Clinical outcomes of hospital admitted acute patients with limited english proficiency

Mrs Emily Micallef1, Ms Julia Maguire1, Ms Leanne Tao1, Professor Terry Haines1,2

1Monash Health, Clayton, Australia, 2Monash University, Clayton, Australia

 

Aim:

To examine the effect of English language proficiency on hospital length of stay (LOS) and clinical outcomes for acute inpatients

Method:

We completed a retrospective case-control study, with a selection of 399 cases at random from a broader population of 4286 people with Limited English Proficiency (LEP) admitted to Monash Health facilities over a 12 month period.  Controls (who were English Speakers (ES)) were matched to cases based on diagnosis related group (DRG), age (+/- 5 years) and expected LOS. Gender and complexity scores were also closely matched. The LEP and ES classifications were assigned based on the patient’s preferred primary language and interpreter utilisation during their admission.  The matched cohorts were examined for differences in actual LOS, Relative Stay Index (RSI) and clinical outcome rates including: Medical Emergency Team (MET) calls; sepsis; falls; 28-day readmission; medication errors and pressure injury.

Results:

The LEP group stayed on average 2.6 days longer (p<0.05) than the ES group (LEP=7.8 days/RSI 85%; ES=5.3 days/RSI 124%). This difference was most marked in the heart failure (n=74; difference=4.3days) and respiratory infection (n=71; difference=3.2 days) DRGs, with almost no difference detected for knee replacement (n=21; difference=0.3days). Sepsis, MET calls, 28 day readmission and falls rates were higher in the LEP group, although only MET call rates were found to be statistically significant (p<0.05).

Significance of the findings to allied health:

Allied health plays a significant role in the patient journey from assessment, intervention to discharge support and planning across the continuum of care. Quality improvement initiatives co-designed and implemented with allied health may assist to reduce the disparity in LOS and clinical outcomes experienced by patients with LEP.