The Effect of Language Barriers at Discharge on Pediatric Adenotonsillectomy Outcomes and Healthcare Contact

Dai, Xi; Ryan, Marisa A.; Clements, Anna Christina; Tunkel, David E.; Links, Anne R.; Boss, Emily F.; Walsh, Jonathan M.

doi:10.1177/0003489420980176

Cited by 17 publications

(19 citation statements)

References 26 publications

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“…13,14 Lack of information retention, reluctance to contact providers, and difficulty accessing interpretation services are contributory factors. 14 The use of written discharge instructions in a native language has been preferred by Spanish-speaking families and can mitigate a potential source of caregiver dissatisfaction. 24 It appears that some health disparities can arise from miscommunication secondary to proficiency in a non-English language preference.…”

Section: Discussionmentioning

confidence: 99%

“…Communication issues have been a focus in prior otolaryngology studies assessing non‐English patients. For example, poor communication with non‐English‐speaking patients has resulted in increased emergency department visits after adenotonsillectomy 13 , 14 . Lack of information retention, reluctance to contact providers, and difficulty accessing interpretation services are contributory factors 14 .…”

Section: Discussionmentioning

confidence: 99%

“…For example, poor communication with non‐English‐speaking patients has resulted in increased emergency department visits after adenotonsillectomy 13 , 14 . Lack of information retention, reluctance to contact providers, and difficulty accessing interpretation services are contributory factors 14 . The use of written discharge instructions in a native language has been preferred by Spanish‐speaking families and can mitigate a potential source of caregiver dissatisfaction 24 .…”

Section: Discussionmentioning

confidence: 99%

“…12 Some of these discharge obstacles could be language related, similar to those identified in discharges and readmissions after adenotonsillectomy. 13,14 As a result, recognizing barriers in the Spanish-speaking community may provide institutions with targets for tracheostomy-based quality improvement initiatives. The primary objective of this study is to determine if language and ethnicity influence index admission outcomes after pediatric tracheostomy in Spanish-speaking families.…”

mentioning

confidence: 99%

“…Tracheostomy‐dependent children with community health disparities encounter longer hospitalization lengths and total costs regardless of medical complexity 12 . Some of these discharge obstacles could be language related, similar to those identified in discharges and readmissions after adenotonsillectomy 13 , 14 . As a result, recognizing barriers in the Spanish‐speaking community may provide institutions with targets for tracheostomy‐based quality improvement initiatives.…”

mentioning

confidence: 99%

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Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

Garza

Chorney

Kou

et al. 2022

Otolaryngol.--head neck surg.

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Objective To compare outcomes after tracheostomy between children from Spanish- and English-speaking families. Study Design Prospective cohort study. Setting Tertiary care children’s hospital. Methods All children <18 years of age who had a tracheostomy placed between 2014 and 2020 were included. Comorbidities and postsurgical outcomes were compared between (1) children whose families preferred speaking Spanish or identified as Hispanic/Latino and (2) children from English-language or non-Hispanic families. Results A total of 339 children met inclusion, with 11% (37/339) from families identifying Spanish as their primary language and 33% (112/339) identifying as Hispanic. Spanish-speaking families were more likely to have tracheostomy-dependent children with cardiac conditions (65% vs 42%, P = .008) and high complexity (72% vs 49%, P = .007). Outcomes were similar regardless of language preference, with 45% (153/339) still tracheostomy dependent, 28% (94/339) decannulated, and 6.8% (23/339) deceased at a median follow-up of 1.77 years (interquartile range, 0.65-3.43). Severe neurocognitive disabilities were similar between Spanish- and English-language families ( P > .05). Spanish language was not associated with times to decannulation or death in univariate or multiple regression models. A sensitivity analysis of self-identified Hispanic or Latino patients did not show significant differences for time to decannulation, death, or neurocognitive disability rates ( P > .05). Conclusion Spanish language and Hispanic ethnicity appear to have minimal impact on pediatric tracheostomy outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

Garza

Chorney

Kou

et al. 2022

Otolaryngol.--head neck surg.

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Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Johnson

Beams

Zaniletti

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe American Academy of Otolaryngology–Head and Neck Surgery Foundation has recommended yearly surgeon self-monitoring of posttonsillectomy bleeding rates. However, the predicted distribution of rates to guide this monitoring remain unexplored.ObjectiveTo use a national cohort of children to estimate the probability of bleeding after pediatric tonsillectomy to guide surgeons in self-monitoring of this event.Design, Settings, and ParticipantsThis retrospective cohort study used data from the Pediatric Health Information System for all pediatric (&lt;18 years old) patients who underwent tonsillectomy with or without adenoidectomy in a children’s hospital in the US from January 1, 2016, through August 31, 2021, and were discharged home. Predicted probabilities of return visits for bleeding within 30 days were calculated to estimate quantiles for bleeding rates. A secondary analysis included logistic regression of bleeding risk by demographic characteristics and associated conditions. Data analyses were conducted from August 7, 2022 to January 28, 2023.Main Outcomes and MeasuresRevisits to the emergency department or hospital (inpatient/observation) for bleeding (primary/secondary diagnosis) within 30 days after index discharge after tonsillectomy.ResultsOf the 96 415 children (mean [SD] age, 5.3 [3.9] years; 41 284 [42.8%] female; 46 954 [48.7%] non-Hispanic White individuals) who had undergone tonsillectomy, 2100 (2.18%) returned to the emergency department or hospital with postoperative bleeding. The predicted 5th, 50th, and 95th quantiles for bleeding were 1.17%, 1.97%, and 4.75%, respectively. Variables associated with bleeding after tonsillectomy were Hispanic ethnicity (OR, 1.19; 99% CI, 1.01-1.40), very high residential Opportunity Index (OR, 1.28; 99% CI, 1.05-1.56), gastrointestinal disease (OR, 1.33; 99% CI, 1.01-1.77), obstructive sleep apnea (OR, 0.85; 99% CI, 0.75-0.96), obesity (OR,1.24; 99% CI, 1.04-1.48), and being more than 12 years old (OR, 2.48; 99% CI, 2.12-2.91). The adjusted 99th percentile for bleeding after tonsillectomy was approximately 6.39%.Conclusions and RelevanceThis retrospective national cohort study predicted 50th and 95th percentiles for posttonsillectomy bleeding of 1.97% and 4.75%. This probability model may be a useful tool for future quality initiatives and surgeons who are self-monitoring bleeding rates after pediatric tonsillectomy.

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Effect of an Outbound Scheduling Team on the Timeliness of Scheduling Referrals to Pediatric Otolaryngology

Allred,

Nakamura,

Mull

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveFamilies preferring to receive care in a language‐other‐than‐English have disparities in access to care. We studied the effect of implementing an ambulatory outbound scheduling team on the timeliness of scheduling referrals to pediatric otolaryngology. We hypothesized this intervention could increase access to care.Study DesignRetrospective cohort analysis.SettingTertiary care academic center.MethodsData were abstracted from the hospital's enterprise database for patients referred to Otolaryngology over 3 years (October 2019‐August 2022; 7675 referrals). An outbound scheduling team was created April 2021 and tasked with calling out to schedule referrals within one business day of receipt. Referral lag was compared across patient cohorts before and after the scheduling intervention. Log‐transformed linear regression models were used to assess the impact of the scheduling intervention on referral lag for language cohorts.ResultsThe median preintervention referral lag was 6 days (interquartile range [IQR] 2‐18), which was reduced to 1 day postintervention (IQR 0‐5; P < .001). Preintervention language‐other‐than‐English families had a median referral lag of 8 days (IQR 2‐23), which was 1.27 times higher than for patients speaking English (P < .001). With implementation of the scheduling intervention, language‐other‐than‐English families were scheduled in a median of 1 day (IQR 0‐6), and the disparity in timeliness of scheduling was eliminated (P = .131). Postintervention, referral lag was reduced by 58% in the English and 64% in the language other than English cohorts.ConclusionImplementation of an outbound ambulatory scheduling process reduces referral lag for all patients and eliminated a disparity in referral lag for language‐other‐than‐English families.

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The Effect of Language Barriers at Discharge on Pediatric Adenotonsillectomy Outcomes and Healthcare Contact

Cited by 17 publications

References 26 publications

Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

Impact of Language and Ethnicity on Pediatric Tracheostomy Outcomes

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Effect of an Outbound Scheduling Team on the Timeliness of Scheduling Referrals to Pediatric Otolaryngology

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