Introduction: Patients who prefer to communicate in a language other than English are vulnerable to the consequences of medical communication barriers. Studies of non-English language preferred (NELP) and English language preferred (ELP) patients have shown differences in rates of hospital admission and wait times—factors known to be related to increased costs and lower patient satisfaction. However, few studies include languages other than Spanish or account for patient acuity level. 

Methods: We performed a retrospective cohort study at an urban, Level I trauma center from January–December 2020. Patients were grouped by language preference, with NELP languages grouped into three categories: Spanish; Chinese (Mandarin, Cantonese, Taishanese, Taiwanese, and Zhongshan-Chinese dialect); and other (all other remaining languages). We extracted age, sex, race, ethnicity, language preference, emergency department (ED) discharge disposition, and Emergency Severity Index Score (ESI) from the electronic health record. The primary outcome was the hospital admission rate. Secondary outcomes were the time from patient arrival to placement in the treatment room and the time from patient arrival to disposition. We analyzed data with chi-square tests, logistic, and linear regressions.

Results: Of the 58,079 unique ED encounters, 26.4% (15,307) patients identified as NELP. Within NELP patient encounters, 75.0% preferred Spanish, 13.9% preferred Chinese, and 11.1% preferred another language. After adjusting for age and acuity, Spanish language- and Chinese language-preferred patients were at 16% and 14% higher odds of admission, respectively (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.10-1.23 and OR 1.14, CI 1.02-1.27 respectively), compared to ELP patients. NELP patients waited an average 5.4 minutes longer to be roomed (95% CI 4.46-6.29) and 15.6 minutes longer until disposition (95% CI 12.62-18.54, P<0.05). This discrepancy was greater for patients triaged at lower acuities, with ESI 5 Spanish language- and Chinese language-preferred patients waiting an average of 50.3 and 90.6 minutes longer than ELP patients until disposition (95% CI 17.67-83.57; and 95% CI 24.31-81.57 respectively).

Conclusion: After adjusting for acuity level and age, non-English language preferred patients were at higher odds of admission and experienced disparate wait times, especially at lower acuity levels. Further investigation is needed to understand the causes of these differences and mitigate these health inequities.

Introduction: The number of emergency department observation units (EDOU) and observation stays has continued to increase. Despite this, there is limited data on the characteristics of patients who return unexpectedly to the ED after EDOU discharge.

Methods: We identified the charts of all patients who were admitted to the EDOU of an academic medical center between January 2018–June 2020 and had a return to the ED within 14 days of discharge from the EDOU. Patients were excluded if they were admitted to the hospital from the EDOU, left against medical advice, or died in the EDOU. We manually extracted selected demographic factors, comorbidities, and healthcare utilization data from the charts. Physician reviewers identified return visits thought to be related to the index visit or potentially avoidable.

Results: During the study period, there were 176,471 ED visits, 4,179 admissions to the EDOU, and 333 return visits to the ED within 14 days from discharge from the EDOU, representing 9.4% of all patients discharged from the EDOU. We identified a higher rate of return for patients treated for asthma and lower rates of return for patients treated for chest pain or syncope than the overall return rate. Physician reviewers determined that 64.6% of unplanned returns were related to the index visit, and 4.5% were potentially avoidable. Of potentially avoidable visits, 53.3% occurred within 48 hours of discharge, supporting the use of this period as a potential quality metric. While there was no significant difference in the percentage of related return visits between males and females, there was a higher rate of potentially avoidable visits for male patients.

Conclusion: This study adds to the limited body of literature on EDOU returns, finding an overall return rate of under 10%, with about two-thirds of returns determined to be related to the index visit and <5% considered to be potentially avoidable.

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