A Reversed Trend: Care for Limited English Proficiency Patients in the Pediatric Emergency Department

Abstract

Objectives. Previous studies in pediatric emergency departments (EDs) showed patients with limited English proficiency (LEP) had gaps in care compared with English-speaking patients. In 2010, the Joint Commission released patient-centered communication standards addressing these gaps. We evaluate the current care of LEP patients in the Children’s Healthcare of Atlanta (CHOA) EDs. Methods. This was a retrospective cohort study of patients <18 years that presented to our EDs in 2016. Length of stay (LOS), change in triage status, return-visit rates, and hospital disposition were compared between patients who requested an interpreter and those who did not. Results. The population included 152,945 patients from 232,787 ED encounters in 2016. Interpreters were requested for 12.1% of encounters. For ED LOS, a model-adjusted difference of 0.77% was found between interpreter groups. For change in triage status, adjusted odds were 7% higher in the interpreter requested cohort. For ED readmission within 7 days, adjusted odds were 3% higher in the interpreter requested cohort. These effect sizes are small (ES < 0.2). Conclusions. Our study showed low ES of the differences in ED metrics between LEP and English-speaking patients, suggesting little clinical difference between the two groups. The impact of this improvement should be further studied.

Disparities in Pediatric Emergency Department Length of Stay and Utilization Associated With Primary Language

“…Consistent with our findings, numerous other studies have reported that NEPL or LEP patients are more frequently triaged to low acuity compared with English-proficient counterparts 5,17–19 . There is ample evidence that LEP families experience poorer access to primary care or a medical home, 36,37 which increases nonurgent ED utilization 38 .…”

“…35 Alternatively, there is evidence suggesting that LOS is comparable for patients with and without language barriers. Most notably, a large pediatric study by Greenky et al, 17 which assumed LEP status if an interpreter was requested, found that LOS was similar between LEP and English-proficient patients after adjusting for ESI. 17 Consistent with our findings, Greenky et al 17 reported that the unadjusted LOS was significantly shorter in their LEP cohort, which was seemingly due to greater frequency of lower acuity presentations among LEP patients.…”

“…Most notably, a large pediatric study by Greenky et al, 17 which assumed LEP status if an interpreter was requested, found that LOS was similar between LEP and English-proficient patients after adjusting for ESI. 17 Consistent with our findings, Greenky et al 17 reported that the unadjusted LOS was significantly shorter in their LEP cohort, which was seemingly due to greater frequency of lower acuity presentations among LEP patients. At least 2 other studies-one based in Canada 18 and the other a small study in an adult ED 22 -did not find LOS disparities.…”

“…Consistent with our findings, numerous other studies have reported that NEPL or LEP patients are more frequently triaged to low acuity compared with English-proficient counterparts. 5,[17][18][19] There is ample evidence that LEP families experience poorer access to primary care or a medical home, 36,37 which increases nonurgent ED utilization. 38 Furthermore, low health literacy-a measure that is related to English proficiency when it comes to navigating the US healthcare system [39][40][41] -has been linked to higher nonurgent ED utilization.…”

“…The primary outcome of interest was mean LOS, which was favored over median LOS to allow for the application of parametric tests and remain comparable with prior studies examining language and ED LOS. 6,17,18,22 Parametric testing is a reasonable approach to large samples regardless of normality and allows for the application of linear regression, which is superior for evaluating confounding variables than the nonparametric equivalent. Length of stay was measured as time in minutes from arrival in the ED to departure.…”