149 - Improving the Completeness of Language-Appropriate Spanish Discharge Guidance: A Quality Improvement Project

Publication Number: 3143.149

Zuleica M. Rodriguez Hernandez, University of California Davis Children's Hospital, Sacramento, CA, United States; Michelle Hamline, University of California Davis Children's Hospital, Sacramento, CA, United States; Jennifer Rosenthal, University of California, Davis, School of Medicine, Sacramento, CA, United States

Background: Language-concordant written discharge instructions are essential for safe hospital-to-home transitions. Yet, patients with language preferences other than English (LOE) often receive less complete and language-discordant discharge guidance compared with English-proficient families.

Objective: We aimed to increase the proportion of complete, language-concordant written discharge guidance provided to patients with Spanish language preference from a baseline of 16.5% to at least 88% over 18 months.

Design/Methods: We employed a quality improvement approach among patients discharged home from the pediatric hospital medicine service with Spanish language preference per EHR. The outcome measure was percentage of eligible patients with complete discharge guidance. Completeness was defined as language-concordant and included the following seven elements: discharge diagnoses, hospital course, follow up appointments, 24/7 hospital contact number, return precautions, list of discharge medications, and medication pick-up instructions, if applicable. Balance measure was percentage discharged before noon; process measure was percentage of discharges using the standardized Smartphrase. Baseline data were determined through a 12-month retrospective chart review. A multidisciplinary pediatric team, including two residents, a medical student, and two hospitalists, developed a key driver diagram to guide targeted interventions and tests of change. Interventions focused on resident education, implementation of a new system-wide discharge Smartphrase, and workflow reminders. Data were analyzed by statistical process control.

Results: Baseline period achieved steady state. Through targeted interventions, the percentage of complete guidance increased from 16.5 % to 46.0% over 18 months and was sustained into the 3-month post-intervention period (Figure 1). This improvement was initially driven by sharing baseline data with residents, highlighting the limited provision of language-concordant discharge guidance for Spanish-speaking patients. The implementation of a standardized Spanish Smartphrase, reinforced by email reminders and fliers in resident workrooms, also played a critical role. Use of the new system-wide Smartphrase stabilized at 54.6%. The percentage of patients discharged before noon remained unchanged.

Conclusion(s): We successfully increased the percentage of complete, language-concordant discharge guidance by more than two-fold without delays in discharge. Through intentional interventions, we can enhance discharge communication for families with Spanish language preference.

Table 1: Interventions Implemented Aimed at Improving the Proportion of Complete Spanish Discharge Guidance
Figure1.0.jpeg

Figure 1: P Chart of Percentage of Patients with Complete Language-Appropriate Discharge Guidance
Figure2.0.jpegThe interventions are denoted by number markers and listed in Table 1. Avg, average. UCL, upper control limit.