Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California;
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
Hosp Pediatr. 2021 Mar;11(3):245-253. doi: 10.1542/hpeds.2020-000745. Epub 2021 Feb 2.
Effective communication is critical for safely discharging hospitalized children, including those with limited English proficiency (LEP), who are at high risk of reuse. Our objective was to describe and compare the safety and family centeredness of nurse communication at hospital discharge for English-proficient (EP) and LEP families.
In this single-center, cross-sectional study, we used direct observation of hospital discharges for EP and LEP children. Observers recorded quantitative and qualitative details of nurse-family communication, focusing on 3 domains: safe discharge, family centeredness, and family engagement. Patient characteristics and percentages of encounters in which all components were discussed within each domain were compared between EP and LEP encounters by using Fisher's exact tests. We used field notes to supplement quantitative findings.
We observed 140 discharge encounters; 49% were with LEP families. Nurses discussed all safe discharge components in 31% of all encounters, most frequently omitting emergency department return precautions. Nurses used all family-centered communication components in 11% and family-engagement components in 89% of all encounters. Nurses were more likely to discuss all components of safe discharge in EP encounters when compared with LEP encounters (53% vs 9%; < .001; odds ratio: 11.5 [95% confidence interval 4.4-30.1]). There were no differences in family centeredness or family engagement between LEP and EP encounters.
Discharge encounters of LEP patients were less likely to include all safe discharge communication components, compared with EP encounters. Opportunities to improve nurse-family discharge communication include providing written discharge instructions in families' primary language, ensuring discussion of return precautions, and using teach-back to optimize family engagement and understanding.
有效的沟通对于安全出院至关重要，包括那些英语水平有限（LEP）的住院儿童，他们是再次入院的高风险人群。我们的目的是描述和比较精通英语（EP）和 LEP 家庭的护士在出院时的沟通的安全性和以家庭为中心的程度。
在这项单中心、横断面研究中，我们使用对 EP 和 LEP 儿童出院的直接观察。观察者记录了护士与家庭沟通的定量和定性细节，重点关注 3 个领域：安全出院、以家庭为中心和家庭参与。通过 Fisher 精确检验比较 EP 和 LEP 患者在每个领域中所有部分都讨论的患者特征和出现比例。我们使用现场记录来补充定量发现。
我们观察了 140 次出院交接，其中 49%是与 LEP 家庭。护士在 31%的所有交接中讨论了所有安全出院的组成部分，最常遗漏急诊科返回预防措施。护士在 11%的所有交接中使用了所有以家庭为中心的沟通组成部分，在 89%的交接中使用了家庭参与组成部分。与 LEP 患者相比，护士在 EP 患者的交接中更有可能讨论所有安全出院的组成部分（53%比 9%；<.001；优势比：11.5[95%置信区间 4.4-30.1]）。在以家庭为中心或家庭参与方面，LEP 和 EP 患者之间没有差异。
与 EP 患者相比，LEP 患者的出院交接中不太可能包括所有安全出院的沟通组成部分。改善护士与家庭出院沟通的机会包括提供家庭主要语言的书面出院指导，确保讨论返回预防措施，并使用回授法来优化家庭参与和理解。
