Introduction: Provider–patient language discrepancies can lead to misunderstandings about follow-up care instructions and decreased adherence to treatment that may contribute to disparities in health outcomes among patients with limited English proficiency (LEP). This observational study aimed to understand how emergency department (ED) staff went about treating patients with LEP and examine the impact of consistent interpretation modality on overall patient satisfaction and comprehension. Method: A cross-sectional study was conducted among Spanish-speaking patients with LEP presenting to the ED. A survey was administered at two different time points: after patients provided their history of present illness and after the patient received information regarding follow-up treatment. Results: Analysis of average visual analog scale (VAS) scores by consistency of interpretation suggested higher overall scores among participants that received care via the same communication modalities during both the history of present illness and at disposition, when compared with patients that did not. At both time points, video-based interpretation was associated with higher VAS scores in comparison to other modalities, whereas phone-based interpretation was associated with lower VAS scores. Conclusion: Providing consistent modes of interpretation to patient’s with LEP throughout their ED visits improved their overall satisfaction of care provided and understandings of discharge instructions.

Study Objectives: We describe the process of clinical staff training of a complex emergency research study through a layered approach to disseminating study protocol information to clinical staff.Methods: The Established Status Epilepticus Treatment Trail (ESETT) seeks to compare effectiveness of fos-phenytoin, levetiracetam, or valproic acid in subjects with benzodiazepine-refractory status epilepticus. ESETT is an EFIC trial in which qualifying subjects can be enrolled by the clinical staff within minutes of ED admission often in the absence of the research team.An e-learning module was created to emphasize crucial clinical care elements of the protocol including: the importance of benzodiazepine dosing and timing, rationale for use of Exception From Informed Consent (EFIC), study drug dosing and administration, the post-infusion assessments, and how to contact the study team.A seizure SIM scenario was drafted based on clinical learning objectives for a successful ESETT enrollment including: recognizing a potential ESETT subject as a patient with seizures despite adequate benzodiazepine dosing (without coordinator prompting); proper study drug administration and follow-up assessments. The study protocol assist device (iPod touch) was set to practice mode and mock-drug (saline) was loaded into the study drug kit.On the day of the SIM, a seizure code was called into ED dispatch and clinical staff to treat a high-fidelity SIM mannequin in status epilepticus. The clinical staff administered mock benzodiazepine doses and then identified the seizing SIM mannequin as a potential ESETT subject. Clinical staff located the ESETT study drug box, verified inclusion/exclusion and study dose, utilized the administered mock study drug and followed the prompts from the protocol assist device through the first post infusion assessment.Immediately after the in situ SIM, a SIM de-brief occurred that included the clinical staff (physicians, nurses and pharmacy staff) and the clinical research team (coinvestigator, lead coordinator).Results: The LMS report showed 40/45 (89%) of ED RN staff viewed the elearning module.During the SIM debriefing, clinical staff and the research team jointly identified logistical barriers to address including: study poster location, slow iPod, procedure to un-blind study drug, proper "next steps for care" in the event of study drug failure.The feedback from the ED staff was that they learn better by doing (kinesthetic learning style). "Hands on is always the best, easier to learn when you get to see and do."Conclusions: In situ simulation (SIM) is used in clinical education and training, but evidence on its utility for protocol training in research trials is limited. A layered approach to disseminating study protocol information to clinical staff including an elearning module and kinesthetic learning through an in situ SIM helped the clinical staff incorporate protocol training into their clinical care.

Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews ( n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site ( n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.