Language-Related Safety Disparities Following a Health Literacy-Informed Rounds Intervention

To examine whether disparities in preventable adverse events (AEs) and family experience for hospitalized children of parents with and without limited comfort with English (LCE) changed following implementation of a health literacy-informed, structured family-centered rounds intervention, Patient and Family Centered I-PASS.

Seven-center prospective before and after intervention study conducted from December 2014 to January 2017. Inclusion criteria includes parents and caregivers of hospitalized children less than 18 years old. LCE defined as parent and caregiver reporting any language other than English as the language in which they were most comfortable speaking to physicians and nurses. Preventable AE rates determined via (1) daily medical record surveillance, solicited clinician reports, hospital incident reports, and family safety interviews, followed by (2) dual-physician masked review and consensus rating. Changes assessed through multivariable mixed-effects logistic regression, controlling for complex chronic conditions, length of stay, parent race and ethnicity, education, and clustering by site. Family experience assessed via predischarge survey (6 domains, 5-point scale). Mixed-effects linear regression estimated changes in mean domain scores by language comfort.

Of 1666 patients, 8.8% (n = 147) had parents with LCE. Preimplementation, over twice as many children of parents expressing LCE experienced preventable AEs, compared with children of parents expressing comfort with English (18.8% vs 7.6%; P = .001; adjusted odds ratio, 3.29; 95% CI, 1.48-7.31). Postimplementation, there were no significant differences between groups (6.4 vs 5.3%; P = .68; adjusted odds ratio, 1.26; 95% CI, 0.42-3.75). Some domains of family experience improved for both groups, although disparities in experience persisted in nurse communication.

Patient safety disparities related to parental comfort with English narrowed after implementing a family-centered rounds communication intervention.