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Chu JN, Wong J, Bardach NS, Allen IE, Barr-Walker J, Sierra M, Sarkar U, Khoong EC. Association between language discordance and unplanned hospital readmissions or emergency department revisits: a systematic review and meta-analysis. BMJ Qual Saf 2024; 33:456-469. [PMID: 38160059 PMCID: PMC11186734 DOI: 10.1136/bmjqs-2023-016295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Studies conflict about whether language discordance increases rates of hospital readmissions or emergency department (ED) revisits for adult and paediatric patients. The literature was systematically reviewed to investigate the association between language discordance and hospital readmission and ED revisit rates. DATA SOURCES Searches were performed in PubMed, Embase and Google Scholar on 21 January 2021, and updated on 27 October 2022. No date or language limits were used. STUDY SELECTION Articles that (1) were peer-reviewed publications; (2) contained data about patient or parental language skills and (3) included either unplanned hospital readmission or ED revisit as one of the outcomes, were screened for inclusion. Articles were excluded if: unavailable in English; contained no primary data or inaccessible in a full-text form (eg, abstract only). DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data using Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for scoping reviews guidelines. We used the Newcastle-Ottawa Scale to assess data quality. Data were pooled using DerSimonian and Laird random-effects models. We performed a meta-analysis of 18 adult studies for 28-day or 30-day hospital readmission; 7 adult studies of 30-day ED revisits and 5 paediatric studies of 72-hour or 7-day ED revisits. We also conducted a stratified analysis by whether access to interpretation services was verified/provided for the adult readmission analysis. MAIN OUTCOMES AND MEASURES Odds of hospital readmissions within a 28-day or 30-day period and ED revisits within a 7-day period. RESULTS We generated 4830 citations from all data sources, of which 49 (12 paediatric; 36 adult; 1 with both adult and paediatric) were included. In our meta-analysis, language discordant adult patients had increased odds of hospital readmissions (OR 1.11, 95% CI 1.04 to 1.18). Among the 4 studies that verified interpretation services for language discordant patient-clinician interactions, there was no difference in readmission (OR 0.90, 95% CI 0.77 to 1.05), while studies that did not specify interpretation service access/use found higher odds of readmission (OR 1.14, 95% CI 1.06 to 1.22). Adult patients with a non-dominant language preference had higher odds of ED revisits (OR 1.07, 95% CI 1.004 to 1.152) compared with adults with a dominant language preference. In 5 paediatric studies, children of parents language discordant with providers had higher odds of ED revisits at 72 hours (OR 1.12, 95% CI 1.05 to 1.19) and 7 days (OR 1.02, 95% CI 1.01 to 1.03) compared with patients whose parents had language concordant communications. DISCUSSION Adult patients with a non-dominant language preference have more hospital readmissions and ED revisits, and children with parents who have a non-dominant language preference have more ED revisits. Providing interpretation services may mitigate the impact of language discordance and reduce hospital readmissions among adult patients. PROSPERO REGISTRATION NUMBER CRD42022302871.
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Affiliation(s)
- Janet N Chu
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeanette Wong
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Naomi S Bardach
- Pediatrics, University of California San Francisco, San Francisco, California, USA
- Philip R Lee Institute for Health Policy Studies, San Francisco, California, USA
| | - Isabel Elaine Allen
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jill Barr-Walker
- Zuckerberg San Francisco General Hospital and Trauma Center Library, San Francisco, California, USA
| | - Maribel Sierra
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Tendo, San Francisco, California, USA
| | - Urmimala Sarkar
- Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Elaine C Khoong
- Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Brewster RCL, Gonzalez P, Khazanchi R, Butler A, Selcer R, Chu D, Aires BP, Luercio M, Hron JD. Performance of ChatGPT and Google Translate for Pediatric Discharge Instruction Translation. Pediatrics 2024:e2023065573. [PMID: 38860299 DOI: 10.1542/peds.2023-065573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients who speak languages other than English face barriers to equitable healthcare delivery. Machine translation systems, including emerging large language models, have the potential to expand access to translation services, but their merits and limitations in clinical practice remain poorly defined. We aimed to assess the performance of Google Translate and ChatGPT for multilingual translation of pediatric discharge instructions. METHODS Twenty standardized discharge instructions for pediatric conditions were translated into Spanish, Brazilian Portuguese, and Haitian Creole by professional translation services, Google Translate and ChatGPT-4.0, and evaluated for adequacy (preserved information), fluency (grammatical correctness), meaning (preserved connotation), and severity (clinical harm), along with assessment of overall preference. Domain-level ratings and preferred translation source were summarized with descriptive statistics and compared with professional translations. RESULTS Google Translate and ChatGPT demonstrated similar domain-level ratings to professional translations for Spanish and Portuguese. For Haitian Creole, compared with both Google Translate and ChatGPT, professional translations demonstrated significantly greater adequacy, fluency meaning, and severity scores. ChatGPT (33.3%, P < .001) and Google Translate (23.3%, P = .024) contained more potentially clinically significant errors (severity score ≤3) for Haitian Creole than professional translations (8.3%). Professional Haitian Creole (48.3%) and Portuguese (43.3%), but not Spanish (15%), translations were most frequently preferred among translation sources. CONCLUSIONS Machine translation platforms have comparable performance to professional translations for Spanish and Portuguese but shortcomings in quality, accuracy, and preference persist for Haitian Creole. Diverse multilingual training data are needed, along with regulations ensuring safe and equitable applications of machine translation in clinical practice.
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Affiliation(s)
- Ryan C L Brewster
- Boston Combined Residency Program in Pediatrics at Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Priscilla Gonzalez
- Boston Combined Residency Program in Pediatrics at Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Rohan Khazanchi
- Departments of Pediatrics
- Internal Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts
- FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts; and
| | - Alex Butler
- Boston Combined Residency Program in Pediatrics at Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Raquel Selcer
- Departments of Pediatrics
- Internal Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts
| | - Derrick Chu
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Barbara Pontes Aires
- Boston Combined Residency Program in Pediatrics at Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
- Departments of Pediatrics
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | - Marcella Luercio
- Departments of Pediatrics
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan D Hron
- Departments of Pediatrics
- Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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3
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Yang S, Barwise A, Perrucci A, Bartz D. Equitable abortion care for patients with non-English language preference. Contraception 2024; 133:110389. [PMID: 38354764 DOI: 10.1016/j.contraception.2024.110389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Sherry Yang
- Harvard Medical School, Boston, MA, United States; Harvard Kennedy School of Government, Cambridge, MA, United States
| | - Amelia Barwise
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States
| | - Alissa Perrucci
- Women's Options Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States
| | - Deborah Bartz
- Harvard Medical School, Boston, MA, United States; Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States.
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Michelson KA, McGarghan FLE, Patterson EE, Samuels-Kalow ME, Waltzman ML, Greco KF. Delayed diagnosis of serious paediatric conditions in 13 regional emergency departments. BMJ Qual Saf 2024; 33:293-300. [PMID: 36180208 DOI: 10.1136/bmjqs-2022-015314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate rates, risk factors and outcomes of delayed diagnosis of seven serious paediatric conditions. METHODS This was a retrospective, cross-sectional study of children under 21 years old visiting 13 community and tertiary emergency departments (EDs) with appendicitis, bacterial meningitis, intussusception, mastoiditis, ovarian torsion, sepsis or testicular torsion. Delayed diagnosis was defined as having a previous ED encounter within 1 week in which the condition was present per case review. Patients with delayed diagnosis were each matched to four control patients without delay by condition, facility and age. Conditional logistic regression models evaluated risk factors of delay. Complications were compared between by delayed diagnosis status. RESULTS Among 14 972 children, delayed diagnosis occurred in 1.1% (range 0.3% for sepsis to 2.6% for ovarian torsion). Hispanic (matched OR 2.71, 95% CI 1.69 to 4.35) and non-Hispanic black (OR 2.40, 95% CI 1.21 to 4.79) race/ethnicity were associated with delayed diagnosis, whereas Asian and other race/ethnicity were not. Public (OR 2.21, 95% CI 1.42 to 3.44) and other (OR 2.43, 95% CI 1.50 to 3.93) insurance were also associated with delay. Non-English language was associated with delay (OR 1.65, 95% CI 1.02 to 2.69). Abnormal vital signs were associated with a lower likelihood of delay (OR 0.15, 95% CI 0.09 to 0.25). In an adjusted model, Hispanic race/ethnicity, other insurance, abnormal vital signs and complex chronic conditions (CCCs) were associated with delay. The odds of a complication were 2.5-fold (95% CI 1.6 to 3.8) higher among patients with a delay. CONCLUSION Delayed diagnosis was uncommon across 13 regional EDs but was more likely among children with Hispanic ethnicity, CCCs or normal vital signs. Delays were associated with a higher risk of complications.
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Affiliation(s)
- Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, South Shore Hospital, Weymouth, Massachusetts, USA
| | - Finn L E McGarghan
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emma E Patterson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Mark L Waltzman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, South Shore Hospital, Weymouth, Massachusetts, USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
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Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med 2024; 83:291-313. [PMID: 38069966 DOI: 10.1016/j.annemergmed.2023.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 10/03/2023] [Accepted: 10/20/2023] [Indexed: 03/24/2024]
Abstract
STUDY OBJECTIVE Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. METHODS This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. RESULTS Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. CONCLUSION Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.
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Affiliation(s)
- Sana Amjad
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Tromburg
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Adesunkanmi
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jannatul Mawa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazif Mahbub
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, Queen's University; Kingston, Ontario, Canada.
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Lim PS, Fortier MA, Bender M, Campos B, Heyming T, Kain ZN. Language barriers and pain disparities in pediatric emergency settings: A call for action. Acad Emerg Med 2024. [PMID: 38497351 DOI: 10.1111/acem.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Paulina S Lim
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, USA
| | - Michelle A Fortier
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, USA
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Children's Hospital of Orange County, Irvine, California, USA
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | - Belinda Campos
- Chicano/Latino Studies, University of California, Irvine, California, USA
| | - Theodore Heyming
- Emergency Medicine, Children's Hospital of Orange County, Orange, California, USA
| | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, USA
- Children's Hospital of Orange County, Irvine, California, USA
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Lowe JT, Leonard J, Dominguez F, Widmer K, Deakyne Davies SJ, Wiersma AJ, Mendenhall M, Grubenhoff JA. Preferred language and diagnostic errors in the pediatric emergency department. Diagnosis (Berl) 2024; 11:49-53. [PMID: 37795819 DOI: 10.1515/dx-2023-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES To investigate the relationship between language and diagnostic errors (DxE) in the pediatric emergency department (ED). METHODS Electronic trigger identified ED encounters resulting in unplanned hospital admission that occurred within 10 days of an index visit from January 2018 through February 2022. Manual screening of each triggered encounter identified cases where the index visit diagnosis and hospitalization discharge diagnosis differed, and these were screened in for review using the Revised Safer Dx instrument to determine if a diagnostic error (DxE) occurred. Non-English primary language (NEPL) and English-proficient (EP) groups were established based on caregiver language. The primary outcome was the proportion of DxE each group. Data were analyzed using univariate analysis and multivariable logistic regression to identify independent predictors of DxE. RESULTS Electronic trigger identified 3,551 patients, of which 806 (22.7 %) screened in for Safer Dx review. 172 (21.3 %) experienced DxE. The proportion of DxE was similar between EP and NEPL groups (21.5 vs. 21.7 %; p=0.97). Age≥12 years and fewer prior admissions in the preceding 6 months predicted higher odds of DxE. NEPL did not predict higher odds of DxE. CONCLUSIONS NEPL was not associated with increased odds DxE resulting in unplanned admission.
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Affiliation(s)
| | - Jan Leonard
- Children's Hospital of Philadelphia, Philadelphia, PN, USA
| | | | - Kaitlin Widmer
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | | | - Alexandria J Wiersma
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Marcela Mendenhall
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Joseph A Grubenhoff
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
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AlSaeed H, Sucha E, Bhatt M, Mitsakakis N, Bresee N, Bechard M. Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada. CAN J EMERG MED 2024; 26:119-127. [PMID: 38117415 DOI: 10.1007/s43678-023-00625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital. METHODS We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children's Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits. RESULTS There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity. CONCLUSIONS Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.
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Affiliation(s)
- Habeeb AlSaeed
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Maala Bhatt
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Natalie Bresee
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Melanie Bechard
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
- University of Ottawa, Ottawa, ON, Canada.
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Ruiz Colón GD, Pizzitola RJ, Grant GA, Prolo LM. Disparities in Postoperative Communication Patterns Among Spanish-speaking Pediatric Patients with Hydrocephalus. J Pediatr 2023; 263:113678. [PMID: 37611737 DOI: 10.1016/j.jpeds.2023.113678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To determine if differences exist in postoperative communication patterns or healthcare use among English-speaking patients (ESPs) and Spanish-speaking patients (SSPs) with childhood hydrocephalus. STUDY DESIGN A single-institution, retrospective cohort study was conducted. Through simple random sampling, 50 ESPs and 50 SSPs (<18 years old) who underwent a ventriculoperitoneal shunt or endoscopic third ventriculostomy were identified. Demographics, communication with clinic (eg, number of calls or messages postoperatively), and healthcare use were collected. Multiple linear regressions assessed the significance of predictors on communication frequency and use. RESULTS SSPs were more likely to have a comorbidity and ventriculoperitoneal shunt than ESPs. SSPs had longer median postoperative length of stay (P < .01) and 30-day readmission rate (P < .01) than ESPs. Only 18% of SSPs communicated with clinic; 11 total calls or messages were from SSPs vs 57 from ESPs (P < .01). The most common reason for outreach among both cohorts was a new symptom. ESP outreach most frequently resulted in reassurance or medical course changes on an outpatient basis (30% ESPs vs 0% SSPs; P = .04), whereas SSP outreach most frequently resulted in guidance to present to the emergency department (3% ESPs vs 36% SSPs; P < .01). Language remained a significant predictor for number of calls or messages, even after adjusting for comorbidity, operation type, and insurance (P < .01). CONCLUSIONS Despite having more complex disease, only 18% of SSPs communicated with the neurosurgical team postoperatively and were more frequently sent to the emergency department for management. Future research will explore communication barriers and preferences to ensure postoperative care is timely and patient centered.
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Affiliation(s)
| | - Rebecca J Pizzitola
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA; Department of Neurosurgery, Duke University School of Medicine, Durham, NC
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA; Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Palo Alto, CA.
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Segal KR, Gomez JA, Schulz JF, Alvandi LM, Fornari ED. The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management. Hosp Pediatr 2023; 13:1001-1009. [PMID: 37850258 DOI: 10.1542/hpeds.2023-007232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85). CONCLUSIONS As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
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Bower SM, Campbell RL, Mullan AF, Heaton HA, Lim TG, Bellamkonda VR, Lichen IM, Jones DD. Association of limited English proficiency with emergency department irregular departures and return visits: A cross-sectional cohort study in the Upper Midwest between January 2018 and December 2021. Acad Emerg Med 2023; 30:1002-1012. [PMID: 37282847 PMCID: PMC10592595 DOI: 10.1111/acem.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/06/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Patients with limited English proficiency (LEP) have been shown to experience disparities in emergency department (ED) care. The objectives of this study were to examine the associations between LEP and irregular ED departures and return ED visits. METHODS We conducted a multicenter cross-sectional analysis of 18 EDs within an integrated health system in the upper Midwest from January 1, 2018, to December 31, 2021. ED visits of pediatric and adult patients who were discharged on the index visit were included for analysis. We analyzed the association of LEP with irregular departures, 72-h and 7-day return visits, and ED disposition at the time of that return visit. Multivariable model associations were calculated using generalized estimating equations and reported as odds ratios (OR) with 95% confidence intervals (CIs). RESULTS A total of 745,464 total ED visits were analyzed, including 27,906 (3.7%) visits among patients with LEP. The most common preferred languages among patients with LEP were Spanish (12,759; 45.7%), Somali (4978; 17.8%), and Arabic (3185; 11.4%). After multivariable adjustment there were no differences in proportions of irregular departures (OR 1.09, 95% CI 0.99-1.21), 72-h returns (OR 0.99, 95% CI 0.92-1.06), or 7-day returns (OR 0.99, 95% CI 0.93-1.05) between patients with LEP or English proficiency. Patients with LEP returning within 72 h (OR 1.19, 95% CI 1.01-1.40) and 7 days (OR 1.15, 95% CI 1.01-1.33) were more likely to be admitted to the hospital. CONCLUSIONS After multivariable adjustment, we did not find an increased frequency of irregular ED departures or 72-h or 7-day returns among patients with LEP compared with people proficient in English. However, we did find that higher proportions of patients with LEP were admitted to the hospital at the time of the return ED visit.
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Affiliation(s)
- Sarah M Bower
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Heather A Heaton
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas G Lim
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Isabella M Lichen
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Derick D Jones
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
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12
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Brumbaugh JE, Tschida‐Reuter DJ, Barwise AK. Meeting the needs of the patient with non-English language preference in the hospital setting. Health Serv Res 2023; 58:965-969. [PMID: 37580055 PMCID: PMC10480083 DOI: 10.1111/1475-6773.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Amelia K. Barwise
- Program in Biomedical Ethics Research and Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
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13
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Rees CA, Stewart AM, Portillo EN, Mehta S, Avakame E, Jackson J, McKay J, Michelson KA, Duggan CP, Fleegler EW. Reporting of Important Social Determinants of Health in Pediatric Clinical Trials. Am J Prev Med 2023; 64:918-926. [PMID: 36610922 PMCID: PMC10200735 DOI: 10.1016/j.amepre.2022.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The objective of this study was to determine the rates and trends in the reporting of preferred language, socioeconomic factors, sexual orientation, and gender identity in published pediatric clinical trials. METHODS A cross-sectional study of pediatric clinical trials conducted in the U.S. published from January 1, 2011 through December 31, 2020 in 5 general pediatric and 5 general medical journals with the highest impact factor in their respective fields was performed. Outcomes were reporting of preferred language, socioeconomic factors, sexual orientation, and gender identity. In late 2021, descriptive statistics and logistic regression to understand how reporting of preferred language and socioeconomic factors changed over time were performed. RESULTS Of 612 trials, 29.6% (n=181) reported preferred language. Among these, 64.6% (n=117 of 181) exclusively enrolled participants whose preferred language was English. From 2011 to 2020, there was a relative increase in the reporting of preferred language (8.6% per year, 95% CI=1.8, 16.0). Socioeconomic factors were reported in 47.9% (n=293) of trials. There was no significant change in the reporting of socioeconomic factors (8.2% per year, 95% CI= -1.9, 15.1). Only 5.1% (9 of 179) of published trial results among adolescent participants reported any measure of sexual orientation, and 1.1% (2 of 179) reported gender identity. CONCLUSIONS Preferred language, socioeconomic factors, sexual orientation, and gender identity were infrequently reported in pediatric clinical trial results despite these characteristics being increasingly recognized as social determinants of health. To achieve more inclusiveness and to reduce unmeasured disparities, these characteristics should be incorporated into routine trial registration, design, funding decisions, and reporting.
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Affiliation(s)
- Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Amanda M Stewart
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elyse N Portillo
- Division of Emergency Medicine, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Sagar Mehta
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Elorm Avakame
- NewYork Presbyterian Hospital, Columbia University, New York City, New York
| | - Jasmyne Jackson
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jheanelle McKay
- Joe DiMaggio Children's Hospital, Memorial Healthcare System, Miami, Florida
| | - Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Duggan
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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14
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Rojas CR, Chamberlain JM, Cohen JS, Badolato GM, Cook LJ, Goyal MK, Berkowitz D. Undertriage for Children With Caregivers Preferring Languages Other Than English. Pediatrics 2023:191273. [PMID: 37190962 DOI: 10.1542/peds.2022-059386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES Undertriage, the underestimation of acuity, can result in delayed care and potential morbidity in the emergency department (ED). Although inequities in ED care based on language preference have been noted, little is known about its association with undertriage. We evaluated for differences in undertriage based on caregiver language preference. METHODS This was a retrospective cross-sectional study of patients aged younger than 21 years, triaged as Emergency Severity Index (ESI) level 4 or 5 (nonurgent), to the pediatric ED from January 1, 2019, through January 31, 2021. Indicators of undertriage were defined as hospital admission, significant ED resource use, or return visits with admission. We used logistic regression with generalized estimating equations to measure the association of preferred language with undertriage. RESULTS Of 114 266 ED visits included in the study, 22 525 (19.8%) represented patients with caregivers preferring languages other than English. These children were more likely to experience undertriage compared with those with caregivers preferring English (3.7% [English] versus 4.6% [Spanish] versus 5.9% [other languages]; Spanish versus English: odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4] and other languages versus English: OR, 1.6; 95% CI, 1.2-2.2). Differences remained after adjusting for sex, insurance, mode of arrival, and clustering by triage nurse (Spanish versus English: adjusted OR, 1.3; 95% CI, 1.3-1.5) and other languages versus English: adjusted OR, 1.6; 95% CI, 1.2-2.2). CONCLUSIONS Children accompanied by caregivers preferring languages other than English are more likely to be undertriaged in the pediatric ED. Efforts to improve the triage process are needed to promote equitable care for this population.
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Affiliation(s)
- Christina R Rojas
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Joanna S Cohen
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Gia M Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Lawrence J Cook
- University of Utah Department of Pediatrics, Salt Lake City, Utah
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
| | - Deena Berkowitz
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and
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15
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Hartford EA, Thomas AA, Kerwin O, Usoro E, Yoshida H, Burns B, Rutman LE, Migita R, Bradford M, Akhter S. Toward Improving Patient Equity in a Pediatric Emergency Department: A Framework for Implementation. Ann Emerg Med 2023; 81:385-392. [PMID: 36669917 DOI: 10.1016/j.annemergmed.2022.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Abstract
Disparities in health care delivery and health outcomes for patients in the emergency department (ED) by race, ethnicity, and language for care (REaL) are common and well documented. Addressing inequities from structural racism, implicit bias, and language barriers can be challenging, and there is a lack of data on effective interventions. We describe the implementation of a multifaceted equity improvement strategy in a pediatric ED using Kotter's model for change as a framework to identify the key drivers. The main elements included a data dashboard with quality metrics stratified by patient self-reported REaL to visualize disparities, a staff workshop on implicit bias and microaggressions, and several clinical and operational tools that highlight equity. Our next steps include refining and repeating interventions and tracking important patient outcomes, including timely pain treatment, triage assessment, diagnostic evaluations, and interpreter use, with the overall goal of improving patient equity by REaL over time. This article presents a roadmap for a disparity reduction intervention, which can be part of a multifaceted approach to address health equity in EDs.
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Affiliation(s)
- Emily A Hartford
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA.
| | - Anita A Thomas
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | - Olivia Kerwin
- Seattle Children's Hospital Emergency Department, Seattle, WA, USA
| | - Etiowo Usoro
- Seattle Children's Hospital Emergency Department, Seattle, WA, USA
| | - Hiromi Yoshida
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | - Brian Burns
- Seattle Children's Hospital Emergency Department, Seattle, WA, USA
| | - Lori E Rutman
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | - Russell Migita
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
| | | | - Sabreen Akhter
- University of Washington, Department Pediatrics, Division of Emergency Medicine, Seattle, WA, USA
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16
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Lee LK, Ellison A. The Responsibility of Addressing Health Disparities in Emergency Medicine. Ann Emerg Med 2023; 81:393-395. [PMID: 36841660 DOI: 10.1016/j.annemergmed.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA.
| | - Angela Ellison
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Health Equity, Children's Hospital of Philadelphia, Philadelphia, PA
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17
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Rosenberg SI, Chu Y, Ouweleen AJ, Hall TB, Patel NM. Is Preferred Language Other Than English Associated With Delayed Surgery After ACL Injury in Children and Adolescents? Clin Orthop Relat Res 2023; 481:292-298. [PMID: 36073983 PMCID: PMC9831159 DOI: 10.1097/corr.0000000000002359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have investigated the impact of social determinants of health, such as the type of healthcare insurance and household income, on children and adolescents with ACL tears. However, despite the increasing incidence of ACL injury in young patients and a substantial proportion of families who may prefer languages other than English, the relationship between language and clinical care remains unclear. QUESTIONS/PURPOSES To investigate the relationship between language and the care of children and adolescents with ACL tears, we asked: (1) Is a preferred language other than English (PLOE) associated with a delay between ACL injury and surgery? (2) Is a PLOE associated with a greater odds of a patient experiencing a meniscal tear and undergoing a meniscectomy than in those who prefer English? METHODS We treated 591 patients surgically for ACL injuries between 2011 and 2021. Of those, we considered patients aged 18 years or younger who underwent primary ACL reconstruction for this retrospective, comparative study. Five percent (31 of 591) of patients were excluded because the date of injury was not clearly documented, 2% (11 of 591) were revision reconstructions, and 1% (6 of 591) underwent procedures that were intentionally delayed or staged, leaving 92% (543 of 591) for analysis. The mean age was 16 ± 2 years, and 51% (276 of 543) of patients were boys. The family's preferred language was noted, as were demographic data, time between injury and surgery, and intraoperative findings. A language other than English was preferred by 21% (113 of 543) of patients. Of these, 94% (106 of 113) preferred Spanish. In a univariate analysis, we used independent-samples t-tests, Mann-Whitney U-tests, and Fisher exact tests, as appropriate. Purposeful-entry multivariable regression analyses were used to determine whether PLOE was associated with increased time to surgery, concomitant meniscus injury, or performance of meniscectomy while adjusting for confounding variables. Variables were included in multivariable models if they met the threshold for statistical significance in univariate testing (p < 0.05). RESULTS The median time between injury and ACL reconstruction was shorter in families who preferred English compared with those with a PLOE (69 days [IQR 80] versus 103 days [IQR 107)]; p < 0.001). After controlling for potentially confounding variables like insurance and age, we found that patients whose families had a PLOE had greater odds of undergoing surgery more than 60 days after injury (OR 2.2 [95% CI 1.3 to 3.8]; p = 0.005) and more than 90 days after injury (OR 1.8 [95% CI 1.1 to 2.8]; p = 0.02). After controlling for insurance, age, and other factors, PLOE was not associated with surgical delay beyond 180 days, concomitant meniscal tears, or performance of meniscectomy. CONCLUSION In this study of children and adolescents undergoing primary ACL reconstruction, patients whose families prefer a language other than English experienced a longer delay between injury and surgery. In areas with a large proportion of families with a PLOE, partnerships with primary care clinicians, emergency departments, schools, athletic teams, and community organizations may improve efficiency in the care of children with ACL injuries. Clinicians proficient in other languages, reliable interpreter services, and translated references and resources may also be impactful. Our results suggest a need for further research on the experiences, needs, and long-term outcomes of these patients, as well as the association of preferred language with results after surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | - Yuyang Chu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Tyler B. Hall
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Neeraj M. Patel
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Orthopaedic Surgery and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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18
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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, Calder LA. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf 2022; 31:806-817. [PMID: 35853646 PMCID: PMC9606537 DOI: 10.1136/bmjqs-2021-014608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/02/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care.
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Affiliation(s)
- Amy C Plint
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda S Newton
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Antonia Stang
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Zach Cantor
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Boutis
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Serge Gouin
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Quynh Doan
- Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Gary Joubert
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Scott Sawyer
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Tyrus Crawford
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Maala Bhatt
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick Weldon
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Millar
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandy Tse
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gina Neto
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simran Grewal
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Melissa Chan
- Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kevin Chan
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Grant Yung
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Jennifer Kilgar
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Tim Lynch
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dale Dalgleish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ken Farion
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - David W Johnson
- Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa A Calder
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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19
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Beams DR, Chorney SR, Kou YF, Teplitzky TB, Wynings EM, Johnson RF. Emergency Department Visits and Hospitalizations After Pediatric Tracheostomy. Laryngoscope 2022. [PMID: 36177909 DOI: 10.1002/lary.30416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine factors associated with frequent emergency department (ED) visits and hospitalizations after pediatric tracheostomy. METHODS A prospective cohort of children (<18 years) with a tracheostomy placed at a tertiary children's hospital between 2015 and 2019 were followed for 24 months after index discharge. ED visits and hospitalizations were recorded to identify risk factors for frequent utilization (≥4 visits). RESULTS A total of 239 children required 1285 total visits to the ED or hospital after index discharge with 112 children (47%) having ≥4 visits. Respiratory-related illness was the most common reason (N = 699, 54%) followed by gastrostomy tube issues (N = 119, 9.3%). Frequent utilization was associated with Black race (OR: 2.01, 95% CI: 1.18-3.70, p = 0.01), mechanical ventilation (OR: 2.74, 95% CI: 1.35-5.59, p = 0.006), and Spanish language (OR: 3.86, 95% CI: 1.47-10.11, p = 0.006) on regression modeling. There were no predictors of visits for tracheostomy-related complications, which accounted for 4.8% of all encounters. A sub-analysis showed that Hispanic ethnicity and gestational age predicted visits for respiratory failure. CONCLUSION Frequent ED visits or hospitalizations are required for 47% of children in the first 2 years after tracheostomy placement. Ventilatory support, Black race, and Spanish language increase the likelihood of high utilization. Although tracheostomy-related visits are uncommon, strategies to anticipate and decrease respiratory-related admissions may have the most impact. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Dylan R Beams
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, U.S.A
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children Medical Center Dallas, Dallas, Texas, U.S.A
| | - Yann-Fuu Kou
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children Medical Center Dallas, Dallas, Texas, U.S.A
| | - Taylor B Teplitzky
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, U.S.A
| | - Erin M Wynings
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, U.S.A
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children Medical Center Dallas, Dallas, Texas, U.S.A
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20
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Villalona S, Castañeda H, Wilson JW, Romero-Daza N, Yanez Yuncosa M, Jeannot C. Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care. HISPANIC HEALTH CARE INTERNATIONAL 2021; 21:60-67. [PMID: 34931564 DOI: 10.1177/15404153211067685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews (n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site (n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.
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Affiliation(s)
- Seiichi Villalona
- 12287Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Heide Castañeda
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Jason W Wilson
- Emergency Department, 7829Tampa General Hospital, Tampa, FL, USA.,Department of Internal Medicine, Morsani College of Medicine at the University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL, USA
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