Aguayo-Rico, Alberto

Colombo, Elizabeth S

English

University of New Mexico

Journal of Quality Improvement in Healthcare  13
Addressing Language Barriers at Hospital Discharge  
of Non-English Speaking Patients
ALBERTO AGUAYO-RICO, MD, CHRISTINA REA-MCCORD, MD, UNM Internal Medicine Resident 
ELIZABETH S. COLOMBO, MD, PHD, UNM Internal Medicine Quality Improvement Chief
Aim of project
The aim of this project is to improve the quality of 
Internal Medicine hospital discharge instructions 
that are provided for patients designated as Spanish 
speaking only, and to assess the influence of 
language on rates of 30 day readmission and ED 
visits. 
Background of project
The University Hospital provides the majority of high 
level care for individuals across the state, many of 
whom only speak Spanish. This demographic offers 
a unique opportunity to study and improve the 
management of Spanish speaking patients. There is 
currently no translation service available to ensure 
hospital discharge instructions are written in the 
patients’ native language.
Planned interventions tested
A Spanish discharge instructions template already 
existed in the Electronic Medical Record of the 
University Hospital (UNMH), however this was out of 
date and difficult to understand. In September 2013 
the template was updated and reviewed along with 
the latest English discharge instructions in order to 
ensure proper instructions were delivered to Spanish 
speaking patients. Because there is no translation 
services available, non-Spanish speaking medical staff 
continue to write discharge instructions in English for 
Spanish speaking patients.
Prediction of Results &/or Intended Results
We hypothesize that providing patients with the 
new updated discharge instructions in their preferred 
language will result in decreased 30 day readmission 
rates and a better understanding of both medical 
diagnoses and required medications.
Baseline Data:
Prior to the new discharge instructions template:
• 30% of Spanish-speaking patients were given 
discharge instructions in Spanish and 70% 
received English discharge instructions.
• Spanish speaking patients have a nearly 23% 
readmission rate, compared to a baseline of 9% 
for all UNMH patients combined.
• Furthermore, Spanish speaking patients are more 
likely to require re-evaluation in the Emergency 
Department (ED) (17%).
Results
New data was reevaluated and it was decided to 
analyze June to December 2013 on Spanish-speaking-
only patients to compare before and after the 
implementation of the new discharge instructions 
template which was uploaded on September 9, 2013. 
Prior to this date, 52 encounters were evaluated. It 
was determined that the 30 day readmission rate 
was 23% and the 30 day ED visit was 17%. After 
implementation of the new discharge instructions, 
there were 0% 30 day readmission rate and 20%  
30 day ED visits from 10 total encounters. 
Prior to new 
template
After new 
template
Encounters 52 10
30 day readmission 12 (23%) 0 (0%)
30 day ED visit 9 (17%) 2 (20%)
14 University of New Mexico
Summary of results
Even though there was a decrease in the percentage 
of 30 day readmission rates after the implemen-
tation of the new discharge instructions, we feel that 
further data is needed to make this more statistically 
significant since there were only 10 encounters in 
Spanish-speaking-only patients available for analysis 
from the selected months.
Discussion 
Improving the quality of discharge materials and 
addressing language inequity in health care delivery 
is likely to decrease post-hospitalization ED visits and 
30-day readmission rates. The Spanish-speaking 
population utilizes a significant share of health care 
resources and has a greater percentage of individuals 
living below the poverty line compared to English 
speaking patients. As a result, this population is 
considerably more likely to be effected by language 
disparities. By not providing discharge instructions in a 
patient’s native language, the ability of that individual 
to manage their own post-hospitalization health 
care needs is greatly impaired. It is our assertion 
that expansion of interpretive services to include 
translation assistance would likely benefit both 
providers and patients. 
Conclusions
Addressing the needs of non-English speakers is a 
challenge across all health care systems. Inadequate 
information on medications and diagnoses at the 
time of discharge can result in misunderstandings, 
inadequate or inappropriate medication use, 
and poor follow up. The inevitable result is poor 
disease management, increased use of the ED and 
re-admissions to the hospital. All aspects of care 
should be optimized to minimize these outcomes 
and to ensure basic understanding of medical 
information. Because of the small number of Spanish-
speaking patients admitted after introduction of the 
improved Spanish discharge template, further analysis 
of the data is required.  Through this project, it is our 
hope that, further advances in addressing language 
barriers will ultimately provide better quality of health 
to non-English speakers


Addressing Language Barriers at Hospital Discharge of Non-English Speaking Patients

https://digitalrepository.unm.edu/cgi/viewcontent.cgi?article=1014&amp;context=cir_jqih

Addressing Language Barriers at Hospital Discharge of Non-English Speaking Patients

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