Tools to improve discharge equity: Protocol for the pilot TIDE trial.

Area of Science:

• Health equity
• Patient safety
• Implementation science

Background:

• Most US hospitals do not provide discharge instructions in patients' preferred non-English languages.
• This gap increases risks of medical errors and hospital readmission for patients with non-English language preference (NELP).
• Innovative solutions are needed to improve discharge equity for NELP patients.

Purpose of the Study:

• To pilot the Tools to Improve Discharge Equity (TIDE) intervention.
• To assess the effectiveness and implementation of language-concordant discharge tools for patients with NELP.
• To inform future strategies for improving hospital discharge safety and equity.

Main Methods:

• A type I hybrid implementation-effectiveness pilot randomized trial.
• The TIDE intervention includes translated medication calendars, pictograms, and audio recordings of discharge instructions.
• Recruitment of 50 patients from top four non-English language groups (Spanish, Haitian Creole, Cape Verdean Creole, Vietnamese) and their care teams.

Main Results:

• Patient recall of primary diagnosis and understanding of discharge instructions measured by a 24-point score.
• Evaluation of patient experience, intervention acceptability, feasibility, appropriateness, and clinical effectiveness (including hospital readmission).
• Mixed methods evaluation to identify determinants of intervention uptake.

Conclusions:

• The TIDE intervention is the first designed to address discharge needs for patients with NELP.
• Study results will guide future multi-level implementation strategies to enhance hospital discharge safety and equity.