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Association between language, serious adverse events, and length of stay among hospitalized children
K Casey Lion1, Sarah A Rafton, Jaleh Shafii
1Department of Pediatrics, University of Washington, Seattle, Washington, USA. casey.lion@seattlechildrens.org
Insights
Hospitalized children speaking Spanish experienced longer stays after adverse events and may face higher risks. Addressing communication barriers is crucial for patient safety in pediatric care.
Area of Science:
- Pediatric patient safety
- Health equity in hospitals
- Clinical risk management
Background:
- Serious and sentinel adverse events in hospitalized children pose significant risks.
- Disparities in healthcare outcomes based on race, ethnicity, and language are a growing concern.
- Effective communication is fundamental to ensuring patient safety and equitable care.
Purpose of the Study:
- To assess the risk of serious/sentinel adverse events in hospitalized children by race, ethnicity, and language.
- To investigate factors influencing length of stay for pediatric patients experiencing adverse events.
- To identify potential disparities in patient safety outcomes related to linguistic background.
Main Methods:
- A retrospective cohort study analyzed pediatric inpatients from October 2007 to October 2009.
- The study examined the association between self-reported race, ethnicity, primary language, and adverse events.
- Clinical complexity was controlled using Clinical Risk Groups to adjust for patient acuity.
Main Results:
- Spanish speakers showed a trend toward increased odds of adverse events (OR: 1.83).
- Adverse events were linked to a nearly fivefold increase in length of stay.
- Spanish-speaking patients with adverse events had significantly longer hospitalizations (26 days) compared to English speakers (12.7 days).
Conclusions:
- Hospitalized children from Spanish-speaking families experienced significantly longer stays associated with adverse events.
- Findings suggest a potential increased risk for serious or sentinel events among Spanish-speaking pediatric patients.
- Addressing communication barriers is essential for improving patient safety and reducing healthcare disparities.
Objective:
To evaluate the risk for serious/sentinel adverse events among hospitalized children according to race, ethnicity, and language and to evaluate factors affecting length of stay associated with serious/sentinel adverse events.
Methods:
We conducted a retrospective cohort study of all pediatric inpatients at a large children's hospital from October 2007 to October 2009. We evaluated the relationship between self-reported race, ethnicity, and primary language; with having a serious or sentinel adverse event, defined as an unexpected occurrence involving risk of death or serious injury; or a potentially harmful event resulting from nonstandard practice. We also examined length of stay. Clinical complexity was adjusted for by using Clinical Risk Groups.
Results:
Of 33885 patients, 8% spoke Spanish and 4% spoke other languages. Serious and sentinel events were rare; however, among patients with such events, 14% spoke Spanish. Adjusting for potential confounders, Spanish speakers trended toward an elevated odds of adverse event (odds ratio: 1.83 [95% confidence interval: 0.98-3.39]). Controlling for age, language, and clinical complexity, having an adverse event was associated with a nearly fivefold increase in length of stay (95% confidence interval: 3.87-6.12). Spanish-speaking patients with an adverse event were hospitalized significantly longer than comparable English speakers (26 vs 12.7 days; P = .03 for interaction between language and adverse event).
Conclusions:
Hospitalized children from Spanish-speaking families had significantly longer hospital stays in association with an adverse event and may have increased odds of a serious or sentinel event. These findings suggest that an important component of patient safety may be to address communication barriers.
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