Emergency department condition acuity, length of stay, and revisits among deaf and hard‐of‐hearing patients: A retrospective chart review

Abstract

Objective: Deaf and hard-of-hearing (DHH) patients are understudied in emergency medicine health services research. Theory and limited evidence suggest that DHH patients are at higher risk of emergency department (ED) utilization and poorer quality of care. This study assessed ED condition acuity, length of stay (LOS), and acute ED revisits among DHH patients. We hypothesized that DHH patients would experience poorer ED care outcomes. Methods:We conducted a retrospective chart review of a single health care system using data from a large academic medical center in the southeast United States. Data were received from the medical center's data office, and we sampled patients and encounters from between June 2011 and April 2020. We compared DHH American Sign Language (ASL) users (n = 108), DHH English speakers (n = 358), and non-DHH English speakers (n = 302). We used multilevel modeling to assess the differences among patient segments in outcomes related to ED use and care.Results: As hypothesized, DHH ASL users had longer ED LOS than non-DHH English speakers, on average 30 min longer. Differences in ED condition acuity, measured through Emergency Severity Index and triage pain scale, were not statistically significant. DHH English speakers represented a majority (61%) of acute ED revisit encounters.

Emergency department patient‐centred care perspectives from deaf and hard‐of‐hearing patients

“…This study reports findings from a qualitative aim of an explanatory sequential mixed‐methods study. Quantitative outcomes of the parent study focused on ED utilization 26 and on condition acuity, triage pain ratings, ED LOS and acute ED revisits 28 . Our qualitative data contextualize these results.…”

“…ED length of stay: DHH ASL‐users had, on average, longer ED LOS (by 30 min) compared to non‐DHH English speakers. There was no difference in ED LOS when comparing DHH and non‐DHH English speakers 28 …”

“…Specifically, we developed purposeful sampling criteria to best capture and explain quantitative findings; in addition, the interview guide was developed using quantitative results. Quantitative findings 26,28 and methodological innovations 36 from this study are published elsewhere. We will explain and contextualize our previous quantitative findings by exploring participants' experiences using qualitative descriptions 41,42 .…”

Integrating Transformative Considerations and Quantitative Results Through a Participant Selection Joint Display in Explanatory Sequential Mixed Methods Studies

“…Statistical results indicated that DHH ASL-users and DHH English-speakers had higher rates of ED utilization than non-DHH English-speakers (James, McKee, et al, 2022; James, Miller, et al, 2022). Two analyses provided insights for qualitative sampling priorities: sub-group analyses, and descriptive results on primary diagnosis for using the emergency department.…”

“…Quantitative data were from electronic health records of patients who used the emergency department at a large academic medical center in the southeastern United States. The methods and results of the quantitative phase have been published elsewhere (James, McKee, et al, 2022; James, Miller, et al, 2022). Qualitative data were from in-depth semi-structured interviews with DHH people who use ASL and English to communicate, who self-reported being patients at the sampled emergency departments during the 3 years prior to the study.…”