Inequities in Length of Stay for Pediatric Patient Families Using Languages Other Than English for Care

Evaluate the correlation between use of language other than English (LOE) for care and length of stay (LOS) in children admitted to the hospital.

Single-center retrospective cohort study at an urban children's hospital including medical and surgical patients aged 0 to 17 years admitted to our pediatric inpatient floor or pediatric intensive care unit between January 1, 2018 and January 1, 2020. LOE families were defined as those with documented use of language interpretation and/or who identified as using LOE for care during registration. LOS in hours and numbers of nights was compared across LOE and English-speaking groups with a Mann-Whitney U test, and across language groups using a Kruskal-Wallis Test. LOS analyses of the surgical population were done using Mann-Whitney U test. A multivariable linear regression model was fit to predict the relationship between LOE and LOS in hours and a negative binomial model was fit to predict number of nights in the hospital, controlling for social work consults, medical consults and acuity at presentation.

4755 patients were included. Median LOS in the LOE group was 64 hours, 6 hours longer than the English group (P < .001). The LOE group stayed in the hospital a median of one night longer (P < .001) than the English group. Families who spoke a Chinese dialect had the longest LOS (median 70 hours) among language subgroups. LOS was longer for LOE patients in both medical (66 hours vs 60 hours, P < .001) and surgical (48 hours vs 42 hours, P < .001) subgroups. LOS was longer for patients with LOE when controlling for social and medical complexity and acuity at presentation.

Use of LOE for care was associated with longer LOS, including a higher median number of hospital overnights. Findings were particularly pronounced in Chinese-speaking families and extended to surgical patients. An extra hospital night is a clinically significant difference that could increase the risk of hospital-acquired infections, raise costs, and decrease patient satisfaction.