SHM Converge Scientific Abstract ePoster Gallery-Reducing Rapid Response System Inequities for Non-English Speaking Hospitalized Patients

Pdf Summary

This quality improvement project addressed inequities in rapid response (RR) care for hospitalized non-English speaking (NES) patients. Prior data from 1,133 RR events showed that Spanish-speaking patients had higher clinical acuity at RR initiation, longer hospital stays after RR events, and a trend toward higher mortality compared with English-speaking patients, suggesting that language barriers may delay recognition of deterioration.<br /><br />To reduce this gap, the team implemented an electronic health record–based workflow using an objective Deterioration Index (DI) score. A patient list automatically populated all adult non-ICU NES inpatients, displaying current DI scores, contributing factors, and recent changes. RR nurses monitored the list in real time and initiated intervention when DI thresholds were met (DI ≥ 60 and/or an increase of ≥10). All encounters were conducted with interpreter services.<br /><br />The intervention also revealed important system issues, including misclassification of preferred language, primary language, and interpreter need, reinforcing the need for better documentation and consistent interpreter use.<br /><br />Preliminary analysis of RR events from May 2021 to January 2023 suggested improvement after implementation: RR events occurred more often, lasted slightly longer, and were triggered at lower disease severity. Importantly, hospitalization after RR events decreased modestly, escalation of care increased slightly, and mortality decreased from 7.3% to 6.7%.<br /><br />Overall, the project suggests that using objective criteria and reliable interpreter-supported workflows may help reduce communication-related delays and improve equitable care for NES hospitalized patients.

Asset Subtitle

Evan Raff

Meta Tag

Author List Carlton Moore, Evan Raff, Lauren Raff, Lindsey Phillips

Category Innovations

Concept Translation Barrier

Concept Rapid Response System

Concept Early Warning Score

Concept Interpreter Documentation

Concept Non-English-Speaking Patient

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Quality Improvement

Keywords

rapid response

non-English speaking

health equity

deterioration index

interpreter services

hospitalized patients

clinical acuity

electronic health record

language barriers

quality improvement

Translation Barrier

Rapid Response System

Early Warning Score

Interpreter Documentation

Non-English-Speaking Patient