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Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers.

ABSTRACT: BACKGROUND:Access to written hospital discharge instructions improves caregiver understanding and patient outcomes. However, nearly half of hospitals do not translate discharge instructions, and little is known about why. OBJECTIVES:To identify barriers to and potential strategies for translating children's hospital discharge instructions. METHODS:We conducted a mixed-methods, multimodal analysis. Data comprised closed- and open-ended responses to an online survey sent to Children's Hospital Association language services contacts (n = 31), an online environmental scan of Children's Hospital Association translation policies (n = 22), and county-level census data. We examined quantitative data using descriptive statistics and analyzed open-ended survey responses and written policies using inductive qualitative content analysis. RESULTS:Most survey respondents (81%) reported having a written translation policy at their hospital, and all reported translating a subset of hospital documents, for example, consent forms. Most but not all reported translating discharge instructions (74%). When asked how inpatient staff typically provide translated discharge instructions, most reported use of pretranslated documents (87%) or staff interpreters (81%). Reported barriers included difficulty translating uncommon languages, mismatched discharge and translation time frames, and inconsistent clinical staff use of translation services. Strategies to address barriers included document libraries, pretranslated electronic health record templates, staff-edited machine translations, and sight translation. Institutional policies differed regarding the appropriateness of allowing interpreters to assist with translation. Respondents agreed that machine translation should not be used alone. CONCLUSIONS:Children's hospitals experience similar operational and organizational barriers in providing language-concordant discharge instructions. Current strategies focus on translating standardized documents; collaboration and innovation may encourage provision of personalized documents.

SUBMITTER: Davis SH

PROVIDER: S-EPMC6876295 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers.

Davis Seethalakshmi H SH Rosenberg Julia J Nguyen Jenny J Jimenez Manuel M Lion K Casey KC Jenicek Gabriela G Dallmann Harry H Yun Katherine K

Hospital pediatrics 20191001 10

<h4>Background</h4>Access to written hospital discharge instructions improves caregiver understanding and patient outcomes. However, nearly half of hospitals do not translate discharge instructions, and little is known about why.<h4>Objectives</h4>To identify barriers to and potential strategies for translating children's hospital discharge instructions.<h4>Methods</h4>We conducted a mixed-methods, multimodal analysis. Data comprised closed- and open-ended responses to an online survey sent to C ...[more]

PMID: 31562199

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Project description:Background:Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge. Objectives:Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors. Methods:Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to "instructions given" and "instructions appropriate" to later conduct bivariate analysis. Results:We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of "appropriate instructions". In fact, our study showed that despite being capable of giving good medication advice, nurses' instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions. Conclusions:In conclusion, our observational study showed that in a Lebanese university hospital, patients' understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions' quality.

Dataset Information

Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers.

Publications

Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers.

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