited English proficiency (LEP) experience communication barriers and are at risk for adverse events after discharge from the pediatric emergency department (ED). We sought to describe the characteristics of ED discharge communication for LEP families and to assess whether the use of a professional interpreter was associated with provider communication quality during ED discharge. METHODS: Transcripts of video-recorded ED visits for Spanish-speaking LEP families were obtained from a larger study comparing professional interpretation modalities in a freestanding children's hospital. Caregiver-provider communication interactions that included discharge education were analyzed for content and for the techniques that providers used to assess caregiver comprehension. Regression analysis was used to assess for an association between professional interpreter use and discharge education content or assessment of caregiver comprehension. RESULTS: We analyzed 101 discharge communication interactions from 47 LEP patient visits; 31% of communications did not use professional interpretation. Although most patients (70%) received complete discharge education content, only 65% received instructions on medication dosing, and only 55% were given return precautions. Thirteen percent of the patient visits included an open-ended question to assess caregiver comprehension, and none included teach-back. Professional interpreter use was associated with greater odds of complete discharge education content (odds ratio [OR], 7.1; 95% confidence interval [CI], 1.4-37.0) and high-quality provider assessment of caregiver comprehension (OR, 6.1; 95% CI, 2.3-15.9). CONCLUSIONS: Professional interpreter use is associated with superior provider discharge communication behaviors. This study identifies clear areas for improving discharge communication, which may improve safety and outcomes for LEP children discharged from the ED.
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