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

Abstract

ObjectiveThe aim of the study was to investigate the association between primary language and length of stay (LOS) in the pediatric emergency department (ED) within the context of known disparities impacting healthcare experiences and outcomes for patients with language barriers.MethodsWe conducted a retrospective cohort study of consecutive encounters of patients presenting to, and discharged from, an urban pediatric ED from May 2015 through April 2018. Encounters were grouped into English primary language (EPL), Spanish (SPL), and other (OPL). Mean LOS comparisons were stratified by Emergency Severity Index (ESI). Bivariate and multivariate analyses were used to examine the relationship between LOS and variables, including age, sex, race/ethnicity, insurance, and time of presentation.ResultsA total of 139,163 encounters were included. A higher proportion of SPL and OPL encounters were characterized as lower ESI acuity compared with EPL. Significantly longer LOS for SPL and OPL encounters was observed in the 2 lower acuity strata. The ESI 4–5 stratum demonstrated the greatest LOS disparity between EPL, SPL, and OPL (94 vs 103 vs 103 minutes, respectively, P < 0.001). In the highest acuity stratum, ESI 1–2, there was a nonsignificant trend toward longer LOS among EPL encounters (P = 0.08). The multivariate model accounted for 24% of LOS variance, but effect sizes were small for all variables except for ESI and age.ConclusionsPatients with Spanish or other non-EPL who were triaged to lower acuity ESI levels experienced longer LOS in the pediatric ED than English-speaking counterparts. They also used the ED more frequently for low acuity issues, possibly reflecting disparities in access to primary care.

The Impact of Patients' Primary Language on Inpatient Gastrointestinal Bleeding Outcomes

“…Cataneo et al (10), using the National Health Interview Survey, showed that patients with limited English proficiency (particularly those who identified as Hispanic) had lower rates of fecal occult blood sampling for colorectal cancer screening, lower rates of physician recommendation for colonoscopy, and lower rates of receiving screening colonoscopies. In the emergency department, Spanish-speaking patients have been shown to receive lower acuity triage scores using the Emergency Severity Index compared with English-speaking patients (11). Lee et al (12) showed that patients with limited English proficiency had longer stay for medical diagnoses such as stroke and coronary artery disease but also for major surgical procedures.…”

Improving Wait Times for Children with Caregivers with Limited English Proficiency in the Emergency Department

“…Previous studies have demonstrated the importance of medical interpreter services on patient satisfaction, quality of care, and outcomes. 5 , 6 Other studies have primarily focused on describing the problem, cost variation, testing, diagnosis, or adverse events’ increase. Limited research exists on systems-level interventions to improve care delivery.…”

“…In 2019, 13% of US children lived with at least one parent with limited English proficiency (LEP), defined as speaking English less than “very well.” 1 Patients with limited English proficiency are more likely to experience safety events, worse outcomes, and increased hospital lengths of stay (LOSs) when compared with non-LEP patients. 2–6 Eliminating health care disparities is one of the top national research priorities.…”

“…1 Patients with limited English proficiency are more likely to experience safety events, worse outcomes, and increased hospital lengths of stay (LOSs) when compared with non-LEP patients. [2][3][4][5][6] Eliminating health care disparities is one of the top national research priorities. As of 2020, the Hispanic population is the largest LEP population in the US, comprising 18.7% of the total US population.…”