Limited English Proficiency Patient Education Access Initiative

BACKGROUND: Health disparities among patients with limited English proficiency (LEP) affect quality of care, length of stay, and readmission rates. Effective communication during hospital discharges, including discharge instructions, decreases adverse events in this vulnerable population. The aim of this study is to provide partially or fully translated standardized discharge education materials for an average of 80% of LEP families by December 2018. This study is set in a 44-bed inpatient pediatric unit within an urban children's hospital. Stakeholders include pediatric residents and attending physicians, nursing staff and interpreter services. PROBLEM: A 2016 needs assessment performed via post-discharge telephone calls with families and an electronic survey of nurses identified a lack of discharge materials in families' preferred language as a barrier to care on the inpatient pediatric unit. METHODS: Plan-Do-Study-Act (PDSA) cycles were used for this project. A baseline chart review from February to December 2017 tracked percentages of families who received partially or fully translated discharge instructions in their preferred language. Inclusion criteria were families admitted to the pediatric medical service for one of the five most common medical diagnoses (bronchiolitis, asthma, pneumonia, seizures or gastroenteritis) whose preferred language was Spanish, Portuguese or Arabic. INTERVENTION: Patient education handouts for these five diagnoses were created and translated into Spanish, Portuguese and Arabic, and subsequently made available in the electronic medical record in January 2018. Emails were sent to nursing and residents, and tip sheets were posted on inpatient units regarding integrating handouts into discharge workflow. A second intervention will be implemented based on feedback from stakeholders in July 2018, such as additional education of stakeholders and translation of other parts of discharge instructions including hospital courses and follow up plans. Provision of discharge paperwork in families' preferred language is being tracked during this process via chart review. RESULTS: In February-December 2017, an average of 48% of families received fully translated discharge paperwork and 73% of families received partially or fully translated materials in their preferred non-English language. Post-implementation data in January-March 2018 showed an average of 29% of families received fully translated discharge paperwork and 63% of families