233 - Improving Spanish Speaking Caregiver's Experience with Standardized Discharge Instructions for Asthma Exacerbation in the Pediatric Emergency Department
Pediatric Resident Nemours Children's Health Orlando, Florida, United States
Background: Asthma is a common chronic condition in children with a high prevalence in minority populations. Language barriers between families and providers are associated with suboptimal knowledge, poor asthma control, and higher rates of resource utilization. Spanish-speaking families face language barriers that hinder their ability to comprehend medical instructions and follow up care. Objective: Our primary aim was to understand the caregiver’s language preferences, their understanding of asthma care provided during their Emergency Department (ED) visit, to standardize asthma discharge instructions, and to determine whether Spanish-speaking families received language concordant asthma material and discharge instructions. Our secondary aim was to determine 72-hour return rates to the ED for enrolled patients. Design/Methods: This is a prospective study on Spanish-speaking families presenting to a community pediatric ED for asthma exacerbation who requested an interpreter. Standardized education materials were created in Spanish on the proper use of MDIs, home steroids, and albuterol. Our nurses gave the standard asthma education using the teach-back method. After discharge, enrolled caregivers completed an electronic survey about their understanding of the information provided during their visit. We monitored the 72-hour return rate for enrolled patients. The after-visit summary was reviewed to assess the discharge instructions' language and clarity. Results: Among the forty caregivers enrolled, 35% did not have a college degree and 60% have lived in the United States for less than ten years. Notably, 93% preferred receiving medical information in Spanish, but only 27(67.5%) families used a medical interpreter. Fifty-four percent of the families received language-concordant written instructions and 82% expressed understanding the discharge instructions given in the ED. The primary contributors to misunderstanding discharge instructions were professional medical terminology (15.8%), language barriers (13.2%), and limited time for addressing questions (26.3%). Almost 8% of our patients returned to the ED within 72 hours with the same chief complaint.
Conclusion(s): Despite the substantial number of patients preferring information in Spanish, language barriers persisted due to inconsistent interpreter utilization and the absence of discharge instructions in the preferred language for over half of the families. This situation may have contributed to the almost 8% return rate within 72 hours, highlighting the need for improved language accessibility to enhance caregiver comprehension and overall healthcare outcomes.
