A Quality Improvement Initiative to Improve the Discharge Process for Spanish-Speaking Patients

Patients with a primary language of Spanish are more likely to receive inequitable care at hospital discharge (DC). National quality measures advocate for language concordance in verbal and written communication. Our aim was to increase the percentage of Spanish-speaking patients (SSPs) discharged from the hospital medicine service with translated documents from 65.5% to 82% in 5 months.

We formed an interdisciplinary quality improvement team and created a process map to highlight each step of DC. Ishikawa diagrams completed by key stakeholders identified lack of standardized DC translation workflow and informed interventions. Primary measure: percentage of patients with translated DC documents. Process measures: percentage of SSPs who had DC translation orders placed and percentage ordered by providers. Balancing measure: length of stay (LOS). Our cycles of intervention included education and electronic medical record (EMR) modifications. We reviewed and analyzed measures biweekly using established rules for statistical process control charts.

Baseline data showed 65.5% of SSPs received translated DC instructions. We noted special-cause variation starting at intervention 2 with a centerline shift to 88%. The percentage of SSPs with DC translation orders increased from 54% to 82%. The percentage of DC translation ordered by providers increased from 11% to 75%. There was no difference in LOS for SSPs with translated documents pre-interventions and post-interventions.

Using the Model for Improvement, we achieved our aim and successfully increased the percentage of SSPs with translated DC documents. Future studies should focus on automaticity within the EMR to increase reliability.