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Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology

Disparate clinical outcomes have been reported for patients with Limited English Proficiency (LEP) in the emergency department setting, including increased length of stay, diagnostic error rates, readmission rates, and dissatisfaction. Our emergency department had no standard processes for LEP patie...

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Autores principales: Martinez, Elizabeth M., Carr, Daniel Timothy, Mullan, Paul C., Rogers, Lakisha E., Howlett-Holley, Wendy L., McGehee, Coleman A., Mangum, Christopher D., Godambe, Sandip A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677944/
https://www.ncbi.nlm.nih.gov/pubmed/34934875
http://dx.doi.org/10.1097/pq9.0000000000000486
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author Martinez, Elizabeth M.
Carr, Daniel Timothy
Mullan, Paul C.
Rogers, Lakisha E.
Howlett-Holley, Wendy L.
McGehee, Coleman A.
Mangum, Christopher D.
Godambe, Sandip A.
author_facet Martinez, Elizabeth M.
Carr, Daniel Timothy
Mullan, Paul C.
Rogers, Lakisha E.
Howlett-Holley, Wendy L.
McGehee, Coleman A.
Mangum, Christopher D.
Godambe, Sandip A.
author_sort Martinez, Elizabeth M.
collection PubMed
description Disparate clinical outcomes have been reported for patients with Limited English Proficiency (LEP) in the emergency department setting, including increased length of stay, diagnostic error rates, readmission rates, and dissatisfaction. Our emergency department had no standard processes for LEP patient identification or interpreter encounter documentation and a higher rate of 48-hour LEP return visits (RV) than English proficient patients. The aim was to eliminate gaps by increasing appropriate interpreter use and documentation (AIUD) for Spanish-speaking LEP (LEP-SS) patients from 35.7% baseline (10/17-05/18) to 100% by October 2020. METHODS: LEP-SS patient data were reviewed in the electronic medical record to determine the AIUD and RV rates. Using the Model for Improvement and multiple Plan-Do-Study-Act (PDSA) cycles, a multi-disciplinary team encouraged stakeholder engagement and identified improvement opportunities, implemented an electronic tracking board LEP icon (PDSA1), standardized documentation using an LEP Form linked to the icon (PDSA2), and included color changes to the icon for team situational awareness (PDSA3). RESULTS: The mean of LEP-SS patients with AIUD improved from 35.7% to 64.5% without significant changes in balancing measures. During the postintervention period (6/1/2018-10/31/2020), no special cause variation was noted from the baseline 48-hour emergency department RV rates for LEP patients (3.1%) or English proficient patients (2.6%). CONCLUSIONS: While the RV rate was not affected, this project is part of a multi-faceted approach aiming to positively impact this outcome measure. Significant improvements in AIUD were achieved without affecting balancing measures.
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spelling pubmed-86779442021-12-20 Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology Martinez, Elizabeth M. Carr, Daniel Timothy Mullan, Paul C. Rogers, Lakisha E. Howlett-Holley, Wendy L. McGehee, Coleman A. Mangum, Christopher D. Godambe, Sandip A. Pediatr Qual Saf Individual QI projects from single institutions Disparate clinical outcomes have been reported for patients with Limited English Proficiency (LEP) in the emergency department setting, including increased length of stay, diagnostic error rates, readmission rates, and dissatisfaction. Our emergency department had no standard processes for LEP patient identification or interpreter encounter documentation and a higher rate of 48-hour LEP return visits (RV) than English proficient patients. The aim was to eliminate gaps by increasing appropriate interpreter use and documentation (AIUD) for Spanish-speaking LEP (LEP-SS) patients from 35.7% baseline (10/17-05/18) to 100% by October 2020. METHODS: LEP-SS patient data were reviewed in the electronic medical record to determine the AIUD and RV rates. Using the Model for Improvement and multiple Plan-Do-Study-Act (PDSA) cycles, a multi-disciplinary team encouraged stakeholder engagement and identified improvement opportunities, implemented an electronic tracking board LEP icon (PDSA1), standardized documentation using an LEP Form linked to the icon (PDSA2), and included color changes to the icon for team situational awareness (PDSA3). RESULTS: The mean of LEP-SS patients with AIUD improved from 35.7% to 64.5% without significant changes in balancing measures. During the postintervention period (6/1/2018-10/31/2020), no special cause variation was noted from the baseline 48-hour emergency department RV rates for LEP patients (3.1%) or English proficient patients (2.6%). CONCLUSIONS: While the RV rate was not affected, this project is part of a multi-faceted approach aiming to positively impact this outcome measure. Significant improvements in AIUD were achieved without affecting balancing measures. Lippincott Williams & Wilkins 2021-12-15 /pmc/articles/PMC8677944/ /pubmed/34934875 http://dx.doi.org/10.1097/pq9.0000000000000486 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Individual QI projects from single institutions
Martinez, Elizabeth M.
Carr, Daniel Timothy
Mullan, Paul C.
Rogers, Lakisha E.
Howlett-Holley, Wendy L.
McGehee, Coleman A.
Mangum, Christopher D.
Godambe, Sandip A.
Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
title Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
title_full Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
title_fullStr Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
title_full_unstemmed Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
title_short Improving Equity of Care for Patients with Limited English Proficiency Using Quality Improvement Methodology
title_sort improving equity of care for patients with limited english proficiency using quality improvement methodology
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677944/
https://www.ncbi.nlm.nih.gov/pubmed/34934875
http://dx.doi.org/10.1097/pq9.0000000000000486
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