Impact of a Call Back Initiative on Limited English Proficiency Patients in a Rural Community

Aim: : Comprehensive and clear communication is vital in any medical setting, especially in a busy, high acuity environment such as the Emergency Department (ED). Patients with Limited English Proficiency (LEP) have a disproportionally increased risk of receiving suboptimal care due to imprecise communication. To avoid such errors when treating patients with LEP, the use of language services is critical. Data supports that inadequate discharge practices with LEP patients increases the risk for adverse events after discharge. When compared to the rest of the US, Vermont’s racial and ethnic minorities account for a small percentage of the population. However, there are many transient Vermonters here seasonally for work, school, or vacation. Our project seeks to improve care for patients with LEP following ED discharge.

Framework:: SQUIRE

Setting:: An academic teaching center, rural level 1 trauma center located in the Northeast serving a population of over one million people.

Stakeholder Team:: Social Workers made phone calls to the patients and collected the data into RedCap. Clinical Research Coordinators analyzed the data. RN, physicians, and social workers developed the project idea and determined the method for implementation.

Methods: : We implemented a program to ensure patients with LEP were called within 72hrs of discharge from the ED. These calls were made by Social Workers with medical interpreters. Data, such as demographics, ED visit details, and follow-up were collected in REDCap from October 2020 to September 2021.During the calls, Social Workers inquired about the use of interpreter services, understanding of discharge instructions, medication access, follow-up appointments, primary care services, return ED visits, and community resources. Data analysis will be performed using the STATA software. Results from the call-back initiative will be analyzed and compared to an average of patients with 72-hour readmission to the emergency department over the previous 5 years.

Outcomes:: We identified that 68% of after visit summaries were not translated upon discharge. Additionally, due to the call-back initiative, 21% of patients were assisted with access to follow up care and making future appointments. 20% of patients that were called received education regarding language line services. 72-hour readmission rates were 1.8% (p < 0.001) for patients with LEP who received a phone call from the call-back program. The average 72-hour readmission rate for the 5 years prior to the call-back program was 5.1%.

Implications:: We conclude that implementation of a call-back program positively impacts LEP patients by reducing readmission rates and assisting patients with accessing community resources. Our results show that there are areas where future work in the ED discharge process can be done to improve communication with patients with LEP, especially increasing discharge paperwork translation. With the current staff size of our ED social work team, this program cannot be consistently offered. We are hoping that with the positive results from this project, we will be able to advocate for increased social work funding so that this project and similar ones can be implemented in the future. Improvements can be made to increase equitable access and health outcome.