Postdischarge instructions—particularly after surgery—are incredibly important. Patients need to let their surgeon or nurse know if they are in pain; physicians need to communicate with patients about their dosage for any medications they may need to take and any side effects they may experience, how to spot signs of infection, and how to schedule follow-up appointments.
But if the patient does not speak or understand the same language as the care provider, these critical instructions may be misunderstood or get lost in translation.
Are We Speaking the Same Language?
A study in the December 2021 issue of The Joint Commission Journal on Quality and Patient Safety by Lev Malevanchik, MD, and coauthors examined this issue using 2018−2019 data to evaluate whether a hospital system’s technology programs or processes reached patients with limited English proficiency (LEP) and English proficient (EP) patients equally. It also measured postdischarge disparities between the two cohorts.*
Patients have the right not only to be informed about their care, but also to have an interpreter present who can communicate with them while they are receiving care. The Joint Commission’s Hospital Accreditation Program and Critical Access Hospital Accreditation Program specifically lay out these standards:
- Provision of Care (PC), Treatment, and Services Standard PC.02.01.21: The hospital effectively communicates with patients when providing care, treatment, and services.
- Element of performance (EP) 1 states, “The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care. Note: Examples of communication needs include the need for personal devices such as hearing aids or glasses, language interpreters, communication boards, and translated or plain language materials.”
- Rights and Responsibilities of the Individual (RI) Standard RI.01.01.03: The hospital respects the patient’s right to receive information in a manner he or she understands.
- EP 1 states, “The hospital provides information in a manner tailored to the patient’s age, language, and ability to understand.”
- EP 2 states, “The hospital provides language interpreting and translation services. Note: Language interpreting options may include hospital-employed language interpreters, contract interpreting services, or trained bilingual staff. These options may be provided in person or via telephone or video. The hospital determines which translated documents and languages are needed based on its patient population.”
The barriers that exist for patients with LEP can lead to several issues, such as higher mortality and readmission rates than those of EP patients. However, our understanding of those barriers postdischarge is limited.
“To address these two knowledge gaps in the care of patients with LEP, we examined data from a care transitions outreach program at a large academic medical center,” the authors wrote. “Our first goal was to evaluate whether the program’s technology and processes reached patients with LEP and English proficiency equally. Our second goal was to measure the prevalence of postdischarge, patient-reported issues, and their association with English proficiency.”
Patients who received outreach phone calls postdischarge were asked whether they had:
- Questions about their discharge instructions
- Difficulty getting prescriptions filled
- Medication concerns
- Questions about follow-up care
- New or worsening symptoms
- Any other clinical issues
“Of the nearly 14,000 patients discharged from our hospitals, 11% had LEP,” wrote Dr. Malevanchik and study coauthor Sachin Shah, MD, MPH, in a follow-up Improvement Insights blog post. “Our program reached 81% of patients with EP and 76% of patients with LEP. When looking at the postdischarge issues, we found that patients with LEP suffered worse outcomes across all six domains.”†
Communication Is Key
The study authors determined that communication plays a critical role in patient care.
“At a minimum, clinicians must use a professional interpreter via telephone, video, or in person to communicate discharge instructions effectively to patients with LEP, standards that have long been articulated by The Joint Commission and federal statutes,” the authors wrote. “Further, these issues go beyond the use of interpreters and require an understanding that communication is often limited by co-occurring low health literacy in patients with LEP.”*
Read the study here.
The Improvement Insights blog post can be found here.
The thoughts and opinions expressed in this column are solely those of Dr. Jacobs and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
*Malevanchik L, Wheeler M, Gagliardi K, Karliner L, Shah SJ. Disparities after discharge: The association of limited English proficiency and postdischarge patient-reported issues. Jt Comm J Qual Patient Saf. 2021;47(12):775-782. Available at: https://www.jointcommissionjournal.com/article/S1553-7250(21)00233-6/fulltext. Accessed January 31, 2022.
†Malevanchik L, Shah SJ. Disparities after discharge. The Joint Commission Improvement Insights blog. January 5, 2022. Available at: https://www.jointcommission.org/resources/news-and-multimedia/blogs/improvement-insights/2022/01/disparities-after-discharge/. Accessed January 31, 2022.