Emergency Department Care for Patients with Limited English Proficiency: a Retrospective Cohort Study

Lucy Schulson, Victor Novack, Peter B Smulowitz, Tenzin Dechen, Bruce E Landon
Journal of General Internal Medicine 2018 September 5

BACKGROUND: Limited English proficiency (LEP) patients may be particularly vulnerable in the high acuity and fast-paced setting of the emergency department (ED).

OBJECTIVE: To compare the care processes of LEP patients in the ED.

DESIGN: Retrospective cohort study.

SETTING: ED in a large tertiary care academic medical center.

PATIENTS: Adult LEP and English Proficient (EP) patients during their index presentation to the ED from September 1, 2013, to August 31, 2015. LEP patients were identified as those who selected a preferred language other than English when registering for care.

MAIN MEASURES: Rates of diagnostic studies, admission, and return visits for those originally discharged from the ED.

KEY RESULTS: We studied 57,435 visits of which 5241 (9.1%) were for patients with LEP. In adjusted analyses, LEP patients were more likely to receive an X-ray/ultrasound (OR 1.11, CI 1.03-1.19) and be admitted to the hospital (OR 1.09, CI 1.01-1.19). There was no difference in 72-h return visits (OR 0.98, CI 0.73-1.33). LEP patients presenting with complaints related to the cardiovascular system were more likely to receive a stress test (OR 1.51, CI 1.22-1.86), and those with gastrointestinal diagnoses were more likely to have an X-ray/ultrasound (OR 1.31, CI 1.02-1.68). In stratified analyses, Spanish speakers were less likely to be admitted (OR 0.8, CI 0.70-0.91), but those preferring "other" languages, which were all languages with < 500 patients, had a statistically significant higher adjusted rate of admission (OR 1.35, CI 1.17-1.57).

CONCLUSIONS: ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.

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