Advancing Equity in Emergency Department Discharge Communication for Spanish-Speaking Families

Patients and families who speak Spanish as a primary language are at risk for communication barriers; studies in the emergency department (ED) have shown that discharge instructions are frequently incomplete and brief, underscoring the need for improved health care communication. Our family experience data suggested this disparity in communication exists with our Spanish-speaking families. Thus, we aimed to optimize equitable communication by implementing language-congruent discharge instruction videos for common conditions seen in the ED and enhancing awareness of interpreter needs, thereby mitigating disparities in this population.

A multidisciplinary team designed interventions targeting key drivers to improve communication with Spanish-speaking families. We a priori selected specific International Classification of Disease, Tenth Revision codes relevant to discharge videos to establish baselines. To assess the effect of these interventions, we tracked families' responses to communication scores, discharge video use during the visit, and return visits within 72 hours of the index visit. As a balancing measure, we assessed eligible patients' length of stay (LOS).

The percentage of Spanish-speaking families affirming that they received enough information about their child's condition and treatment increased from 56% to 70.6%; English-speaking families remained stable at 66.7%. The equity gap improved from a baseline of 10% to -3%. Discharge instruction video order rate improved from 0% to 27.6%. There was no change in return visits or LOS.

This multifaceted approach to language equity integrated the awareness of language barriers with effective communication tools. Providing standardized, understandable, and linguistically congruent discharge instructions in a clinical setting with increased emphasis on recognizing language barriers enhanced communication equity.