Improving Hospital-to-Home for Medically Complex Children: Views From Spanish-Speaking Caregivers

Area of Science:

• Pediatric healthcare
• Health communication
• Caregiver support

Background:

• Children with medical complexity (CMC) face higher risks of adverse events during and after hospitalization.
• These risks are amplified for CMC whose caregivers prefer a language other than English.
• Communication challenges are a significant factor contributing to adverse events in CMC.

Purpose of the Study:

• To explore perspectives of Spanish-speaking caregivers and physicians regarding communication during hospital discharge for CMC.
• To identify barriers and facilitators to language-concordant care for CMC and their families.
• To inform strategies for improving safe transitions from hospital to home for this vulnerable population.

Main Methods:

• Conducted semistructured interviews with 14 Spanish-speaking caregivers and 14 inpatient attending physicians of hospitalized CMC.
• Interviews occurred 24–72 hours post-discharge and continued until thematic sufficiency.
• Data were audio-recorded, transcribed, translated, and analyzed using inductive thematic analysis.

Main Results:

• Identified three key themes: barriers in language-concordant care planning, logistical challenges with interpreter use, and caregiver discomfort in asking questions due to language barriers.
• Caregivers reported feeling hesitant to ask physicians questions about their child's medical management.
• Participants suggested empowering families, utilizing medical educators, and improving post-discharge physician follow-up.

Conclusions:

• Physicians aim to provide language-concordant care, but gaps persist, particularly in interpreter availability for medical-device education.
• Unresolved communication issues during discharge planning can compromise safe transitions for CMC.
• Further attention is needed to address these communication gaps and enhance patient safety.